Social Autopsy of maternal, neonatal deaths and stillbirths in rural Bangladesh: qualitative exploration of its effect and community acceptance

Abstract

Objectives Social Autopsy (SA) is an innovative strategy where a trained facilitator leads community groups through a structured, standardised analysis of the physical, environmental, cultural and social factors contributing to a serious, non-fatal health event or death. The discussion stimulated by the formal process of SA determines the causes and suggests preventative measures that are appropriate and achievable in the community. Here we explored individual experiences of SA, including acceptance and participant learning, and its effect on rural communities in Bangladesh. The present study had explored the experiences gained while undertaking SA of maternal and neonatal deaths and stillbirths in rural Bangladesh. Design Qualitative assessment of documents, observations, focus group discussions, group discussions and in-depth interviews by content and thematic analyses. Results Each community's maternal and neonatal death was a unique, sad story. SA undertaken by government field-level health workers were well accepted by rural communities. SA had the capability to explore the social reasons behind the medical cause of the death without apportioning blame to any individual or group. SA was a useful instrument to raise awareness and encourage community responses to errors within the society that contributed to the death. People participating in SA showed commitment to future preventative measures and devised their own solutions for the future prevention of maternal and neonatal deaths. Conclusions SA highlights societal errors and promotes discussion around maternal or newborn death. SA is an effective means to deliver important preventative messages and to sensitise the community to death issues. Importantly, the community itself is enabled to devise future strategies to avert future maternal and neonatal deaths in Bangladesh.

New challenges for verbal autopsy: Considering the ethical and social implications of verbal autopsy methods in routine health information systems

“…use of social autopsy can itself act as a social intervention helping communities to identify and work on health problems (Biswas et al, 2016). D'Ambrouso et al , for instance, have incorporated questions about the recognition of severity, access to, and quality of health services into the VA.…”

Shifting paradigm of maternal and perinatal death review system in Bangladesh: A real time approach to address sustainable developmental goal 3 by 2030

“…Community interaction enhances the ownership of the community, allows understanding of their own problems, and empowers the community to think and take appropriate action. Representative publicly-elected community leaders at the village level can change social barriers to prevent unwanted deaths, minimize delays and influence pregnant mothers to uptake care at government health facilities 46 , 47 .…”

“…Ensuring the quality of data though conduction of verbal autopsy in the community and the best utilization of the findings at various level is also a challenge 40 – 42 . Moreover, social autopsy findings showed that social barriers are still a key issue in averting maternal and neonatal deaths 45 , 46 . It is recommended that social autopsy intervention in the community could play pivotal role in changing the beliefs and practices of the community to seek appropriate care during pregnancy, delivery and postpartum period.…”

Social autopsy for maternal and perinatal deaths in Bangladesh: a tool for community dialog and decision making

“…All of these decisions are implemented and monitored by community leaders along with the members of local government. Community members also make a commitment to try and prevent any other future deaths [ 19 ].…”