Dr. Strong’s presentation was based on her recently published book “Documenting Death Maternal Mortality and the Ethics of Care in Tanzania.” She began her presentation by discussing the problem of maternal mortality at large. Sub-Saharan African and South Asian countries bear the burden of these deaths globally at approximately 350,000 deaths a year.
Dr. Strong went on to discuss her field research in the Rukwa region of Tanzania at the Mawingu Regional Hospital’s maternity ward. This particular hospital is in a remote location and poorly connected to the rest of the country. It is also understaffed–with 20 nurses and midwives delivering between 450-600 babies per month. Dr. Strong went into detail discussing maternal death audit meetings. These meetings are part of a formal government mandated accountability mechanism. Each quarter the hospital staff, regional medical officers, district medical officers, and others are supposed to gather to audit all maternal deaths, neonatal and stillbirths. At these meetings, they establish if the death was preventable. According to Dr. Strong, 90% of deaths are determined by audits to have been preventable. Following audit meetings, the team creates action plans and points of intervention so each patient’s death leaves behind lessons that can save another.
Audit meetings have become a technology of reproductive governance which the state enforces through tracking birth rates and maternal rates. Through this data, state institutions, NGOs, churches, and other institutions exert legislative control to push their own agendas around maternal mortality. Dr. Strong argues that data can be seen as an example of reproductive governance tools meant to shape women into responsible producers.
While these audit meetings are meant to provide a qualitative in depth analysis of each death, oftentimes this is not the case. The meetings have become performative rather than functional. Dr. Strong adds, they are “not suitable for an analytical discourse nor stimulate action oriented dialogue.” When the meeting does take place, the first few cases are reviewed with more careful consideration, but as the meetings continue for hours attendees begin to copy details of action plans from previously discussed cases. The meeting becomes a performance with the goal of meeting bureaucratic requirements, rather than figuring out how to offer better care to expecting mothers. In turn, every subsequent meeting will see the same gaps and pitfalls that have already been identified. The deeper roots of maternal mortality will remain unacknowledged and women will continue to die under conditions that were preventable.