The 'Three Delays' as a framework for examining maternal mortality in Haiti

Debora Barnes-Josiah, Cynthia Myntti, Antoine Augustin

Research output: Contribution to journalArticle

155 Citations (Scopus)

Abstract

Haiti has one of the highest rates of maternal mortality in the Caribbean. The 'Three Delays' model proposes that pregnancy-related mortality is overwhelmingly due to delays in: (1) deciding to seek appropriate medical help for an obstetric emergency; (2) reaching an appropriate obstetric facility; and (3) receiving adequate care when a facility is reached. This framework was used to analyze a sample of 12 maternal deaths that occurred in a longitudinal cohort of pregnant Haitian women. Because of political upheavals in Haiti during the survey, these deaths are an underestimate of all deaths that occurred in the cohort. Family and friend interviews were used to obtain details about the medical and social circumstances surrounding each death. A delayed decision to see medical care was noted in eight of the 12 cases, whereas delays in transportation only appeared to be significant in two. Inadequate care at a medical facility was a factor in seven cases. Multiple delays were relevant in the deaths of three women. Family and friend interviews suggest that a lack of confidence in available medical options was a crucial factor in delayed or never made decisions to seek care. Expanding the coverage of existing referral networks, improving community recognition of obstetric emergencies, and improving the ability of existing medical institutions to deliver quality obstetric care, are all necessary. However, services will continue to be under-utilized if they are perceived negatively by pregnant women and their families. The current data thus suggest that improvements to Haiti's maternity care system which focus on reducing the third delay - that is, improving the quality and scope of care available at existing medical facilities - will have the greatest impact in reducing needless maternal deaths.

Original languageEnglish (US)
Pages (from-to)981-993
Number of pages13
JournalSocial Science and Medicine
Volume46
Issue number8
DOIs
StatePublished - Apr 15 1998

Fingerprint

maternal mortality
Haiti
Maternal Mortality
Obstetrics
obstetrics
death
Maternal Death
Quality of Health Care
Pregnant Women
Emergencies
Interviews
pregnancy
Aptitude
mortality
Referral and Consultation
interview
Pregnancy
medical care
Mortality
family

Keywords

  • Haiti
  • Maternal mortality
  • Maternity care
  • Verbal autopsies

ASJC Scopus subject areas

  • Health(social science)
  • History and Philosophy of Science

Cite this

The 'Three Delays' as a framework for examining maternal mortality in Haiti. / Barnes-Josiah, Debora; Myntti, Cynthia; Augustin, Antoine.

In: Social Science and Medicine, Vol. 46, No. 8, 15.04.1998, p. 981-993.

Research output: Contribution to journalArticle

Barnes-Josiah, Debora ; Myntti, Cynthia ; Augustin, Antoine. / The 'Three Delays' as a framework for examining maternal mortality in Haiti. In: Social Science and Medicine. 1998 ; Vol. 46, No. 8. pp. 981-993.
@article{09a4d8a24d4d4886bf4397a6c4eae8ca,
title = "The 'Three Delays' as a framework for examining maternal mortality in Haiti",
abstract = "Haiti has one of the highest rates of maternal mortality in the Caribbean. The 'Three Delays' model proposes that pregnancy-related mortality is overwhelmingly due to delays in: (1) deciding to seek appropriate medical help for an obstetric emergency; (2) reaching an appropriate obstetric facility; and (3) receiving adequate care when a facility is reached. This framework was used to analyze a sample of 12 maternal deaths that occurred in a longitudinal cohort of pregnant Haitian women. Because of political upheavals in Haiti during the survey, these deaths are an underestimate of all deaths that occurred in the cohort. Family and friend interviews were used to obtain details about the medical and social circumstances surrounding each death. A delayed decision to see medical care was noted in eight of the 12 cases, whereas delays in transportation only appeared to be significant in two. Inadequate care at a medical facility was a factor in seven cases. Multiple delays were relevant in the deaths of three women. Family and friend interviews suggest that a lack of confidence in available medical options was a crucial factor in delayed or never made decisions to seek care. Expanding the coverage of existing referral networks, improving community recognition of obstetric emergencies, and improving the ability of existing medical institutions to deliver quality obstetric care, are all necessary. However, services will continue to be under-utilized if they are perceived negatively by pregnant women and their families. The current data thus suggest that improvements to Haiti's maternity care system which focus on reducing the third delay - that is, improving the quality and scope of care available at existing medical facilities - will have the greatest impact in reducing needless maternal deaths.",
keywords = "Haiti, Maternal mortality, Maternity care, Verbal autopsies",
author = "Debora Barnes-Josiah and Cynthia Myntti and Antoine Augustin",
year = "1998",
month = "4",
day = "15",
doi = "10.1016/S0277-9536(97)10018-1",
language = "English (US)",
volume = "46",
pages = "981--993",
journal = "Social Science and Medicine",
issn = "0277-9536",
publisher = "Elsevier Limited",
number = "8",

}

TY - JOUR

T1 - The 'Three Delays' as a framework for examining maternal mortality in Haiti

AU - Barnes-Josiah, Debora

AU - Myntti, Cynthia

AU - Augustin, Antoine

PY - 1998/4/15

Y1 - 1998/4/15

N2 - Haiti has one of the highest rates of maternal mortality in the Caribbean. The 'Three Delays' model proposes that pregnancy-related mortality is overwhelmingly due to delays in: (1) deciding to seek appropriate medical help for an obstetric emergency; (2) reaching an appropriate obstetric facility; and (3) receiving adequate care when a facility is reached. This framework was used to analyze a sample of 12 maternal deaths that occurred in a longitudinal cohort of pregnant Haitian women. Because of political upheavals in Haiti during the survey, these deaths are an underestimate of all deaths that occurred in the cohort. Family and friend interviews were used to obtain details about the medical and social circumstances surrounding each death. A delayed decision to see medical care was noted in eight of the 12 cases, whereas delays in transportation only appeared to be significant in two. Inadequate care at a medical facility was a factor in seven cases. Multiple delays were relevant in the deaths of three women. Family and friend interviews suggest that a lack of confidence in available medical options was a crucial factor in delayed or never made decisions to seek care. Expanding the coverage of existing referral networks, improving community recognition of obstetric emergencies, and improving the ability of existing medical institutions to deliver quality obstetric care, are all necessary. However, services will continue to be under-utilized if they are perceived negatively by pregnant women and their families. The current data thus suggest that improvements to Haiti's maternity care system which focus on reducing the third delay - that is, improving the quality and scope of care available at existing medical facilities - will have the greatest impact in reducing needless maternal deaths.

AB - Haiti has one of the highest rates of maternal mortality in the Caribbean. The 'Three Delays' model proposes that pregnancy-related mortality is overwhelmingly due to delays in: (1) deciding to seek appropriate medical help for an obstetric emergency; (2) reaching an appropriate obstetric facility; and (3) receiving adequate care when a facility is reached. This framework was used to analyze a sample of 12 maternal deaths that occurred in a longitudinal cohort of pregnant Haitian women. Because of political upheavals in Haiti during the survey, these deaths are an underestimate of all deaths that occurred in the cohort. Family and friend interviews were used to obtain details about the medical and social circumstances surrounding each death. A delayed decision to see medical care was noted in eight of the 12 cases, whereas delays in transportation only appeared to be significant in two. Inadequate care at a medical facility was a factor in seven cases. Multiple delays were relevant in the deaths of three women. Family and friend interviews suggest that a lack of confidence in available medical options was a crucial factor in delayed or never made decisions to seek care. Expanding the coverage of existing referral networks, improving community recognition of obstetric emergencies, and improving the ability of existing medical institutions to deliver quality obstetric care, are all necessary. However, services will continue to be under-utilized if they are perceived negatively by pregnant women and their families. The current data thus suggest that improvements to Haiti's maternity care system which focus on reducing the third delay - that is, improving the quality and scope of care available at existing medical facilities - will have the greatest impact in reducing needless maternal deaths.

KW - Haiti

KW - Maternal mortality

KW - Maternity care

KW - Verbal autopsies

UR - http://www.scopus.com/inward/record.url?scp=0031912539&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031912539&partnerID=8YFLogxK

U2 - 10.1016/S0277-9536(97)10018-1

DO - 10.1016/S0277-9536(97)10018-1

M3 - Article

C2 - 9579750

AN - SCOPUS:0031912539

VL - 46

SP - 981

EP - 993

JO - Social Science and Medicine

JF - Social Science and Medicine

SN - 0277-9536

IS - 8

ER -