Faculty of Law, University of Bergen, Magnus Lagabøtes Plass 1, Bergen 5010, Norway.
School of Law, Mekelle University, Adi-Haqi Campus, Mekelle, Tigray, Ethiopia.
Health Policy Plan. 2024 Oct 15;39(9):985-999. doi: 10.1093/heapol/czae071.
The Maternal Death Surveillance and Response (MDSR) system is designed to continuously identify and review all maternal deaths. It aims to help countries understand the scale and distribution of maternal deaths, identify their causes, and inform corrective measures to address the challenge. Despite the growing adoption of the MDSR by numerous low- or middle-income countries, its implementation faces various challenges, including legal ones. This scoping review was conducted to map legal issues and challenges that arise during the implementation of the MDSR. It adapted the Bain and Kongnyuy framework, categorizing legal issues into data, people, use of findings, and legal regulation. Literature was retrieved from seven databases, complemented by additional online searches. We included studies published in English between 2010 and November 2022 that report on legal issues arising during the implementation of MDSR. Out of 1174 studies screened, 31 were selected for review. The review highlighted the limited attention given to the legal dimension of the MDSR by the research community. It also documented the lack of adequate legal framework essential for the system's effective implementation. Inadequate safeguards for informational privacy and the lack of confidentiality reinforce a prevalent sense of being blamed, mainly among health workers. Consequently, widespread under-reporting and intentional misattribution of causes of maternal death, defensive referrals, and disengagement from the MDSR process were reported. We recommend that implementing countries regulate the gathering and use of MDSR data through appropriate laws and legally ensure that the MDSR data are only used for the intended purpose. Appropriate complaint-handling mechanisms are needed in health systems to prevent the misuse of the MDSR. Future studies on MDSR implementation would benefit from involving legal experts, considering the multifaceted legal dimensions of the MDSR.
孕产妇死亡监测和应对（MDSR）系统旨在持续识别和审查所有孕产妇死亡病例。它旨在帮助各国了解孕产妇死亡的规模和分布情况，确定其原因，并提出纠正措施以应对这一挑战。尽管越来越多的中低收入国家采用 MDSR，但在实施过程中面临各种挑战，包括法律挑战。本范围综述旨在绘制在实施 MDSR 过程中出现的法律问题和挑战。它采用了 Bain 和 Kongnyuy 框架，将法律问题分为数据、人员、调查结果的使用和法律监管。文献从七个数据库中检索，同时还进行了额外的在线搜索。我们纳入了 2010 年至 2022 年 11 月期间以英文发表的、报告 MDSR 实施过程中出现的法律问题的研究。在筛选的 1174 项研究中，有 31 项被选中进行综述。该综述强调了研究界对 MDSR 的法律层面关注有限，并记录了缺乏必要的法律框架，这对系统的有效实施至关重要。信息隐私保护不足和缺乏保密性的保障措施加剧了卫生工作者普遍感到被指责的情况，这主要是由于担心被指责而导致报告不足和故意错误归因于孕产妇死亡的原因、防御性转诊以及从 MDSR 流程中脱离。我们建议实施国家通过适当的法律规范 MDSR 数据的收集和使用，并合法确保 MDSR 数据仅用于预期目的。卫生系统需要适当的投诉处理机制，以防止 MDSR 的滥用。未来关于 MDSR 实施的研究将受益于法律专家的参与，因为 MDSR 涉及多方面的法律问题。
