The “three delays” as a framework for examining maternal mortality in Haiti

The role of delays in severe maternal morbidity and mortality: expanding the conceptual framework

“…19 The barriers most related to health care-seeking behaviour are economic status, 18 distance to facility, 20 educational level, 21 women's autonomy, 21,22 recognition of disease, 17,23 aetiology, 20 severity of symptoms 15,19,22 and knowledge and attitudes about use of the health system. 18,24,25 Given that decision-making is a complex behaviour related to perception of needs, which is dependent on the interaction between individual traits, characteristics and the exposure to social, cultural, and economic conditions, gathering information requires a broad approach. 19,26 For instance, the use of antenatal care seems to enhance the utilization of emergency obstetric care, the same way that lack of antenatal access is associated with delays leading to poor maternal outcomes.…”

“…These include chronic shortages of trained staff and essential supplies, 1 the interval between the decision to do emergency surgery and the time of starting the surgery exceeding 30 minutes; 37 delays in initiating any adequate treatment following arrival at the facility; 35 and shortages of blood products, lack of technical competence among staff and poor attitudes towards patients, caused by shortage of funds. 16,18,24,32 Some 37 In low-income countries the poor quality of care found even in tertiary facilities 38 contributes to maternal mortality both directly (due to sub-optimal standards of emergency care) and indirectly (deterring health service utilization). 39 The poor quality of services in turn influences women's decision-making and mitigates against timely care.…”

Maternal mortality in Jordan: role of substandard care and delays

“…Understanding the specific details of responsible factors that operate during pregnancy, delivery and the postpartum are the key to success in the prevention of maternal mortality [3]. Inadequate quality of hospital care and delays at different levels have been linked by many studies to rising maternal mortality rates [4][5][6]. Delays have been described briefly in a previous national study on maternal mortality in Jordan in 1995, in which delayed obstetric care was present in 68% of cases, delays in seeking care in 62% and delays in transportation in 12% [7].…”

Delay in the provision of adequate care to women who died from abortion-related complications in the principal maternity hospital of Gabon

“…2 A review of studies carried out in developing countries found that distance and cost were major obstacles in the decision to seek care and reach a facility. 3 On the other hand, there is evidence from Bolivia and Argentina that women seeking medical care for complications of unsafe abortion are often left waiting for treatment for longer periods of time than other patients.…”