Perceived causes and contributory conditions for perinatal death: midwives', parents', and communities' perspectives in Northwest Ethiopia: A qualitative study

Dawit Tiruneh Arega^1*Tesfaye Gobena²Nega Assefa³Abera Kenay Tura^3,4

• ¹Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
• ²School of Environmental Health Sciences, College of Health and Medical Sciences, Haramaya University, Hara, Ethiopia
• ³School of Nursing, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
• ⁴Liverpool School of Tropical Medicine, Department of International Public Health, Liverpool, UK, Liverpool, United Kingdom

Background: Despite many efforts made to reduce perinatal death, it is common in low-and middle-income, including Ethiopia. Perinatal death has huge repercussions on parents and families, altering their self-esteem and ambitions related to parenting. Therefore, it is crucial to develop targeted and cost-effective interventions to reduce the burden of perinatal death. Objective: This study aimed to investigate how midwives, parents, and communities perceive the causes and factors contributing to perinatal death in the Lay Gayint District of Northwest Ethiopia. Methods: A phenomenological study was utilized to include 14 study participants (midwives, parents, and community members). The study participants were recruited through purposive sampling guided by emerging themes. A probe guide was prepared to conduct the interview and was piloted. Two trained data collectors gathered the data using in-depth, face-to-face interviews from November 01, 2022, to May 30, 2023. Participants listened to the audio records, reviewed the transcripts, and provided feedback for accuracy. Each interview was recorded and lasted between 15 and 65 minutes. The data were analyzed using grounded theory and an inductive theme-building approach with NVivo-14 software. Results: Three major themes emerged for perceived causes of perinatal death: spiritual shadows, harmful traditional customs, and obstetric causes, and five major themes emerged for contributory factors: Barriers to women's empowerment, geographic and economic challenges, healthcare quality challenges, emotional turbulence, culture, and midwives as cultural mediators. The study proposed a new theory entitled, "The dynamism of the culture, healthcare system, and midwifery practices in perinatal death." Conclusions: The study emphasizes how healthcare, economic, and cultural factors interact to contribute to perinatal death, highlighting the crucial role of midwives as cultural mediators. The new theory proposes culture, healthcare systems, and midwifery practices play a crucial role in perinatal death reduction. The study reflects the need for a multidisciplinary approach, culturally relevant interventions, and collaboration with stakeholders and cultural experts. The study provides policymakers with an understanding of how to build successful and targeted programs that consider cultural, economic costs, and women empowerment, particularly for parents dealing with perinatal death.