Ethics: maternal suicide – why is it not recognised internationally?
Maternal mental illness remains a hidden problem globally. The factors behind this are complex, but at the tip of the iceberg is a failure to recognise or report maternal deaths from suicide, the reluctance to classify any identified deaths as pregnancy-related and hence to begin to develop policies and interventions to address maternal mental illness and prevent deaths in the future.
The aim of this project would be to describe the epidemiology of maternal suicide internationally through a literature review and analysis of existing data sources, including, but not limited to, WHO maternal mortality estimates, existing published literature, and Confidential Enquiry reports (UK, Netherlands, France, South Africa), and to describe different international approaches to identifying and investigating maternal suicide, including techniques such as linked and unlinked routine vital statistics, verbal autopsy, or Confidential Enquiry. These epidemiological findings would be interpreted in light of the different approaches to develop estimates, taking into account any potential under-reporting, and describing socio-cultural barriers to reporting. This latter could incorporate a qualitative interview or survey component, with experts and field workers recruited from within international research and surveillance teams on maternal mortality, experts at WHO and other relevant organisations.
This epidemiological review would be used as the basis for an in-depth ethical analysis of the ethical challenges surrounding agenda-setting for maternal mental illness and suicide, including: understanding ethical controversies impacting the measurement and classification of maternal suicide, challenges in reporting and data collection, and other possible barriers to accurately measuring the burden of disease internationally. The project may also address research ethics questions to identify ethically/culturally sensitive epidemiology and surveillance methods to better account for prevalence and causes without causing unintended harm or stigma. Methods for the ethics component would include ethical analysis/argument, literature review, and either qualitative or quantitative analysis of the interview or survey data with key stakeholders.
RESEARCH EXPERIENCE, RESEARCH METHODS AND TRAINING
The project will provide a range of advanced training opportunities in putting into practice epidemiological and health services research methods, including literature review, qualitative and quantitative epidemiological studies, secondary data analysis, conceptual ethical analysis and empirical ethics methodologies.
field work, secondments, industry placements and training
Some interview fieldwork may be required with international experts, however, this could be conducted using telephone/video interviews.
This project would suit a candidate wishing to develop expertise in a range of techniques in development of epidemiology and health services research and ethical issues in population health, with a particular interest in women’s health, pregnancy and childbirth.