What maternal morbidities are and what they mean for women: A thematic analysis of twenty years of qualitative research in low and lower-middle income countries

Abstract

Background With an estimated 27 million annual incidents of maternal morbidity globally, how they are manifested or experienced is diverse and shaped by societal, cultural and personal influences. Using qualitative research to examine a woman's perception of her pregnancy, its complications, and potential long-term impact on her life can inform public health approaches and complement and inform biomedical classifications of maternal morbidities, historically considered a neglected dimension of safe motherhood. As part of the WHO’s Maternal Morbidity Working Group’s efforts to define and measure maternal morbidity, we carried out a thematic analysis of the qualitative literature published between 1998 and 2017 on how women experience maternal morbidity in low and lower-middle income countries. Results and conclusions Analysis of the 71 papers included in this study shows that women’s status, their marital relationships, cultural attitudes towards fertility and social responses to infertility and pregnancy trauma are fundamental to determining how they will experience morbidity in the pregnancy and postpartum periods. We explore the physical, economic, psychological and social repercussions pregnancy can produce for women, and how resource disadvantage (systemic, financial and contextual) can exacerbate these problems. In addition to an analysis of ten themes that emerged across the different contexts, this paper presents which morbidities have received attention in different regions and the trends in researching morbidities over time. We observed an increase in qualitative research on this topic, generally undertaken through interviews and focus groups. Our analysis calls for the pursuit of high quality qualitative research that includes repeat interviews, participant observation and triangulation of sources to inform and fuel critical advocacy and programmatic work on maternal morbidities that addresses their prevention and management, as well as the underlying systemic problems for women’s status in society.

Measurement of maternal functioning during pregnancy and postpartum: findings from the cross-sectional WHO pilot study in Jamaica, Kenya, and Malawi

“…This MMM Framework is aligned with the standardised definition of maternal morbidity and associated disability developed by the same group: any health condition attributed to and/or complicating pregnancy and childbirth that has a negative impact on the woman's wellbeing and/or functioning" [7]. Maternal health is a social and economic phenomenon, not just a clinical issue [8], and the context and environment in which a woman and her family live has an important effect on outcomes, as recognised by the current strategy towards ending preventable maternal mortality (EPMM) [9]. The MMM Framework recognises that optimal maternal health is not limited to a single short-span event; and considers a life-cycle approach to better reflect how previous pregnancies and experiences impact current and future pregnancy outcomes.…”

Maternal Multimorbidity During Pregnancy and After Childbirth in Women in Low- and Middle-Income Countries: A Systematic Literature Review

“…There is a need to incorporate women's understanding, perceptions and lived experience of maternal multimorbidity into public health approaches to improve maternal health and wellbeing during pregnancy and after childbirth in LMIC. 73,74…”

Maternal Multimorbidity During Pregnancy and After Childbirth in Women in Low- and Middle-Income Countries: A Systematic Literature Review

“…Valid comparable measurements of maternal multimorbidity to date are limited, and this con rms the need for a new approach and focus. [70][71][72] It will be important for future healthcare practice and research to agree and apply: (a) common identi cation criteria for maternal multimorbidity taking into account the different types of physical, psychological, and social morbidity; (b) standardised and validated data collection tools that can be used in different languages and at all levels of healthcare; with, (c) validation of self-reported measurements of maternal morbidity compared to clinical assessment, investigations and diagnosis determined by healthcare providers. 6,[70][71][72] More recognition must be given that maternal morbidity is often not a single disease condition in isolation but more complex with important associations between different morbidities.…”