London School of Hygiene & Tropical Medicine, London, UK.
Soc Sci Med. 2010 Nov;71(10):1749-56. doi: 10.1016/j.socscimed.2010.03.056. Epub 2010 May 31.
Averting women's pregnancy-related death is today recognised as an international health and development priority. Maternal survival is, in this sense, a success story. There is, however, little research into what happens to the women who survive the severe obstetric complications that are the main causes of maternal mortality. This paper examines findings from repeated in-depth interviews with 64 women who survived a clinically defined 'near-miss.' These interviews were conducted as part of a prospective longitudinal study of women who 'nearly died' of pregnancy-related complications in Burkina Faso, a poor country in West Africa. Drawing on sociological and anthropological perspectives that consider the defining characteristics of 'loss' to be social as much as biomedical, the paper seeks to understand loss as disruption of familiar forms and patterns of life. Women's accounts of their lives in the year following the near-miss event show that such events are not only about blood loss, seizures or infections, but also about a household crisis for which all available resources were mobilised, with a train of physical, economic and social consequences. The paper argues that near-miss events are characterised by the near-loss of a woman's life, but also frequently by the loss of the baby and by further significant disruptions in three overlapping dimensions of women's lives. These include disruption of bodily integrity through injury, ongoing illness and loss of strength and stamina; disruption of the household economy through high expenditure, debts and loss of productive capacity; and disruption of social identity and social stability. Maternal health policy needs to be concerned not only with averting the loss of life, but also with preventing or ameliorating others losses set in motion by an obstetric crisis.
避免与妊娠相关的妇女死亡如今被认为是国际卫生和发展的重点。从这个意义上说，产妇的生存是一个成功的案例。然而，对于那些从导致产妇死亡的主要原因严重产科并发症中幸存下来的妇女，人们对她们的后续情况知之甚少。本文探讨了对 64 名被临床定义为“接近死亡”的妇女进行重复深入访谈的结果。这些访谈是作为布基纳法索（西非的一个贫穷国家）中一项关于因妊娠并发症“几乎死亡”的妇女的前瞻性纵向研究的一部分进行的。本文借鉴了社会学和人类学的观点，认为“损失”的定义不仅是生物医学上的，也是社会上的，试图理解损失是对熟悉的生活形式和模式的破坏。在接近死亡事件发生后的一年里，妇女对自己生活的描述表明，这些事件不仅与失血、癫痫发作或感染有关，而且还与家庭危机有关，为此动员了所有可用资源，随之而来的是一系列身体、经济和社会后果。本文认为，接近死亡事件的特点是妇女的生命几乎丧失，但也经常伴随着婴儿的死亡以及妇女生活的三个重叠维度的进一步重大破坏。这些包括通过伤害、持续的疾病和失去力量和耐力来破坏身体完整性；通过高支出、债务和丧失生产能力来破坏家庭经济；以及破坏社会身份和社会稳定。孕产妇健康政策不仅需要关注避免生命损失，还需要预防或减轻产科危机引发的其他损失。
