The Effect of Maternal Death on the Health of the Husband and Children in a Rural Area of China: A Prospective Cohort Study

Abstract

Objective: To examine the effects of maternal death on the health of the index child, the health and educational attainment of the older children, and the mental health and quality of life of the surviving husband.

Methods: A cohort study including 183 households that experienced a maternal death matched to 346 households that experienced childbirth but not a maternal death was conducted prospectively between June 2009 and October 2011 in rural China. Data on household sociodemographic characteristics, physical and mental health were collected using a quantitative questionnaire and medical examination at baseline and follow-up surveys. Multivariate linear regression, logistic regression models and difference-in-difference (DID) were used to compare differences of outcomes between two groups.

Findings: The index children who experienced the loss of a mother had a significantly higher likelihood of dying, abandonment and malnutrition compared to children whose mothers survived at the follow-up survey. The risk of not attending school on time and dropping out of school among older children in the affected group was higher than those in the control group during the follow-up. Husbands whose wife died had significantly lower EQ-5D index and EQ-VAS both at baseline and at follow-up surveys compared to those without experiencing a wife's death, suggesting an immediate and sustained poorer mental health quality of life among the surviving husbands. Also the prevalence of posttraumatic stress disorder (PTSD) was 72.6% at baseline and 56.2% at follow-up among husbands whose wife died.

Conclusions: Maternal death has multifaceted and spillover effects on the physical and mental health of family members that are sustained over time. Programmes that reduce maternal mortality will mitigate repercussions on surviving family members are critical and needed.

Fig 1. Flowchart of participants of affected households and control households.

The figure represents selection of study participants in both groups from pre-baseline (end of the delivery) to baseline and follow-up. The primary reason of loss to follow-up for husbands is they went out for work during surveys. Index children in the affected group had a higher rate of death and abandonment than control group during pre-baseline and follow-up periods.

Fig 2. Assessment in each dimension of EQ-5D for the affected and control groups.

The black and gray bars represent husbands in the affected group, and the other two bars represent those from the control group. In each domain of EQ-5Q, the higher score, the worse outcome it indicates.