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Social determinants of maternal health: a scoping review of factors influencing maternal mortality and maternal health service use in India

BACKGROUND: Maternal health remains a major public health problem in India, with large inter- and intra-state inequities in maternal health service use and maternal deaths. The Commission on Social Determinants of Health provides a framework to identify structural and intermediary factors of health...

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Autores principales: Hamal, Mukesh, Dieleman, Marjolein, De Brouwere, Vincent, de Cock Buning, Tjard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265229/
https://www.ncbi.nlm.nih.gov/pubmed/32514389
http://dx.doi.org/10.1186/s40985-020-00125-6
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author Hamal, Mukesh
Dieleman, Marjolein
De Brouwere, Vincent
de Cock Buning, Tjard
author_facet Hamal, Mukesh
Dieleman, Marjolein
De Brouwere, Vincent
de Cock Buning, Tjard
author_sort Hamal, Mukesh
collection PubMed
description BACKGROUND: Maternal health remains a major public health problem in India, with large inter- and intra-state inequities in maternal health service use and maternal deaths. The Commission on Social Determinants of Health provides a framework to identify structural and intermediary factors of health inequities, including maternal health, and understand their mechanism of influence, which might be important in addressing maternal health inequities in India. Our review aims to map and summarize the evidence on social determinants influencing maternal health in India and understand their mechanisms of influence by using a maternal health-specific social determinants framework. METHODS: A scoping review was conducted of peer-reviewed journal articles in two databases (PubMed and Science Direct) on quantitative and qualitative studies conducted in India after 2000. We also searched for articles in a search engine (Google Scholar). Forty-one studies that met the study objectives were included: 25 identified through databases and search engines and 16 through reference check. RESULTS: Economic status, caste/ethnicity, education, gender, religion, and culture were the most important structural factors of maternal health service use and maternal mortality in India. Place of residence, maternal age at childbirth, parity and women’s exposure to mass media, and maternal health messages were the major intermediary factors. The structural factors influenced the intermediary factors (either independently or in association with other factors) that contributed to the use of maternal health service or caused maternal deaths. The health system emerged as a crucial and independent intermediary factor of influence on maternal health in India. Issues of power were observed in broader social contexts and in the relationships of health workers which led to differential access to maternal healthcare for women from different socioeconomic groups. CONCLUSION: The model integrates existing information from quantitative and qualitative studies and provides a more comprehensive picture of structural and intermediary factors of maternal health service use and maternal mortality in India and their mechanisms of influence. Given the limitations of this study, we indicate the areas for further research pertaining to the framework and maternal health.
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spelling pubmed-72652292020-06-07 Social determinants of maternal health: a scoping review of factors influencing maternal mortality and maternal health service use in India Hamal, Mukesh Dieleman, Marjolein De Brouwere, Vincent de Cock Buning, Tjard Public Health Rev Review BACKGROUND: Maternal health remains a major public health problem in India, with large inter- and intra-state inequities in maternal health service use and maternal deaths. The Commission on Social Determinants of Health provides a framework to identify structural and intermediary factors of health inequities, including maternal health, and understand their mechanism of influence, which might be important in addressing maternal health inequities in India. Our review aims to map and summarize the evidence on social determinants influencing maternal health in India and understand their mechanisms of influence by using a maternal health-specific social determinants framework. METHODS: A scoping review was conducted of peer-reviewed journal articles in two databases (PubMed and Science Direct) on quantitative and qualitative studies conducted in India after 2000. We also searched for articles in a search engine (Google Scholar). Forty-one studies that met the study objectives were included: 25 identified through databases and search engines and 16 through reference check. RESULTS: Economic status, caste/ethnicity, education, gender, religion, and culture were the most important structural factors of maternal health service use and maternal mortality in India. Place of residence, maternal age at childbirth, parity and women’s exposure to mass media, and maternal health messages were the major intermediary factors. The structural factors influenced the intermediary factors (either independently or in association with other factors) that contributed to the use of maternal health service or caused maternal deaths. The health system emerged as a crucial and independent intermediary factor of influence on maternal health in India. Issues of power were observed in broader social contexts and in the relationships of health workers which led to differential access to maternal healthcare for women from different socioeconomic groups. CONCLUSION: The model integrates existing information from quantitative and qualitative studies and provides a more comprehensive picture of structural and intermediary factors of maternal health service use and maternal mortality in India and their mechanisms of influence. Given the limitations of this study, we indicate the areas for further research pertaining to the framework and maternal health. BioMed Central 2020-06-02 /pmc/articles/PMC7265229/ /pubmed/32514389 http://dx.doi.org/10.1186/s40985-020-00125-6 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Review
Hamal, Mukesh
Dieleman, Marjolein
De Brouwere, Vincent
de Cock Buning, Tjard
Social determinants of maternal health: a scoping review of factors influencing maternal mortality and maternal health service use in India
title Social determinants of maternal health: a scoping review of factors influencing maternal mortality and maternal health service use in India
title_full Social determinants of maternal health: a scoping review of factors influencing maternal mortality and maternal health service use in India
title_fullStr Social determinants of maternal health: a scoping review of factors influencing maternal mortality and maternal health service use in India
title_full_unstemmed Social determinants of maternal health: a scoping review of factors influencing maternal mortality and maternal health service use in India
title_short Social determinants of maternal health: a scoping review of factors influencing maternal mortality and maternal health service use in India
title_sort social determinants of maternal health: a scoping review of factors influencing maternal mortality and maternal health service use in india
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265229/
https://www.ncbi.nlm.nih.gov/pubmed/32514389
http://dx.doi.org/10.1186/s40985-020-00125-6
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