In the last 10 years, a number of measures have been introduced to reduce persistently high maternal mortality globally. Nevertheless, an estimated 300,000 women lose their lives in pregnancy and childbirth each year. The WHO's Maternal Death Surveillance and Response System (MDSR) is a tool for improving maternal mortality reporting, identifying challenges and defining measures to remedy the problems. In low-income countries where the health service is less developed, significant weaknesses have been documented in reporting routines and data flow in the MDSR system. Systematic underreporting has been linked to pressure to meet global maternal health goals, heavy workload and lack of legal protection of health workers. This results in impaired quality of the data material in the MDSR system and uncertain maternal mortality figures.
The project is carried out in Ethiopia and Tanzania by an interdisciplinary research group from the social sciences, law and medicine, and aims to improve the quality of maternal mortality reporting. Through a combination of ethnography, survey and analysis of register data, we investigate the relation between observed and reported clinical practice. We look at the handling of reported data within the health bureaucracy and how the data is used to improve reporting and services. Through legal methods, we investigate health personnel's experiences of legal prosecution related to the reporting of maternal deaths. By drawing on social science theory on the production of numbers and statistics (metrics), the project will contribute to increased knowledge about challenges in the reporting system and the development of a better framework for reporting and legal protection of health personnel.
Partners: University of Bergen, Muhimbili University of Health and Allied Sciences, University of Dar es Salaam, Addis Ababa University and Ethiopian Public Health Institute. Associated partners: Gynecology/obstetrics-, midwives- and women’s associations.
A number of medical and technical interventions have been introduced into health systems to reduce persistently high global maternal mortality rates. Yet, in 2015 an estimated 303 000 women died from causes related to pregnancy and childbirth. The Maternal Death Surveillance and Response System (MDSR) is a tool to enhance maternal mortality reporting and corrective action. However, in low income contexts where MDSR is introduced into overburdened health systems, significant weaknesses in reporting routines, accountability structures and data flow have been documented. Systematic underreporting has been related to the tension between demands for health worker accountability and legal protection of health workers. As a result, both the quantity and quality of data feeding into the MDSR system are compromised. Based in Ethiopia and Tanzania and with a team from medicine, law and social science, the project aims to improve the quality of maternal mortality reporting to strengthen the knowledge on which to base remedial action to reduce maternal deaths. Through inter-disciplinary methodological and theoretical approaches, the project explores institutional reporting routines, legal frameworks and accountability processes. Using ethnographic and mixed methods approaches, we investigate the relationship between delivered and reported clinical practices and the management of reported data within the health bureaucracy. Through a combination of doctrinal- and ‘law in context’ research we moreover investigate health care providers’ concerns over litigation and prosecution processes in clinical reporting. In the process we aim to extend the scholarship on contextual rights based approaches within maternal health. Close collaborative ties with policy makers, professional- and community-based organizations will ensure the development of interventions to enhance the quality of reporting and consecutive corrective action to reduce maternal mortality.