ABSTRACT:
Maternal and Perinatal Death Surveillance and Response (MPDSR) aims to improve maternal mortality reporting and inform corrective actions to reduce maternal deaths. However, a critical ethical dilemma emerges between fostering accountability and avoiding a culture of blame and shame. While naming and shaming may encourage responsibility, it can also discourage open reporting and learning. Conversely, avoiding blame may lead to impunity and inaction. This study explores these tensions by examining stakeholders' perspectives on accountability in MPDSR. We conducted key informant interviews with major actors in MPDSR, including two representatives from government agencies, four from professional associations and clinical leadership, and five from international NGOs and UN agencies. Data were analyzed thematically to identify recurring challenges and proposed solutions. while stakeholders recognize the importance of accountability, fear of punishment discourages full disclosure. Weak confidentiality measures and a lack of protective legislation create fear among healthcare providers, deterring honest reporting. Concerns about blame such as work bans, legal penalties, fines, loss of licenses, or imprisonment drive defensive clinical practices. Providers prioritize risk avoidance over patient-centered care by making premature referrals, rigidly following protocols despite individual patient needs, and withholding reports of errors or near misses to avoid blame. Informants emphasized that MPDSR is meant to be a learning process, not a punitive one. MPDSR must navigate the fine line between accountability and blame, raising important ethical considerations in maternal mortality reporting. A just culture where errors drive system improvements rather than individual punishment aligns with ethical principles of fairness, non-maleficence, and professional integrity. Punitive approaches risk discouraging transparency and eroding trust, while an ethical framework rooted in learning and shared responsibility fosters a safer healthcare system. Strengthening maternal mortality reporting through ethical accountability not only improves patient outcomes but also upholds the moral duty to learn from mistakes without resorting to blame.