Postmortem Lessons: A Community-Based Model for Averting Maternal Mortality and Newborn Death in Ethiopia

Based on the techniques of death review/audit, a community-based retrospective approach using explorative, descriptive and contextual study design, combining both qualitative and quantitative methods (mixed methods) were used for theory generation to develop a prototype model to avert the prevailing maternal mortality and newborn death in Ethiopia. The model was developed within the existing frameworks for theory generation in an attempt to increase women’s access to skilled care during pregnancy, childbirth and post-partum within their communities. The "three phases delay model" of Thaddeus & Maine (1994: 1091-110) provided a theoretical framework for the empirical study which identified factors that have limited access to maternal and newborn care. The empirical perspectives of the study laid the foundation and led to the syntheses and identification of the core theme known as 'community-based-care'. Using Walker and Avant (1995:39 and 2005:28) method, concept analysis of 'community-based care' were conducted in order to analyse and generate descriptions, definitions and to further explore the meaning of this concept in the context of averting maternal mortalities and newborn deaths.

The structure and process of a community-based maternal and newborn care model for preventing maternal mortality and newborn death in Ethiopia, based on the findings from empirical perspectives of the study as conceptualized following the six aspects of activity by Dickoff, James and Wiedenbach (1968:422) form the basis for development and description of the model for averting maternal mortality and newborn deaths in Ethiopia. Agent - who or what performs the activity? (The community midwife or health workers, and the community).

Recipient - who or what is the recipient of the activity? (The mother and the newborn baby).

Context - In what context is the activity performed? (Home, en route to health facility and health facility).

Purpose - What is the end result of the activity (averting maternal mortalities and newborn deaths).

Dynamic - What is the power sources that can drive the activity towards the attainment of the goal (best interest of the community).

Procedure - What is the guiding procedure (Set of modus operandi for community maternal and newborn care).

Finally, the model was evaluated using the pre-determined criteria by Chinn and Kramer (2008:192-196) and refined by experts in qualitative research and theory generation. Guidelines were developed which do not form part of this article. Theoretical validity was ensured. Recommendations, limitations, challenging hypothesis and conclusions were made.