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

• Published in: Public health reviews Vol. 41; no. 1; p. 13
• Main Authors: Hamal, Mukesh, Dieleman, Marjolein, De Brouwere, Vincent, de Cock Buning, Tjard
• Format: Journal Article
• Language: English
• Published: Switzerland BioMed Central 02.06.2020; Frontiers Media S.A
• Subjects: Attended births; Births; Caste; Childbirth & labor; Differential media; Economic status; Ethnicity; Fatalities; Health disparities; Health problems; Health services; Health services utilization; Health status; India; Intermediary factors; Mass media; Maternal & child health; Maternal characteristics; Maternal health; Maternal mortality; Mortality; Obstetrics; Population; Postpartum period; Prenatal care; Public health; Qualitative research; Religion; Reproductive health; Residence; Review; Reviews; Search engines; Social determinants; Social environment; Social factors; Socioeconomic factors; Structural factors; Women; United States > US; Maine; India; Structural factors; Social determinants; Maternal health; Intermediary factors; India
• ISSN: 0301-0422; 2107-6952; 2107-6952
• DOI: 10.1186/s40985-020-00125-6

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 and 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. 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. Economic status, caste/ethnicity, education, gender, religion, and culture were the most important 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 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. 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.