The “Three Delays” at the Root of Maternal Mortality
The World Health Organization (WHO) estimates 303,000 women will die of maternal causes by the end of 2015. While this figure has been reduced by approximately 44 percent in the past 25 years, improvements to maternal mortality rates still need to be made. Almost 99 percent of maternal deaths occur in developing regions, two-thirds of which are concentrated in sub-Saharan Africa.
In 1994, Sereen Thaddeus of the United States Agency for International Development (USAID) and Deborah Maine, Professor Emerita at the Columbia University Mailman School of Public Health, linked causes of maternal mortality to “three delays:” delay in seeking care, delay in arrival at a health facility, and delay in the provision of adequate care.
Today, these three delays still make up a framework that helps in understanding what causes maternal deaths.
1. Delay in Seeking Care
Around 28 percent of maternal deaths stem from pre-existing conditions like anemia and malaria, according to WHO. Women, however, may put off seeking prepartum care because of the inadequacy of available health facilities.
The question of agency plays another role in this delay. According to Kingsley Ighobor, in some countries such as Mali, Burkina Faso and Nigeria, many women do not make the decisions over their health. This responsibility is instead left to spouses or other relatives.
2. Delay in Arrival at a Health Facility
Those living in rural areas face the major obstacle of distance from healthcare facilities. In developing nations, Thaddeus and Maine pointed out how weak infrastructure often means poor roads and slow transportation methods which can delay a woman’s arrival at a health facility.
Socioeconomic divisions within countries often mean unequal access to health facilities. WHO reports “delivery care… is strongly associated with their income, whether they live in a rural or urban area, and their level of education”.
3. Delay in the Provision of Adequate Care
Postpartum hemorrhage accounts for 27 percent of maternal deaths while obstructed labor constitutes eight percent.
Especially in developing nations, a shortage of staff, insufficient training, little to no antibiotic availability and more means health facilities are often ill-equipped to respond to a mother’s needs during and after her pregnancy.
Inadequate sanitation can also be detrimental to mothers. Maternal deaths as a result of infection rank at 15 percent.
Solutions moving forward
Goal Three, Target 3.1 of the 2015 Sustainable Development Goals seeks to “reduce the global maternal mortality rate to less than 70 per 100,000 live births by 2030.”
Achieving this goal may call for tackling the three delays that play a central role in the causes of maternal mortality.
“One of the easiest ways to continue to reduce the rate of maternal mortalities is to improve access to reproductive health”, Dana Dovey of Medical Daily said.
Educating women and relatives on reproductive health along with strengthening the infrastructure of health facilities is necessary to ensure mothers have the help they need for safe pregnancies.
– Jocelyn Lim
Sources: Medical Daily, Kingsley Ighobor, Nawal M. Nour, Sereen Thaddeus and Deborah Maine, United Nations, World Health Organization (WHO), WHO report on health from MDGs to SGDs, WHO: Trends in maternal mortality, 1990-2015
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