Centre for International Health
research project

Challenges with reporting in context

Professor Astrid Blystad will lead a new RCN-funded Researcher Project that will explore why women in LMIC are still dying from causes related to pregnancy and childbirth.


Main content


Numerous medical interventions and technologies have been introduced into health systems around the world in recent years to reduce persistently high maternal mortality rates. Yet, in 2015 an estimated 303 000 women died globally from causes related to pregnancy and childbirth. The overwhelming majority of these deaths occurred in low-income countries where systemic inequality disproportionately affects poor, rural, and uneducated women. Nearly all of these women could have been saved by the timely provision of low-cost, evidence-based health care service interventions.

The Maternal Death Surveillance and Response System (MDSR) is a tool to enhance maternal mortality reporting and corrective action. However, in low-income contexts where MDSR is introduced into overburdened health systems, significant weaknesses in reporting routines, accountability structures and data flow have been documented. Systematic underreporting has been related to the tension between demands for health worker accountability and legal protection of health workers. As a result, both the quantity and quality of data feeding into the MDSR system are compromised.

Based in Ethiopia and Tanzania and with a team from medicine, law and social science, the project aims to improve the quality of maternal mortality reporting to strengthen the knowledge on which to base remedial action to reduce maternal deaths. Through inter-disciplinary methodological and theoretical approaches, the project explores institutional reporting routines, legal frameworks, and accountability processes. Using ethnographic and mixed methods approaches, we investigate the relationship between delivered and reported clinical practices and the management of reported data within the health bureaucracy.

We moreover will use a combination of doctrinal- and ‘law in context’ research to investigate health care providers’ concerns over litigation and prosecution processes in clinical reporting. In the process we aim to extend the scholarship on contextual rights-based approaches within maternal health. Close collaborative ties with policy makers, professional- and community-based organizations will ensure the development of interventions to enhance the quality of reporting and consecutive corrective action to reduce maternal mortality.


Primary and secondary objectives

The primary objective of this project is to improve the quality of maternal mortality reporting to strengthen the knowledge on which to base remedial action to reduce maternal deaths.


The secondary objectives:

1. Investigate systematic differences between how clinical care is delivered and how it is reported in MDSR registries and reviews on health facility level

2. Uncover how reported maternal mortality data is reviewed and managed within the health bureaucracy, and how / to what extent feedback mechanisms work to identify remedial action

3. Investigate legal frameworks surrounding the maternal surveillance and reporting system

4. Develop measures to improve maternal mortality reporting, including measures to enhance the balance between professional accountability and legal protection of health professionals.