A review of cultural influence on maternal mortality in the developing world.

OBJECTIVE: identify research examining the effect of culture on maternal mortality rates.
DESIGN: literature review of CINAHL, Cochrane, PsychInfo, OVID Medline and Web of Science databases.
SETTING: developing countries with typically higher rates of maternal mortality. PARTICIPANTS: women, birth attendants, family members, nurse midwives, health-care workers, and community members. MEASUREMENTS AND
FINDINGS: reviews, qualitative and mixed-methods research have identified components of culture that have a direct impact on maternal mortality. Examples of culture are given in the text and categorised according to the way in which they impact maternal mortality. KEY
CONCLUSIONS: cultural customs, practices, beliefs and values profoundly influence women's behaviours during the perinatal period and in some cases increase the likelihood of maternal death in childbirth. The four ways in which culture may increase MMR are as follows: directly harmful acts, inaction, use of care and social status. IMPLICATIONS FOR PRACTICE: understanding the specifics of how the culture surrounding childbirth contributes to maternal mortality can assist nurses, midwives and other health-care workers in providing culturally competent care and designing effective programs to help decrease MMR, especially in the developing world. Interventions designed without accounting for these cultural factors are likely to be less effective in reducing maternal mortality.