Gaining Insight into the Prevention of Maternal Death Using Narrative Analysis: An Experience from Kerman, Iran

Reduction in maternal mortality requires an in-depth knowledge of the causes of death. This study was conducted to explore the circumstances and events leading to maternal mortality through a holistic approach. Using narrative text analysis, all documents related to maternal deaths occurred from ۲۰۰۷ to ۲۰۱۱ in Kerman province/Iran were reviewed thoroughly by an expert panel. A ۹۳-item chart abstraction instrument was developed according to the expert panel and literature. The instrument consisted of demographic and pregnancy related variables, underlying and contributing causes of death, and type of delays regarding public health aspects, medical and system performance issues. A total of ۶۴ maternal deaths were examined. One third of deaths occurred in women less than ۱۸ or higher than ۳۵ years. Nearly ۹۵% of them lived in a low or mid socioeconomic status. In half of the cases, inappropriate or nonuse of contraceptives was seen. Delay in the provision of any adequate treatment after arrival at the health facility was seen in ۵۹% of cases. The most common medical causes of death were preeclampsia/eclampsia (۱۵.۶%), postpartum hemorrhage (۱۲.۵%) and deep phlebothrombosis (۱۰.۹%), respectively. Negligence was accounted for ۹۵% of maternal deaths. To overcome the root causes of maternal death, more emphasis should be devoted to system failures and patient safety rather than the underlying causes of death and medical issues solely.

Keywords:

Maternal Mortality , Maternal Health Services/Organization and Administration , Patient Safety