A Civil Society Report on Maternal Deaths in India

Civil Society Report on Maternal Deaths in India describes the findings of an analysis of 124 maternal deaths identified and documented over two years between January 2012 and December 2013. The analysis is a part of the Dead Women Talking initiative, established by several civil society organisations in response to the high maternal mortality in the country.

The 124 maternal deaths were first identified by community members and civil society. Following a home visit to verify if the death was a maternal death, families of the deceased are invited to participate in a social autopsy.

The findings of the social autopsy were analysed and recommendations developed using a framework developed to identify gaps that contributed to the deaths across four domains: technical factors, health system factors, social factors, and human rights.

Challenges:

  • Number of training sessions: One training session on social autopsies was not sufficient to train civil society organisation staff.
  • Incomplete information from families: Information from families needed to be triangulated as they did not always want or were unable to provide a complete story behind the death.
  • Deaths under certain conditions missed: Late maternal deaths and deaths due to unsafe abortions and home deliveries were likely missed. As a result, greater efforts, such as training community-based organisations, were needed to ensure deaths under these conditions were recognised.
  • Difficulty in getting the health system perspective: In almost all districts any attempt to link with the government conducting verbal autopsies was not successful. There was also resistance from the health system to cooperate in CSO-led social autopsies, questioning the expertise of the team conducting the social autopsies and thus not engaging with the findings.
  • Blame culture: There was a culture of blaming those at the lowest of the hierarchy for the death, such as peripheral health workers. This meant that health workers were reluctant to speak about the deaths.

Recommendations include:

  • Involve multiple stakeholders in the MDR process, such as CSOs, community-based organisations, and local governance structures such as Village Health and Sanitation Committees.
  • Ensure that Action Taken Reports are on the agenda for the MDR committee meetings and are made public. Feedback loops should be established in order for lessons learnt from preventable maternal deaths to be used by the health system and for community action.

Full reference: Subha, Sri, B. & Khanna, R. (2014). Dead Women Talking: A civil society report on maternal deaths in India. CommonHealth and Jan Swasthya Abhiyan