Abstract
Despite significant global improvements, maternal mortality in low-income countries remains unacceptably high. Increasing attention in recent years has focused on how social factors, such as family and peer influences, the community context, health services, legal and policy environments, and cultural and social values, can shape and influence maternal outcomes. Whereas verbal autopsy is used to attribute a clinical cause to a maternal death, the aim of social autopsy is to determine the non-clinical contributing factors. A social autopsy of a maternal death is a group interaction with the family of the deceased woman and her wider local community, where facilitators explore the social causes of the death and identify improvements needed. Although still relatively new, the process has proved useful to capture data for policy-makers on the social determinants of maternal deaths. This article highlights a second aspect of social autopsy - its potential role in health promotion. A social autopsy facilitates "community self-diagnosis" and identification of modifiable social and cultural factors that are attributable to the death. Social autopsy therefore has the potential not only for increasing awareness among community members, but also for promoting behavioural change at the individual and community level. There has been little formal assessment of social autopsy as a tool for health promotion. Rigorous research is now needed to assess the effectiveness and cost effectiveness of social autopsy as a preventive community-based intervention, especially with respect to effects on social determinants. There is also a need to document how communities can take ownership of such activities and achieve a sustainable impact on preventable maternal deaths.
Highlights
Despite significant reductions worldwide between 1990 and 2015, hundreds of thousands of women are still dying due to complications of pregnancy and/or childbirth each year, and 99% of these deaths occur in low-income countries.[1]
In countries where vital registration systems are suboptimal, verbal autopsy has been a standard method for attributing a clinical cause to maternal deaths that have occurred in the community.[6]
Social autopsy is similar to verbal autopsy, in that it aims to identify factors related to maternal deaths through a structured interview process
Summary
Despite significant reductions worldwide between 1990 and 2015, hundreds of thousands of women are still dying due to complications of pregnancy and/or childbirth each year, and 99% of these deaths occur in low-income countries.[1]. In countries where vital registration systems are suboptimal, verbal autopsy has been a standard method for attributing a clinical cause to maternal deaths that have occurred in the community.[6] Social autopsy is similar to verbal autopsy, in that it aims to identify factors related to maternal deaths through a structured interview process. Social autopsy has the potential for increasing awareness among community members,[11,12] and for promoting behavioural change at the individual and community level.[13,14] This article explores the potential of social autopsy as a tool for preventing maternal deaths in low-income countries, thereby helping to address the first target of Sustainable Development Goal 3.3
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