Barriers to conventional postmortem and acceptability of non-invasive
postmortem after stillbirth: a qualitative study of an East London
community
Abstract
Objectives: In high-income countries, women in adverse socioeconomic
circumstances are at higher risk of stillbirth, have a lower uptake of
stillbirth investigation, and are underrepresented in stillbirth
research. Our objective was to describe the barriers to conventional
postmortem in a community with the lowest rates of stillbirth
investigation. Design: Qualitative grounded theory study to construct a
thematic analysis. Setting: East London Mosque during Ramadan June 2018.
Population: All male and female attendees of reproductive age were
invited to participate. Methods: Anonymised questionnaire with five
fixed-choice questions on pregnancy loss and acceptability of
conventional invasive postmortem and non-invasive postmortem. The fifth
question was expanded into free-text to explore barriers to conventional
postmortem. Main outcome measures: Primary outcome was barriers to
conventional postmortem, and secondary outcome was acceptability of
conventional and non-invasive postmortem. Results: 123 questionnaires
were included. There were 73 male (59·3%) and 50 female (40·7%)
respondents. The primary barriers to conventional postmortem were
religious belief, desecration of the body, further emotional pain to the
family, and fatalism. 14 respondents would agree to conventional
postmortem while 107 would not accept (11·4% versus 87·0%). Nearly all
respondents would agree to non-invasive postmortem while nine
respondents would still not accept postmortem in any form (92·7% versus
7·3%). Conclusions: In this community the barriers to postmortem are
influenced by cultural factors. While conventional postmortem is poorly
received, our study suggests high acceptability of non-invasive
postmortem. More culturally-appropriate work must be done to improve
postmortem uptake in high-risk communities. Funding: No funding
obtained.