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Social determinants of maternal health: a scoping review of factors influencing maternal mortality and maternal health service use in India

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Background: Maternal health remains a major public health problem in India, with
large inter- and intra-state inequities in maternal health service use and maternal
deaths. The Commission on Social Determinants of Health provides a framework to
identify structural and intermediary factors of health inequities, including maternal
health, and understand their mechanism of influence, which might be important in
addressing maternal health inequities in India. Our review aims to map and
summarize the evidence on social determinants influencing maternal health in India
and understand their mechanisms of influence by using a maternal health-specific
social determinants framework.
Methods: A scoping review was conducted of peer-reviewed journal articles in two
databases (PubMed and Science Direct) on quantitative and qualitative studies
conducted in India after 2000. We also searched for articles in a search engine
(Google Scholar). Forty-one studies that met the study objectives were included: 25
identified through databases and search engines and 16 through reference check.
Results: Economic status, caste/ethnicity, education, gender, religion, and culture
were the most important structural factors of maternal health service use and
maternal mortality in India. Place of residence, maternal age at childbirth, parity and
women’s exposure to mass media, and maternal health messages were the major
intermediary factors. The structural factors influenced the intermediary factors (either
independently or in association with other factors) that contributed to the use of
maternal health service or caused maternal deaths. The health system emerged as a
crucial and independent intermediary factor of influence on maternal health in India.
Issues of power were observed in broader social contexts and in the relationships of
health workers which led to differential access to maternal healthcare for women
from different socioeconomic groups. Conclusion: The model integrates existing information from quantitative and
qualitative studies and provides a more comprehensive picture of structural and
intermediary factors of maternal health service use and maternal mortality in India
and their mechanisms of influence. Given the limitations of this study, we indicate
the areas for further research pertaining to the framework and maternal health.

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Articles publicats en revistes (ISGlobal)

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Social determinants of maternal health: a scoping review of factors influencing maternal mortality and maternal health service use in India