Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
Department of Obstetrics and Gynecology, School of Medicine, University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana.
BMC Pregnancy Childbirth. 2022 Sep 5;22(1):683. doi: 10.1186/s12884-022-05006-1.
Maternal mortality has a multifaceted impact on families, especially in low- and middle-income countries, where rates of maternal mortality are high and resources can be lacking. The objective of this study was to explore the ways that maternal mortality influences the physical and emotional wellbeing, financial stability, and caregiving structure of families, and identifies sources of and gaps in support.
Our study used a mixed-methods design. All maternal mortalities in an 18-month period at a tertiary hospital in Ghana were identified using death certificates. Participants were 51 family members (either husbands or other heads of households) in families affected by maternal mortality. A questionnaire assessed demographic characteristics and changes in family health, income, and family structure. Two validated scales assessing psychological wellbeing were administered: the Patient Health Questionnaire-9 and the Inventory of Complicated Grief. Semi-structured interviews were conducted to assess impact on family wellbeing.
Quantitative and qualitative results converged to highlight large, negative impacts of maternal mortality on four areas of family wellbeing: 1) mental health and emotional wellbeing; 2) physical health; 3) family structure; 4) financial stability and security. On the Patient Health Questionnaire-9, 54% (27/50) of participants reported elevated depressive symptoms, with 14% (7/50) of scores falling in the moderately severe or severe ranges. On the Inventory of Complicated Grief, 38% (19/50) exceeded the cutoff for significant impairment in functioning. Worsened family health was associated with greater complicated grief (b = 21.41, p = .004); there were no other significant predictors of depressive symptom severity or complicated grief. Effects on family health centered on concerns about the nutritional status and health of the surviving infant. Family structure was primarily affected by fracturing of the central family unit by sending children to live with relatives. Immense economic strain resulted from hospital bills, funeral expenses, and loss of income. The majority of participants received helpful support from their family (41/51, 80.4%), the community (32/51, 62.7%), and their religious institution (43/51, 84.3%); however, support often stopped soon after the death.
Maternal mortality has profound negative impacts on families in Ghana. Impacts are experienced by husbands and heads of households, as well as surviving children. Both immediate and sustained support is needed for families following a maternal death, especially mental health and financial support.
孕产妇死亡对家庭有多种影响，尤其是在孕产妇死亡率高且资源匮乏的中低收入国家。本研究旨在探讨孕产妇死亡对家庭的身体和心理健康、经济稳定和照顾结构的影响，并确定支持的来源和差距。
我们的研究采用混合方法设计。使用死亡证明在加纳的一家三级医院确定了 18 个月期间的所有孕产妇死亡。参与者是受孕产妇死亡影响的家庭中的 51 名家庭成员（丈夫或其他家庭户主）。问卷调查评估了人口统计学特征以及家庭健康、收入和家庭结构的变化。使用两个经过验证的评估心理健康的量表进行评估：患者健康问卷-9 和复杂悲痛量表。进行半结构化访谈以评估对家庭健康的影响。
定量和定性结果的一致性突出了孕产妇死亡对家庭健康的四个方面的巨大负面影响：1）心理健康和情绪健康；2）身体健康；3）家庭结构；4）经济稳定和安全。在患者健康问卷-9 上，54%（27/50）的参与者报告存在抑郁症状，14%（7/50）的分数处于中度或重度范围。在复杂悲痛量表上，38%（19/50）的得分超过功能显著受损的临界值。家庭健康恶化与更严重的复杂悲痛有关（b=21.41，p=.004）；抑郁症状严重程度或复杂悲痛没有其他显著预测因素。对家庭健康的影响主要集中在对幸存婴儿的营养状况和健康的担忧上。家庭结构主要受到将孩子送到亲戚家生活的核心家庭单位破裂的影响。巨大的经济压力来自于医院账单、丧葬费和收入损失。大多数参与者得到了家人（41/51，80.4%）、社区（32/51，62.7%）和他们的宗教机构（43/51，84.3%）的帮助；然而，支持往往在死亡后不久就停止了。
孕产妇死亡对加纳的家庭产生了深远的负面影响。影响不仅发生在丈夫和家庭户主身上，也发生在幸存的孩子身上。在孕产妇死亡后，家庭需要立即和持续的支持，特别是心理健康和经济支持。
