Social determinants of health pave the path to maternal deaths in rural Sri Lanka: reflections from social autopsies

Reproductive Health

Research

Thilini Chanchala Agampodi¹  Nuwan Darshana Wickramasinghe¹  Suneth Buddhika Agampodi¹  Sandaru Hasaranga Shanthapriya¹  Sajaan Praveena Gunarathne¹  Indika Ruwan Prasanna²  Lasandha Irangani³ 

[1] Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, 50008, Saliyapura, Sri Lanka;Department of Economics, Faculty of Social Sciences and Humanities, Rajarata University of Sri Lanka, 50300, Mihintale, Sri Lanka;Department of Humanities, Faculty of Social Sciences and Humanities, Rajarata University of Sri Lanka, 50300, Mihintale, Sri Lanka;

关键词: Maternal death;    Social autopsy;    Social determinants of health;    Sri Lanka;   

DOI  :  10.1186/s12978-022-01527-2

 received in 2022-04-22, accepted in 2022-11-14,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundEnding preventable maternal deaths remains a challenge in low- and middle-income countries (LMICs). Society perceived causes and real-life observations can reveal the intangible causes of maternal deaths irrespective of formal maternal death investigations. This study reports complex patterns in which social determinants act towards paving the path to maternal deaths in a rural Sri Lankan setting.MethodsWe conducted social autopsies for 15/18 maternal deaths (in two consecutive years during the past decade) in district A (pseudonymized). In-depth interviews of 43 respondents and observations were recorded in the same field sites. During thematic analysis, identified themes were further classified according to the World Health Organization framework for social determinants of health (SDH). The patterns between themes and clustering of social determinants based on the type of maternal deaths were analyzed using mixed methods.ResultsDiscernable social causes underpinned 12 out of 15 maternal deaths. Extreme poverty, low educational level, gender inequity, and elementary or below-level occupations of the husband were the characteristic structural determinants of most deceased families. Social isolation was the commonest leading cause manifesting as a reason for many other social factors and resulted in poor social support paving the path to most maternal deaths. A core set of poverty, social isolation, and poor social support acted together with alcohol usage, and violence leading to suicides. These core determinants mediating through neglected self-health care led to delay in health-seeking. Deficits in quality of care and neglect were noted at health institutions and the field.ConclusionSocial autopsies of maternal deaths revealed complex social issues and social determinants of health leading to maternal deaths in Sri Lanka, indicating the need for a socially sensitive health system.

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

12888_2022_4365_Article_IEq42.gif

12888_2022_4365_Article_IEq37.gif

12888_2022_4365_Article_IEq30.gif