Knowledge Denhere
1,2,3* 
, Malizgani Mhango
3,41 Department of Laboratory Medicine and Clinical Ethics Committee, The Rotunda Hospital, Dublin, Ireland
2 School of Public Health, University of the Western Cape, Cape Town, South Africa
3 Department of Laboratory Diagnostics and Investigative Sciences, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
4 National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
Abstract
Infectious disease outbreaks can disrupt maternity care while adding infection-prevention constraints to time-critical decisions. Community health workers and faith leaders are often engaged to sustain trust and service use, and evidence supports these partnerships. Less attention has been given to situations in which urgent clinical action, a woman’s preferences, and a religious or spiritual practice cannot all be accommodated in full. We call this sacred-clinical discordance and propose a Maternal Emergency Concordance Framework for outbreak preparedness. The framework has five functions: anticipate predictable conflicts, define clinical and ethical boundaries, agree meaningful alternatives, rehearse high-risk scenarios, and create a rapid mediation and review pathway. The framework does not seek shared belief or unrestricted accommodation; its purpose is to reduce avoidable delay and conflict while protecting informed choice, infection-prevention requirements, and culturally meaningful care. We outline safeguards and research priorities for testing feasibility, acceptability, safety, and effects on referral and trust.