understanding and responding to the determinants of maternal deaths

Understanding and responding to the determinants of maternal deaths

Photo by Renee Bourque, Bright Star Consultants, www.brightstargrants.com

Learning objectivesBy the end of this session, participants will be able to:

• Explain the difference between causes and determinants of maternal death• Classify determinants using the “3 delays”• Identify how community-level action links

to MDSR

Brainstorming Exercise

In the next 5 minutes:

1) List 3-5 main causes of death during or immediately after childbirth in Ethiopia

2) For each of these, note down what social factors you think contribute to them

Follow up Discussion

1) Sharing different determinants identified by the group

2) Grouping similar ones together3) Discuss how many may be outside the

health system!

Review of Terms

Causes

The immediate clinical or medical reason for the woman’s death,

classified as a direct or indirect maternal death

Determinants

The “causes of the causes” or factors that increased the woman’s

risk of dying from a specific cause

Common Determinants of Maternal Deaths

1) Poor access to family planning and safe abortion services

2) Insufficient use of antenatal services3) No skilled attendance at delivery4) Difficulties in obtaining transport5) Insufficient supplies or staff6) Low status of women

These are very different factors, operating at different levels of social influence

The “3 Delays” Model • Generally refers to events following an

obstetric emergency, so very specific• Related to seeking and obtaining clinical care• Divides the process of accessing care into 3

phases:

– Recognising an emergency & need for treatment– Reaching a health facility where care is available– Receiving the care that is needed

Delay 1 Delay in deciding to seek care:• Rapid recognition of a problem can be critical to

saving a mother’s life (esp. for excessive bleeding)• Delay 1 measured as length of time from onset of

a complication to decision to seek care• Determinants include:– Inadequate knowledge– Reliance on family members who are not present– Lack of familiarity with or trust in services

• Education, socio-economic status and women’s autonomy also affect Phase 1 in seeking care

Delay 2 Delay in reaching care:• Once decision to seek care is made, there can be

delays in reaching it• Determinants include:– Unavailable or expensive transport– Long distances to facilities– Costs related to accompanying woman or paying fees/

expenses related to services– Inadequate referral systems between facilities

• Inequitable or insufficient distribution of CemOnc services increase type 2 delays

Delay 3 Delay in receiving care:

• Delays 1 & 2 can lead to a women never reaching a facility or arriving in critical condition

• Delays within a facility also contribute to maternal deaths or “near misses”

• Determinants relate to Quality of Care:– Shortages of staff, equipment or blood products– Time lag between arrival and initiation of

treatment/ surgery– Poor technical competence

Addressing Community Level Determinants

• Delay 1 relates mainly to Individual & Family determinants

• Delay 2 relates to Community determinants• Delay 3 relates to Health System determinants• All delays reflect background factors, such as:– Women’s autonomy & education– General reproductive health– Laws, policies and cultural norms

GROUP WORK

• Divide into small groups of 5-6 people• Group will be assigned one of the 3 delays• Discuss what factors in Ethiopia are most likely to

lead to that delay• Identify at least 3 strategies or activities that

targets the factors you identified and might help reduce the delay

Summary Points• Social determinants are the “causes of the causes” of

maternal deaths, and depend on many social levels• Addressing maternal deaths thus requires action at

every level, not just medical or health services• Because many women die at home, in transit or soon

after arrival at a facility, understanding the delays in receiving care helps analyse patterns of deaths

• MDSR identifies determinants related to the 3-delays from the onset of obstetric complications

• At higher levels (RHB, national) social determinants beyond the 3 delays should be considered (culture, gender)