Death, Culture, and Conflict: A Qualitative Study on Sociocultural Practices and Their Implications for Maternal and Perinatal Death Surveillance in Eastern Democratic Republic of Congo

Background: Death is a social and cultural phenomenon whose meaning shapes how and whether losses are mourned, disclosed, and reported. These dynamics have direct implications for maternal and perinatal death surveillance and response (MPDSR), yet remain understudied, particularly in humanitarian contexts. Methods: This phenomenological qualitative study was conducted in two conflict-affected health zones in Eastern Democratic Republic of Congo. In-depth interviews (n=50) were conducted with bereaved family members of maternal or perinatal deaths, community leaders, and health providers to understand the socio-cultural practices surrounding death and the factors influencing MPDSR. Interviews were transcribed in French and analyzed using inductive thematic content analysis. Results: Four themes characterized the socio-cultural practices surrounding maternal and perinatal deaths: burial practices, mourning and bereavement traditions, rationale for these practices, and the impact of insecurity on customs. Burial and mourning practices differed markedly by type of death, with stillbirths and neonatal deaths accorded significantly less social recognition than maternal deaths. Deaths were commonly attributed to witchcraft or spiritual causality, or blame directed at mothers, husbands, and health providers. Active conflict further disrupted customary practices and eroded community trust. Collectively, these dynamics inhibit disclosure and reporting of deaths, undermining MPDSR case identification. Conclusion: Effective MPDSR in conflict-affected settings requires culturally responsive adaptation, community involvement in case identification, and trust in health sector actors. By documenting specific actors involved in burials, variations in burial and mourning practices, and how conflict changes socio-cultural practices, findings offer actionable entry points for strengthening MPDSR in conflict-affect health zones in Eastern DRC.