Abstract

Background: Over half of the known stillbirths occur in four highly populated countries—India among them. While acknowledged as a significant public health issue in western societies, little is known about maternal coping with stillbirth in developing countries. The purpose of this mixed methods study is to explore how issues of gender and power, social support, coping efforts, and religious beliefs influence perinatal grief outcomes among poor women in rural Chhattisgarh, India.

Methods: In Phase 1 of this mixed methods study, grounded theory methods were used to explore perceptions regarding stillbirth. A de-identified medical records review of 536 deliveries at Christian Hospital, Mungeli was followed by 17 key informant interviews, and 2 focus groups. In phase two, 21 villages were visited and 355 structured interviews conducted with women of reproductive age (178 with a history of stillbirth, 177 without).

Results: Qualitative results suggest that perinatal grief is a significant issue for rural Indian women. Gender and power issues included health disparity, lack of autonomy, abuse of authority, and social norms including religious beliefs favoring males. This was validated by quantitative study results showing that women who had experienced stillbirth had significantly higher perinatal grief scores. They were also noted to have higher risk factors including tobacco use, low education, domestic violence, short birth intervals, and health problems compared to women without a history of stillbirth. A highly skewed sex ratio is further evidence of gender discrimination.

Conclusion: Women in this region experience significant perinatal grief as a result of stillbirth. Thus the findings of this study add to the limited literature from developing countries regarding women's perceptions about the stillbirth phenomenon, and specifically Indian women's perceptions.

Significance to Public Health: The findings of this study will allow the development of a culturally sensitive health education program designed to increase social support and promote progressive attitudes towards social norms, thereby reducing psychological distress to prevent complicated perinatal grief, a significant social burden which impacts the health of these rural Indian women.

School

School of Public Health

First Advisor

Susanne A. Montgomery

Second Advisor

Barbara Anderson

Third Advisor

Jerry W. Lee

Degree Name

Doctor of Public Health (DrPH)

Degree Level

Ph.D.

Year Degree Awarded

2011

Date (Title Page)

5-2011

Language

English

Library of Congress/MESH Subject Headings

Stillbirth -- epidemiology -- India -- Chhattisgarh; Risk Factors; Bereavement -- psychology; Adaptation, Psychological; Maternal Behavior -- psychology; Women's Health -- India; Health Education -- India; Chhattisgarh (India) -- Social conditions

Type

Dissertation

Page Count

xiii; 192

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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