THE CRITICAL ROLE OF A NON-HEALTHCARE APPROACH TO MATERNAL MORTALITY REDUCTION Qualitative insights from Rwanda’s success

Abstract

Maternal mortality is one of the most critical contemporary development challenges as it accounts for a substantial number of deaths every year, despite the fact that we today have the medical knowledge to prevent it. Sub-Saharan Africa is the most affected region, accounting for more than half of the world’s maternal deaths. Research is highly skewed towards healthcare sector aspects of maternal mortality, while there is an obvious lack of focus on the non-health sector determinants. Merely healthcare sector interventions are not sufficient to inform policy-making aiming to reduce maternal mortality and achieve the UN’s Sustainable Development Goal target 3.1. This thesis aims to address this research gap and identify efforts outside of the healthcare sector that have the potential to contribute to maternal mortality reduction. This is conducted through a qualitative process tracing study of Rwanda, having made great advances in reducing maternal deaths. Burundi serves as a comparative shadow-case. The empirical analysis suggests that additional state efforts complementing medical interventions are vital. These include incorporating direct governmental investment in the problem, for example through oversight procedures such as auditing medical facilities for maternal deaths; tailoring efforts to combat maternal mortality to specific contexts, and complying with international targets. These non-medical state efforts also include incorporating indirect governmental investment through gender equality promotion and effective administrative and financial decentralization.