Three ‘Delays’ as a Framework for Critical Analysis of Maternal Near Miss and Maternal Mortality

Abstract

Objective: The aim of the study was to assess the magnitude and causes of three delays and their possible implications for safe motherhood. Methods:The cross-sectional prospective study was carried out over a period of 1 year from January to December 2010. All patients who fulfill the WHO criteria for maternal near miss and all cases of maternal death during this period were included in the study. The various factors responsible for the delays in accessing obstetrics care facilities at all the three levels were analyzed. Results:During 1 year period there were 10,553 emergency admissions in labor room and there were 4538 deliveries, out of these 123 patients who fulfilled the WHO criteria for near miss were included in the study. 83% of patients (102) reported first delay in seeking care and the most common reason for delay was inability to judge the graveness of situation. After initial care there was a delay in reaching a facility with comprehensive obstetric care in 62% of cases (76 patients) and this delay was of around 6 to 8 hours. Once the patients reached Jinnah Hospital there was a delay in about 15 (12%) patients. There were 13 maternal deaths during this period of 1 year and there was a delay both at seeking initial care and referral by the initial care providers. Conclusion:Delay in deciding to seek care (1st delay) was the major factors responsible for high maternal mortality and morbidity. So the role of community actors such as mothers in law, husbands, local healers and pharmacies and increased access to properly trained birth attendants need to be addressed if delays in reaching health facilities are to be shortened.

Praying until death: revisiting three delays model to contextualize the socio-cultural factors associated with maternal deaths in a region with high prevalence of eclampsia in India

“…In our study, delays related to supplier or provider side were less observed in 19 percent of maternal deaths. The third delay is relatively rarely reported as compared to first and second delays in the previous literature [28, 29]. Type 3 delay is directly indicative of suboptimal quality of care and it is also reflected in our study [6].…”

“…It is observed in many studies that public transportation may not be accessible at the time required or may take a considerable time to arrive at the health facility [27]. In our low socio-economic settings, earning daily wage may be prioritized over transportation expenses for reaching health facility at the time of complications [8, 28]. Pregnant women require health care services closer to them or promptly accessible affordable public transport as a solution for the type 2 delay.…”

A Prospective Observational Study of Near-miss Events and Maternal Deaths in Obstetrics

“…In our study first delay was present in 71% cases in MNM group and 90% in maternal death group. It corresponds with the study conducted by Yunus et al 12 in which the first delay was observed as the major cause of delay in 80% of the patients in both the groups.…”

Factors Influencing Male Participation in Maternal Health Care among Married Couples in Nepal: A Population-based Cross-sectional Study

“…19 The socioeconomic status (SES) was defined by Kuppuswamy's socioeconomic status scale modified to the Nepalese context. 20 This scale categorizes the family into upper (26)(27)(28)(29), middle (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) and lower (< 10) socio-economic status. 20 Enabling factors include exposure and knowledge related to reproductive health such as use of family planning methods (yes/no), place of availability of family planning devices (yes/no) and discussion with others/health workers (yes/no), immunization (yes/no), breast feeding (yes/no), HIV/AIDS (yes/no).…”

“…7,8 Men's active involvement plays a vital role in a reduction of three delays: delay in decision to seek care; delay in reaching care; and delay in receiving care. [9][10][11] Therefore, when men are the sole decision makers, men need to be well aware of the needs during pregnancy, delivery and childbirth. Several studies have reported advantages of male involvement in MHCPs: increased contraceptive usage, improved maternal mental health, increased access to antenatal and postnatal care services, and reduced unhealthy practices such as smoking during pregnancy.…”