Sociocultural, political, and health system-related determinants of perinatal deaths in Jordan from the perspectives of health care providers: a qualitative study

Abstract

Background

Perinatal mortality is a fundamental indicator of the quality of the healthcare provided to women during pregnancy and childbirth, as well as the healthcare provided to neonates in the first week of life. At the national level, determining the direct and indirect causes of these deaths is vital, as it will assist in tracking the quality of antenatal, natal and postnatal care and help to detect the areas for avoidance. This study aimed to identify the main determinants of perinatal deaths in Jordan from the perspectives of health care providers (HCPs).

Methods

A descriptive qualitative approach using focus group discussion was used. Four focus groups were conducted in each of the four hospitals where the approached HCPs are employed. An average of 5 HCPs were interviewed in each focus group with a total of 80 HCPs participating in the 16 focus groups. Thematic analysis was carried out to analyze the data.

Results

The HCPs provided a detailed description of the determinants of perinatal and neonatal death from their points of view. Four main themes with multiple subthemes emerged, namely maternal factors (ignorance, concealment of medical condition, and husbands’ negligence), sociocultural factors (socioeconomic status, tribal and consanguineous marriage, and harmful cultural practices), political factors (early marriage driven by displacement and war consequences on maternal health), and health system-related factors (services management including capabilities and logistics, overcrowding of emergency rooms, discharge against medical advice, and unskilled general practitioners in private maternity clinics).

Conclusions

As perceived by HCPs, maternal factors, sociocultural factors, political factors, and health system-related factors are the main determinants of perinatal deaths in Jordan. Improvement in the quality of maternal and neonatal health care services, maternal health education, and maternity staff training are strongly recommended.

Keywords:

• Perinatal death
• social determinants
• health system

Authors’ contributions

All authors took part in the study YK, AB, MA, KK, and WK contributed to conception, design, drafting of the manuscript, writing as well as final editing of the manuscript. YK, MY, NS, SA authors took the main responsibility for data collection and writing. HB, MY, ZH, KS did data analysis. YK, ZH, AB, HB, WK were more involved in critical revision for important intellectual content. All authors have read and approved the manuscript

Disclosure statement

The authors declare that they have no competing interests

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request

Additional information

Funding

This research received grant from International Development Research Center/Canada and UNCEF.