The rhetoric of community participation in maternal and perinatal death surveillance and response (MPDSR) in Kenya: Qualitative study

Maternal and perinatal death surveillance and response (MPDSR) aims to prevent maternal and perinatal deaths by analysing clinical and social data after the death and using these insights to generate knowledge in the form of recommendations. This requires collaboration between health professionals and community members to co-produce knowledge to prevent future deaths. Our study asked: how do interactions between community members and health workers shape knowledge co-production in MPDSR processes? And what are the implications for policy and practice? This qualitative study used interviews, focus groups, and observations of MPDSR sessions in two Kenyan counties. MPDSR aims to prevent deaths by learning from past experiences, yet we found that the policies and tools used in MPDSR may prevent learning. Health workers questioned community members' competence as knowers and undervalued community knowledge. Community members worried that MPDSR sessions were intended to expose 'bad' deaths. These dynamics created contested spaces where different ways of knowing competed for legitimacy. Our findings show MPDSR processes must examine how and why certain forms of knowledge are deemed to be credible and others are excluded. Without recognising diverse perspectives, MPDSR risks producing fragmented understanding, limiting its potential as a participatory and transformative tool for preventing deaths.