Three Delay Model

The Three Delay model by Thaddeus and Maine was proposed as a theoretical framework for this study (Thaddeus & Maine 1994). It is still one of the most widely applied models in maternal health programming today and argues that delay in recognizing complications and deciding to seek care, delay in reaching a treatment facility, and delay in receiving adequate care and treatment at the facility are the main contributing factor to maternal death (McCarthy & Maine; Thaddeus & Maine 1994). The framework focuses on factors that look into the interval “between onset of obstetric complications and its outcome.” It stresses that “normal” home births are taken out of this equation and delays occur in response to change delivery setting in times of emergencies;

2014). Literature also holds examples of bringing these services closer to the community, e.g.; training of community health workers in well-baby visits (Gebrehiwot et al. 2012), but realistically this will be difficult to implement due to lack of skilled staff, financial restraints and might oppose public health strategies in promoting skilled birth attendance and preventative services on facility level.

Apart from different explanatory models of etiology of disease, result confirmed literature findings that perceptions of local practices being familiar and allowing family supportive care in case of delivery and illness were strong factors for choosing local health care providers above health care services in this context (Sorensen et al. 2011; Mrisho et al. 2007; Doctor et al. 2012).

Royston and Armstrong argue that next to logistical factors concerning distance, transport and cost, access to health care includes perceptual issues such as estimation of personal risk and perceived quality of care (Royston E, Armstrong S. Preventing Maternal Deaths. Geneva: WHO;

Promotion of female education and literacy is described in several studies as one of the most effective measure to reduce maternal and neonatal mortality (Mekonnen & Mekonnen 2003; Addai 1998; Ikeako et al. 2006). Furthermore, community effects of education have shown to possibly initiate self-organization and involvement of communities in shaping adequate health services (Grosse & Auffrey 1989; Levine & Rowe 2009).

As literature shows, limited availability of transportation options play a crucial role in whether or not a facility can be reached in time (Doctor et al. 2012; Parkhurst et al. 2006; Mrisho et al. 2007; Mwangome et al. 2012). Furthermore, the importance of financial constraints in terms of transport costs has been described in literature as a main reason for delay in accessing health care services (Sorensen et al. 2011; Shiferaw et al. 2013; Bohren et al. 2014). Women often perceive birth and especially complications in delivery as a sudden event that does not give time for preparations (Bohren et al. 2014; Oyerinde et al. 2012; Bedford et al.