Besides the three delays: Factors which have a bearing on maternal health
Author: Ranjani K. Murthy, August 11 2014 - It is widely recognized that three delays have a bearing on accessing maternal health care, namely, delays in decision to seek care, delays in reaching care, and delays in receiving adequate quality care. See Box 1 for details:
Box 1 THREE DELAYS IN ACCESSING MATERNAL HEALTH Care
Delay in decision to seek care
Low status of women
Poor understanding of complications and risk factors in pregnancy and of when medical interventions are needed
Previous poor experience of health care
Acceptance of maternal death
Financial implications
Delay in reaching care
Distance to health centres and hospitals
Availability of and cost of transportation
Poor roads
Geography e.g. mountainous terrain, rivers
Phase 3: Delay in receiving adequate health care
Poor facilities and lack of medical supplies
Inadequately trained and poorly motivated medical staff
Inadequate referral systems
Source: Maternity Worldwide, n.d Three Delays Model
These three delays and the factors spelt out under each indeed have a bearing on access to maternal health care.
'Maternal health' however is beyond 'maternal health care' and some of the other factors that need to be taken into account include:
Household | Community | Market | State | Inter-State |
Eradication of violence during pregnancy
Eating of balanced meals together- not women eating last
Male engagement in household work during pregnancy and lactation
Conditional Cash transfer for pregnant women linked to not undertaking for strenuous and hazardous jobs and institutional delivery
IEC on harmful impact of passive and active smoking during pregnancy[1]
IEC on harmful impact of alcohol consumption during pregnancy and breast feeding[2] | Eradication of early marriage
Eradication of harmful food habits[3]
Eradication of son preference so that pregnant women are not under pressure and have to go through more pregnancies
Changing attitudes on women’s mobility and norms on interaction with male providers
Raising awareness on the pros of government health services over quacks | Implementation of maternity leave and benefits, leave for safe and legal abortion[4]
Amendment of labour regulation so that pregnant women are not employed in hazardous occupations. | Treatment for health conditions[5] that have a bearing on maternal health Provision of contraception for spacing and limiting – including for couples from communities considered endangered[6]
Treatment for malnutrition of pregnant women and infants.
Evolving inter province referral systems in communities where pregnant women go to marital home for delivery.
Provision of maternity leave and benefits for those in the informal sector. Similarly for safe and legal abortion
Privacy and gender sensitivity of service | Allocation of funds for maternal health, contraception, safe and legal abortion, while at the same time banning sex selective abortion
Delinking lending on health to introduction of user fees |
[1] Prevalent in some of the indigenous communities in India
[2] Prevalent in some of the indigenous communities in India
[3] Belief that eating a full meal would enhance the size of the fetus
[4] Making sure the abortion is not for sex selection
[5] For example, treatment of silicosis of lungs amongst pregnant women in coal mining areas.
[6] Couples from communities considered endangered are not provided with access to contraception in the province of Jharkhand, India. As a result some of them even have 7 children. Pregnancies at a later age as well as one after the other pose high risk for women
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