Too far to walk: maternal mortality in context

This key paper, published in 1994, develops and explains the three delays model in seeking, reaching and accessing adequate care, within the context of maternal health. This paper is based on multidisciplinary literature review on the factors contributing to maternal mortality in the developing world, with a focus on those affecting the interval between the onset of obstetric complication and its outcome.This review was conducted as part of the Prevention of Maternal Mortality Programme, and aimed at guiding programmatic efforts in the context of this programme as well as more broadly in the field of maternal mortality.The researchers developed the influential three-delay model to analyse the various factors underpinning maternal mortality highlighted in the literature:Delay 1: deciding to seek care Distance to the facility and costs both can influence the decision to seek care. However, the researchers’ analysis suggests that other factors are also at play, such as

• ilness-related factors (patients’ perceptions of the severity of their condition)
• gender
• socioeconomic status
• quality of care

The researchers furthermore highlight evidence that quality of care is often more important than cost in affecting people’s decision to seek care.Delay 2: reaching a healthcare facility The distribution and location of facilities, distance to the nearest facility, available transport options are interlinked and underpin delays in reaching a facility, thereby increasing the risk of mortality.Delay 3: receiving adequate care Lastly, delays in receiving care also increase the risk of mortality. The researchers show that this type of delay is largely due to:

• staff shortage
• insufficient drugs and essential supplies
• lack of blood for transfusion
• inadequate management
• late or inadequate diagnosis by clinical staff 

Overall, this review is key in showing the role and interplay of multiple factors contributing to maternal deaths, and in highlighting how quality of care affects care-seeking behaviour and health outcomes for pregnant women.To read this paper, click here. Subscription of payment required for full access.Thaddeus, S., & Maine, D. (1994). Too far to walk: maternal mortality in context. Social Science and Medicine, 38(8), 1090–1110.