Why interventions to reduce maternal mortality based on biomedical causes of death are less effective
Background: Maternal Mortality Ratio in 2009 in Zambia was 329 per 100,000 live births while in Sweden it was 5 per 100,000 live births (World data atlas 2020). To address this difference the Investigate Maternal Deaths and Act (IMDA) model to reducing maternal mortality was piloted in Ndola District of Copperbelt Province (Hadley 2011). At the time reports into causes of maternal mortality typically focused on the biomedical causes divided into a few categories such as haemorrhage, infection, eclampsia. The IMDA model, by contrast, was concerned with the underlying factors and the appropriate actions needed to address them. trained focal persons identified maternal deaths occurring in the District. Interviewers contacted the next of kin and, using a snowballing approach, interviewed those who knew or were involved with the deceased woman. The researchers used three open-ended questions that focused on: characteristics of the woman and the environment in which she lived, her pregnancy and the time-period from when things started to go wrong until her death.
Key findings: The stories from families, friends and health workers were obtained from the majority of the 100 women whose deaths were classified as ‘maternal’. One of the cases was a young woman living in a remote location without transport. She gave birth in the early hours of the morning, bled profusely, and died shortly after the birth. The birth took place in a mud hut in the company of her equally young (and bewildered) husband. In all a total of xx factors contributing to the 100 maternal deaths that were identified during the calendar year, including thoseplaying a role in the death of this young woman. The relevant authorities made xx recommendations to address these factors.
Policy implications: When programme implementors match biomedical causes of death to interventions rather than to the contributing factors there is a difference. Interventions to prevent deaths from haemorrhage typically include increasing availability of blood in hospitals and refresher training to midwives in the management of post-partum haemorrhage. However, in the case of the young woman in the case described neither of these two interventions would have averted the death. Access to blood transfusion and expert care was not one of her options at the time. A detailed birth plan for the couple, clear knowledge of the complications of a delivery and a ‘mother’s shelter’ attached to the nearest health facility,whichcould manage a post-partum haemorrhage would have been required.
