Exploring the intersection between country context and priority setting to prevent maternal mortality: A...

Area of Science:

• Global Health
• Obstetrics and Gynecology
• Health Systems Research

Background:

• The obstetric transition model posits that causes of maternal mortality shift with economic development.
• Countries are categorized into five stages based on maternal mortality ratios to guide interventions.
• This study aims to validate the model using data from six diverse low- and middle-income countries.

Purpose of the Study:

• To validate the obstetric transition model using real-world data from six diverse low- and middle-income countries.
• To assess the alignment of country-specific maternal health priorities with the model's predictions.
• To identify factors influencing deviations from the model's predicted stages.

Main Methods:

• Utilized secondary country data and primary data from multi-stakeholder National Dialogues and key informant interviews.
• Analyzed data in four phases: contextual profiling, theme/indicator mapping, stakeholder prioritization, and deviation analysis.
• Included data from Bangladesh, Cote d'Ivoire, India, Mexico, Nigeria, and Pakistan.

Main Results:

• The obstetric transition model's stages generally align with predicted social, epidemiological, and health system characteristics.
• Some deviations were observed, often linked to health system deficiencies and access barriers.
• Equity and women's rights emerged as cross-stage priorities, sometimes diverging from model predictions.

Conclusions:

• The obstetric transition model is a valid and useful tool for decision-makers prioritizing maternal mortality reduction.
• Country context, including a focus on equity, is crucial for refining priority-setting.
• The model provides a framework, but context-specific challenges must be considered for effective implementation.