title: Socio-cultural and service delivery dimensions of maternal mortality in rural central India: a qualitative exploration using a human rights lens.
abstract: BACKGROUND
  Despite the avoidable nature of maternal mortality, unacceptably high numbers of maternal deaths occur in developing countries. Considering its preventability, maternal mortality is being increasingly recognised as a human rights issue. Integration of a human rights perspective in maternal health programmes could contribute positively in eliminating avertable maternal deaths. This study was conducted to explore socio-cultural and service delivery-related dimensions of maternal deaths in rural central India using a human rights lens.
  
  
  METHODS
  Social autopsies were conducted for 22 maternal deaths during 2011 in Khargone district in central India. The data were analysed using thematic analysis. The factors associated with maternal deaths were classified by using the 'three delays' framework and were examined by using a human rights lens.
  
  
  RESULTS
  All 22 women tried to access medical assistance, but various factors delayed their access to appropriate care. The underestimation of the severity of complications by family members, gender inequity, and perceptions of low-quality delivery services delayed decisions to seek care. Transportation problems and care seeking at multiple facilities delayed reaching appropriate health facilities. Negligence by health staff and unavailability of blood and emergency obstetric care services delayed receiving adequate care after reaching a health facility.
  
  
  CONCLUSIONS
  The study highlighted various socio-cultural and service delivery-related factors which are violating women's human rights and resulting in maternal deaths in rural central India. This study highlights that, despite the health system's conscious effort to improve maternal health, normative elements of a human rights approach to maternal health (i.e. availability, accessibility, acceptability, and quality of maternal health services) were not upheld. The data and analysis suggest that the deceased women and their relatives were unable to claim their entitlements and that the duty bearers were not successful in meeting their obligations. Based on the findings of our study, we conclude that to prevent maternal deaths, further concentrated efforts are required for better community education, women's empowerment, and health systems strengthening to provide appropriate and timely services, including emergency obstetric care, with good quality.
authors.affiliation: United Nations Population Fund, Bhopal, India.|Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.|Swedish Research School for Global Health, Umeå University, Umeå, Sweden; tejram@unfpa.org; jattejram@yahoo.co.in.
authors.forename: Tej Ram
authors.initials: TR
authors.lastname: Jat
authors.affiliation: United Nations Population Fund, Bhopal, India.
authors.forename: Prakash R
authors.initials: PR
authors.lastname: Deo
authors.affiliation: Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.|Umeå Centre for Gender Studies, Umeå University, Umeå, Sweden.
authors.forename: Isabel
authors.initials: I
authors.lastname: Goicolea
authors.affiliation: Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.|Swedish Research School for Global Health, Umeå University, Umeå, Sweden.
authors.forename: Anna-Karin
authors.initials: AK
authors.lastname: Hurtig
authors.affiliation: Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Miguel
authors.initials: M
authors.lastname: San Sebastian
mesh_terms: D000328:Adult; D003466:Cultural Characteristics; D003695:Delivery of Health Care / Q000458:organization & administration*; D003906:Developing Countries / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D006806:Human Rights; D006801:Humans; D007194:India; D008427:Maternal Health Services / Q000458:organization & administration*; D008428:Maternal Mortality; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D028701:Patient Rights; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: India; maternal death; maternal health; right to health; rights-based approach
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