Modelling the first two delays of the "three-delays model" for emergency obstetric care in Bangladesh: a choice model approach.

Abstract

Women in Bangladesh have a life-time risk of dying from pregnancy and child-related causes which is estimated to be about 500 times higher than that in the developed countries. More than 100 mothers die daily in Bangladesh due to maternity-related causes. Studies show that 5% of about 600,000 patients in Bangladesh with obstetric complications attend medical facilities, 27.5% of pregnant women receive some prenatal care, 3.5% of women deliver in institutions, and practically no women go for postnatal care. The provision of emergency obstetric care is an extremely important element in the prevention of maternal mortality. While there are inadequate emergency obstetric care services in Bangladesh, those which are available are underutilized because of the medical, social, cultural, economic, geographic, and community barriers women with obstetric complications encounter. The "three-delays" model proposed by Maine in 1993 depicts the roles of communities and the health system in the use status of emergency obstetric care. The model suggests that the outcome of an obstetric emergency is influenced by factors which govern the decision to seek care, reaching the medical facility, and receiving adequate treatment. These three delays impede the use of emergency obstetric care facilities. Using an econometric choice model, the authors identify the relative importance of the factors which affect the first two delays.