Determinants Of Maternal Mortality Research Articles

MODELING OF MATERNAL MORTALITY (MMR) IN EAST JAVA 2017-2019 USING PANEL REGRESSION APPROACH

Maternal Mortality Rate (MMR), is a country's welfare indicator especially about the women's health. It is included in the development index and the quality of life index. The determinants of maternal mortality are elements that collectively cause maternal mortality. This quantitative research used secondary data on MMR and its influencing factors in East Java Province during the 2017-2019 period and the analysis of the panel data used regression. The trend of Maternal mortality in East Java Province has decreased from year to year; in 2019, it was 89.81 per 100,000 live births. The variable pregnant women using blood-added pills (X1) with a probability value of 0.020 (p<0.05) is found to significantly affected the maternal mortality in the panel regression analysis utilizing the Random Effect Model. The Random Effect Model, which this study found to be the best, contains the model equation Yit = 225.7721 - 1.919457 X1it and the administration of blood-added pills is the variable that significantly affects maternal mortality. The results of this study indicate the need for educational efforts, especially regarding to the benefits of blood-added pills for pregnant women and to correct the misunderstanding about the benefits of blood-added pills in the community, so that the coverage of blood supplement consumption in pregnant women can be increased. Together with the primary health care system and obstetricians, an integrative approach and counseling among pregnant women and their partners will increase awareness of maternity health and birth management.

Faktor determinan kematian ibu di Kabupaten Sintang periode Agustus 2021 – 2022

Background: indicators of maternal health in a country can be seen through the high and low Maternal Mortality Rate (MMR). Sintang District in 2021 will be the second highest contributor to MMR in West Kalimantan Province. The determinants of maternal mortality are inconclusive and show different results in each region according to the method of collecting maternal mortality data.Objectives: the general objective of this research is to find out the Determinant Factors for Maternal Mortality in Sintang District for the period August 2021 – August 2022.Methods: using a mix of quantitative and qualitative methods with sequential explanatory. Quantitative research samples totaled 16 cases and qualitative informants amounted to 40 informants with indepth interview method. .Results: quantitative proxy determinant of maternal death caused by complications of childbirth (37.5%) 6 cases, determinant intermediate age > 35 years (68.75%) 11 cases and ANC examination (68.75%) 11 cases, contextual determinant geographical area (75%) 12 cases. The qualitative results of the proxy determinants of maternal death were cases of retained placenta bleeding, the determinant intermediate the risk factors for maternal age > 35 years, high maternal parity ≥ 3 times giving birth and incomplete ANC examinations < 6 times. The determinant is far because it is in a rural area.Conclusion: the causes of maternal death in Sintang district are very complex and multifactor. Assistance for high-risk pregnant women by health personnel and monitoring periodic evaluations of the Program Birth Planning and Complication Prevention (P4K) must be carried out to reduce MMR in Sintang District.

Determinants of Maternal Mortality at the Community University Hospital of Bangui: Central African Republic

Determinants of Maternal Mortality at the Community University Hospital of Bangui: Central African Republic

Determinants Of Maternal Mortality: An Empirical Study of Indian States Based on The Random Effect Model Analysis

Background: Healthcare for mothers and children is a significant indicator of a country's well-being. India is one of the nations that were experiencing a rather slow improvement in maternal and child health. Aims: The objective of this study is to analyse the changes in maternal healthcare in India from 2010-11 in health inputs like health infrastructure and government expenditure, health outcomes like antenatal care, postnatal care, institutional delivery, and health impact like Maternal Mortality Ratio (MMR). Methodology: The study is based on secondary data. It employs Average Increasing Rate (AIR) and Average Reduction Rate (ARR), as well as a panel data random effect model, on key health indicators for Indian states. Results: Empirical results say MMR has a statistically significant inverse relationship with female literacy, Per capita Net State Domestic Product (PNSDP), and institutional delivery. The study concludes that after the introduction of NRHM and its constituent elements like JSY and JSSK, government expenditure on health, infrastructure, the percentage of antenatal care, post-natal care, and institutional delivery increased in most of the Indian states, thus helping to increase the pace of the reduction of MMR. However, state performance varies greatly. Conclusions: Policy alone will not provide the desired results; it is also critical to focus on education, particularly female literacy, and economic empowerment. We can make a difference in the health sector if these come together.

CAUSATIVE FACTOR OF DELAY IN MATERNAL REFERRAL - SYSTEMATIC REVIEW

Background: Every day in the world, around 810 mothers have died from preventable causes. The causes of delay in maternal referral care were analyzed using the Three Delay Model (Thaddeus & Maine, 1994) and the determinants of maternal mortality (McCarthy & Maine, 1992). Purpose: To describe the factors that causing delays in seeking care for maternal referrals. Methods: This is a systematic review study of articles published between 2010 and 2020 based on database from ScienceDirect, Scopus, SageJournals, and Google Scholar. Nine articles that met the inclusion and exclusion criteria were included as samples for further review. The results regarding the factors causing late referral are described and explained in narrative form. Results: First delay (8 articles), Second delay (5 articles), Third delay (4 articles), mother’s education (6 articles), mother's income and occupations (2 articles), women's empowerment (6 articles), family status in society (4 articles), community status (3 articles), and cultural influences (7 articles) studies are acquired. Conclusions: The previous delay will affect the next delay and the problem of delay in seeking health care is in decision-making which mostly found in upper-middle countries, the causes of cultural factors which also causing the delay in referrals, followed by the socioeconomic influence that most widely discussed are maternal education and women's empowerment, the problem which is also most commonly found in upper-middle-income countries.

Determinants of maternal mortality in a critical care unit: A prospective analysis.

Introduction:An admission of a pregnant woman to an intensive care unit (ICU) is considered as an objective marker of maternal near miss. Only a few studies from the Indian subcontinent have reported on the ability of ICU scoring systems in predicting the mortality in obstetric patients.Methods:A prospective analysis of all critically ill obstetric patients admitted to the critical care department was done.Results:In the period between April 2013 and September 2017, there were 101 obstetric admissions to the critical care ICU. Of these, 82 patients (81.2%) were discharged from the hospital, 18 patients (17.8%) died, and one left against medical advice. The common diagnoses seen in these patients were cardiac failure (n = 39; 38.6%); pregnancy-induced hypertension (n = 26; 25.7%); acute respiratory distress syndrome (n = 20; 19.8%); intra-abdominal sepsis (n = 19; 18.8%); tropical diseases (n = 19; 18.8%); and tuberculosis (n = 13; 12.9%). When we compared the survivors with the nonsurvivors, a higher severity of illness score and a low PaO2/FiO2 were found to increase the odds of death. The area of distribution under the receiver operator characteristic curve was 0.726 (95% confidence interval [CI] = 0.575–0.877), 0.890 (95% CI = 0.773–1.006), 0.867 (95% CI = 0.755–0.979), and 0.850 (95% CI = 0.720–0.980) for the PaO2/FiO2, Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation (APACHE) II score, respectively, for predicting mortality. The standardized mortality ratio was better with SAPSII than with APACHE II.Conclusions:Cardiac dysfunction is a leading cause of ICU admission. Obstetric patients frequently require ventilatory support, intensive hemodynamic monitoring, and blood transfusion. The APACHE II score is a good index for assessing ICU outcomes.

Prevalence and Determinants of Maternal Mortality in Southeastern Iran (2013 - 2017): A Retrospective Cross-sectional Study

Background: Recognizing the factors affecting maternal death can lead to the adoption of strategies to prevent similar deaths. Objectives: This study was performed to investigate the prevalence and causes of pregnant mothers' death in the population covered by Zahedan University of Medical Sciences. Methods: In this retrospective, descriptive, cross-sectional study, the files of 126 pregnant mothers who died during 2013 - 2017 were evaluated. Demographic and obstetrics information and variables related to maternal mortality, such as maternal mortality ratio (MMR), the cause of mother’s death, the time of mother’s death, and place of death, were evaluated in general and separately in each city (i.e., Zahedan, Khash, Saravan, and Chabahar) based on descriptive statistics and according to the nature of the variables. Results: Maternal mortality ratio in Zahedan was 174.96 per 100,000 case, in Khash 190.56 per 100,000 cases, in Saravan 371.87 per 100,000 cases, and in Chabahar 384.03 per 100,000 cases. Bleeding was the most common cause of death (42.53%), 61.9% of pregnant women were living in rural areas, 80.2% died in the third trimester of pregnancy, and 42.9% died in first 24 hours after delivery. The most common underlying disease was hypertension, 70.6% of mothers died in hospitals, and 47.6% were illiterate. The most common cause of maternal death in Zahedan was cardiac disease, in Khash it was hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, eclampsia, and preeclampsia, and in Saravan and Chabahar the leading cause was bleeding. Conclusions: Maternal mortality ratio was high in Sistan and Baluchestan. The investigation of the causes of maternal deaths showed that some of these deaths are avoidable. It is also necessary to improve midwifery emergencies management with intensive monthly courses to increase team capabilities for making the best use of golden time measures.

Birth Preparedness Practice: Profiling Determining Factors for Male Involvement in Southern Nigeria

Maternal mortality remains high in most African countries including Nigeria. Delays in seeking care for normal delivery and obstetric emergencies are the major determinants of maternal mortality. Birth Preparedness (BP) has been found to be very effective in reducing these delays. Females have always been focused on birth preparedness studies. This study was however designed to investigate male involvement in the practice of birth preparedness in Southern, Nigeria. This was a descriptive study design using a validated structured interviewer-administered questionnaire. A multistage sampling technique was used to select 302 married men in the community. Knowledge on BP was measured on a 48-point knowledge scale and a 30-point practice scale was used to determine male involvement in BP. Data were analysed using descriptive and inferential statistics at p<0.05. The mean age of the respondents was 38.0 ± 8.6 years. Majority (59.9 %) of the respondents had good knowledge on birth preparedness. Mean score for level of involvement was 21.52±5.4 and 43.0% of the respondents had good score. Identified factors militating against male involvement in birth preparedness include low socioeconomic status, busy work schedule, cultural belief, and poor attitude of health workers. There was significant association between knowledge of birth preparedness and religion as well as level of male involvement in BP (p=0.018; 0.001 respectively). This study showed low level of male involvement in birth preparedness. Several factors were identified to be responsible for this. There is therefore the need for sustainable community health education programmes to motivate and encourage male involvement in birth preparedness. Keywords: Birth preparedness, Knowledge, Male involvement, Practices

Determinan Kematian Maternal di Kabupaten Tangerang Tahun 2018-2019

Based on data from the SDKI, the Maternal Mortality Rate (MMR) in Indonesia is still quite high, namely 359 per 100,000 live births1, and the results of the Inter-Census Population Survey show a decrease to 305 per 100,0002, this result is still quite far considering the Sustainable Development Goals (SDGs) target, namely reduce maternal mortality to below 70 per 100,000 target by 20303. The diversity of causes of maternal mortality and differences in regional characteristics make it necessary to make policies and plans to reduce MMR. AKI is an indicator of maternal health status. McCharty and Maine suggest 3 factors that influence maternal mortality, namely the near determinant, the intermediate determinant and the distant determinant.This research uses analytical research method, using secondary data, this method was chosen because in the first stage research will be conducted on the determinants of maternal mortality, then in the second stage an analysis will be carried out (analytic) to determine the determinants that have the most influence on maternal mortality in Tangerang Regency.There is a relationship between parity and maternal mortality with a p value of 0.025; OR = 5.667, which means that parity has 5.6 times the maternal mortality. There is a relationship between Ante Natal Care (ANC) examination and maternal mortality with a p value of 0.004; OR = 8,889 which means that ANC examination has 8.8 times of maternal mortality. There is a relationship between complications and maternal death with a p value of 0.019; OR = 7.5, which means that complications have 7.5 times the death rate and husband's work with maternal mortality p value 0.035; OR = 0.117. Thus parity, ANC examination, complications and husband's occupation have an effect on the determinants of maternal mortality.

Bayesian multilevel model on maternal mortality in Ethiopia

Maternal mortality is one of the socio-economic problems and widely considered a serious indicator of the quality of a health. Ethiopia is considered to be one of the top six sub-Saharan countries with severe maternal mortality. The objective of this study was to investigate the effects of the Demographic and Socio-economic determinant factors of maternal mortality in Ethiopia. Data from the 2016 Ethiopia Demographic and Health Survey indicated that the sample of women (15–49) was (n = 10,103). The Bayesian multilevel we were used to explore the major risk factors and regional variations in maternal mortality in Ethiopia. Markov chain Monte Carlo methods with non-informative priors have been applied. The Deviance Information Criterion model selection criteria were used to select the appropriate model. The analysis result, 145 (1.43%) mothers were died due to pregnancy. Using model selection criteria Bayesian multilevel random coefficient was found to be appropriate. With this model, Age of mother, marital status, number of living children, wealth index and Education are found to be the significant determinants of maternal mortality in Ethiopia. The study indicated that there was within and between regional variations in maternal mortality. Inference is the fully Bayesian multilevel model based on recent Markov chain Monte Carlo techniques. The socioeconomic, demographic and environmental determinants included in the study were found to be statistically significant. The result of the Bayesian multilevel model in this study has shown that educational attainment, wealth index, an age of mother, status and number of living children was a significant factor of maternal mortality.

Hospital bed supply and inequality as determinants of maternal mortality in China between 2004 and 2016

BackgroundDriven by the government’s firm commitment to promoting maternal health, maternal mortality ratio (MMR) in China has achieved a remarkable reduction over the past 25 years. Paralleled with the decline of MMR has been the expansion of hospital bed supply as well as substantial reduction in hospital bed distribution inequalities, which were thought to be significant contributors to the reduction in MMR. However, evidences on the impact of hospital bed supply as well as how its distribution inequality has affected MMR remains scarce in China. Addressing this uncertainty is essential to understand whether efforts made on the expansion of healthcare resource supply as well as on improving its distribution inequality from a geographical perspective has the potential to produce measurable population health improvements.MethodsPanel data of 31 provinces in China between 2004 and 2016 were extracted from the national statistical data, including China Statistical Yearbooks, China Health Statistical Yearbooks and other national publications. We firstly described the changes in hospital bed density as well as its distribution inequality from a geographical perspective. Then, a linear mixed model was employed to evaluate the impact of hospital bed supply as well as its distribution inequality on MMR at the provincial level.ResultsThe MMR decreased substantially from 48.3 to 19.9 deaths per 100,000 live births between 2004 and 2016. The average hospital bed density increased from 2.28 per 1000 population in 2004 to 4.54 per 1000 population in 2016, with the average Gini coefficient reducing from 0.32 to 0.25. As indicated by the adjusted mixed-effects regressions, hospital bed density had a negative association with MMR (β = − 0.112, 95% CI: − 0.210--0.013) while every 0.1-unit reduction of Gini coefficient suggested 14.50% decline in MMR on average (β = 1.354, 95% CI: 0.123–2.584). Based on the mediation analysis, the association between hospital bed density or Gini coefficient with MMR was found to be significantly mediated by facility birth rate, especially during the period from 2004 to 2009.ConclusionsThis study provided empirical evidences on China’s impressive success in the aspect of reducing MMR which could be attributed to the expansion of hospital beds as well as the improvement in its distribution inequality from a geographical perspective. Such findings were expected to provide evidence-based implications for long-term policy-making procedures in order to achieve rational healthcare resource allocations as well as promoting the equity and accessibility to obtaining health care from a holistic perspective. Constant efforts should be made on improving the equity in healthcare resource allocations in order to achieve the penetration of universal healthcare coverage.

Perspective of Maternal Deaths: A Retrospective Autopsy Study

Reducing maternal mortality has been a constant struggle globally. The major causes of maternal mortality remain to be ante and post-partum haemorrhage, anaemia, obstructed labour, hypertensive disorders and post-partum infections, liver disorders as observed in various studies. The present study was carried out with view to determine factors causing maternal deaths, and utility of autopsy with autopsy record as a useful and adjunct data source for ascertainment of maternal deaths. In this study we have retrospectively considered the autopsy of maternal cases during 2015 to 2019 referred to RCSM GMC Kolhapur, Kolhapur, Maharashtra. Of the total 66 cases of maternal deaths, maximum number of cases were seen in age group of 20 to 29 years comprising 42 out of 66 (63.63%), Maximum cases 53 (81.30%) were resident of rural areas. Maximum causes of death on autopsy were direct causes, of which hemorrhage was the predominant cause. Most of the cases (42 out of 66 ) died within 24 hours of admission to the hospital. The determinants of maternal mortality need to be studied through the lens of autopsy.

Determinants of Maternal Mortality: In a Tertiary Care Hospital of Central India

Determinants of Maternal Mortality: In a Tertiary Care Hospital of Central India

Ratios and determinants of maternal mortality: a comparison of geographic differences in the northern and southern regions of Cameroon

BackgroundWhile maternal mortality has declined worldwide in the past 25 years, this is not the case for Cameroon. Since there is a predominantly young population in this country, high maternal mortality ratios may persist. Maternal mortality ratios vary within countries, yet it is unknown if the North and South, the most distinct parts of Cameroon, differ in terms of ratios and determinants of maternal mortality.MethodsThis study explored ratios and determinants of maternal mortality in women of childbearing age (15–49 years) and assessed differences between the North and South. We used the Cameroon Demographic and Health Surveys (2004 and 2011) to extract a sample of 18,665 living or deceased women who had given birth. Multivariable logistic regression was used to explore the relationship between maternal mortality and sociocultural, economic and healthcare factors.ResultsMaternal mortality ratios were different for the two regions and increased in the North in 2011 compared to 2004. In the North, any level of education and being Muslim were protective against maternal mortality. Meanwhile, the odds of maternal mortality decreased with increasing age, and having secondary or higher education in the South. Domestic violence and ethnicity were associated with maternal death in the South. Increasing parity was protective of maternal death in both the North and South.ConclusionsMaternal mortality ratios and determinants varied between women of childbearing age in the North and South of Cameroon. These reinforce recommendations for region specific strategies that will improve health communication, community education programs, curb domestic violence and train more community health workers to connect pregnant women with the health system. Programs to reduce maternal death among women with low parity and little or no education should be national priority.

Expected Surge in Maternal Mortality and Severe Morbidity among African-Americans in the Era of COVID-19 Pandemic.

Prior to the COVID-19 pandemic, African-American mothers were three times as likely to die from pregnancy-related causes compared to white mothers. The impact of the pandemic among African-Americans could further worsen the racial disparities in maternal mortality (MM) and severe maternal morbidity (SMM). This study aimed to create a theoretical framework delineating the contributors to an expected rise in maternal mortality (MM) and severe maternal morbidity (SMM) among African-Americans in the era of the COVID-19 pandemic due to preliminary studies suggesting heightened vulnerability of African-Americans to the virus as well as its adverse health effects. Rapid searches were conducted in PubMed and Google to identify published articles on the health determinants of MM and SMM that have been or likely to be disproportionately affected by the pandemic in African-Americans. We identified socioeconomic and health trends determinants that may contribute to future adverse maternal health outcomes. There is a need to intensify advocacy, implement culturally acceptable programs, and formulate policies to address social determinants of health.

Levels and determinants of maternal mortality in northern and southern Nigeria

BackgroundMaternal mortality is still a major risk for women of childbearing age in Nigeria. In 2008, Nigeria bore 14% of the global burden of maternal mortality. The national maternal mortality ratio has remained elevated despite efforts to reduce maternal deaths. Though health disparities exist between the North and South of Nigeria, there is a dearth of evidence on the estimates and determinants of maternal mortality for these regions.MethodsThis study aimed to assess differences in the levels and determinants of maternal mortality in women of childbearing age (15–49 years) in the North and South of Nigeria. The Nigeria Demographic and Health Surveys (2008 and 2013) were used. The association between maternal mortality (outcome) and relevant sociocultural, economic and health factors was tested using multivariable logistic regression in a sample of 51,492 living or deceased women who had given birth.ResultsThere were variations in the levels of maternal mortality between the two regions. Maternal mortality was more pronounced in the North and increased in 2013 compared to 2008. For the South, the levels slightly decreased. Media exposure and education were associated with maternal mortality in the North while contraceptive method, residence type and wealth index were associated with maternal death in the South. In both regions, age and community wealth were significantly associated with maternal mortality.ConclusionsDifferences in the levels and determinants of maternal mortality between the North and South of Nigeria stress the need for efforts to cut maternal deaths through new strategies that are relevant for each region. These should improve education of girls in the North and access to health information and services in the South. Overall, new policies to improve women’s socioeconomic status should be adopted.

Multilevel Factors Associated With Pregnancy-Related Health Behaviors in Indonesia: Evidence From the 2007, 2012, and 2017 Indonesian Demographic Health Surveys.

Indonesia has one of the highest maternal mortality rates among Southeast Asia countries. Mothers' pregnancy-related behaviors were proven to be the major determinants of maternal mortality. This study attempted to measure individual- and community-level factors that contribute to pregnancy-related health behaviors among Indonesian women. This study used representative nationwide survey samples among women aged 15 to 49 years from the Indonesian Demographic Health Survey in the years 2007 (N = 15 314), 2012 (N = 15 197), and 2017 (N = 15 300). Generalized linear mixed models were constructed to simultaneously analyze relationships of pregnancy-related health behaviors with other individual- and community-level explanatory factors. We found that women's educational level, household wealth index, insurance status, access to health facilities, geographic location, general health condition, pregnancy intentions, and community-level socioeconomic status were significantly associated with different outcome behaviors. The findings of this study suggest that future policies should focus on both individual- and community-level factors to improve women's pregnancy-related behaviors.

Determinants of maternal mortality: A prospective study from single centre of Bhopal

Determinants of maternal mortality: A prospective study from single centre of Bhopal

Inhibitory effects of unripe, ripe peels and seed volatile oils of Dennettia tripetala on some pathogens and free radicals

Background: Nigeria currently has the second highest number of pregnancy-related deaths, which accounts for 15% of global estimates. Emerging contributors to maternal mortality have graced the medical literature in the last 3 decades. Objectives: We sought to document the current contributors to maternal death in our hospital and to highlight the increasing role of non-obstetric causes of maternal mortality. Methods: Maternal mortality recorded in the Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin City from January 2011 to December 2018 was retrospectively studied to evidence a trend across the years. The major non-obstetric causes of maternal mortality were determined by simple proportion, and the relationship of maternal mortality to specific determinants was expressed as specific fatality. Results: MMR was 1,114/100,000 live births. Mortality was higher in unbooked women, teenagers, older and grand-multiparous women, and women in lower social class. The majority th of mortality was from obstetric haemorrhage. HIV deaths ranked 5 overall. HIV, VTE, cardiac disease, diabetes and anaesthesia were the leading non-obstetric causes of maternal mortality. Conclusions: Maternal mortality is common in our environment. The contribution of nonobstetric causes of maternal mortality appears to be on the increase. The health consequences of poverty, ignorance and disease are determinants of maternal mortality. Addressing socioeconomic empowerment of women will improve overall maternal health indices. Key words: Maternal mortality, Trend in maternal mortality, Non-obstetric causes, University of Benin Teaching Hospital

The fourth delay and community-driven solutions to reduce maternal mortality in rural Haiti: a community-based action research study

BackgroundIn Haiti, the number of women dying in pregnancy, during childbirth and the weeks after giving birth remains unacceptably high. The objective of this research was to explore determinants of maternal mortality in rural Haiti through Community-Based Action Research (CBAR), guided by the delays that lead to maternal death. This paper focuses on socioecological determinants of maternal mortality from the perspectives of women of near-miss maternal experiences and community members, and their solutions to reduce maternal mortality in their community.MethodsThe study draws on five semi-structured Individual Interviews with women survivors of near-misses, and on four Focus Group Discussions with Community Leaders and with Traditional Birth Attendants. Data collection took place in July 2013. A Community Research Team within a resource-limited rural community in Haiti undertook the research. The methods and analysis process were guided by participatory research and CBAR.ResultsParticipants identified three delays that lead to maternal death but also described a fourth delay with respect to community responsibility for maternal mortality. They included women being carried from the community to a healthcare facility as a special example of the fourth delay. Women survivors of near-miss maternal experiences and community leaders suggested solutions to reduce maternal death that centered on prevention and community infrastructure. Most of the strategies for action were related to the fourth delay and include: community mobilization by way of the formation of Neighbourhood Maternal Health/Well-being Committees, and community support through the provision/sharing of food for undernourished women, offering monetary support and establishment of a communication relay/transport system in times of crisis.ConclusionsFinding sustainable ways to reduce maternal mortality requires a community-based/centred and community-driven comprehensive approach to maternal health/well-being. This includes engagement of community members that is dependent upon community knowledge, political will, mobilization, accountability and empowerment. An engaged/empowered community is one that is well placed to find ways that work in their community to reduce the fourth delay and in turn, maternal death. Potentially, community ownership of challenges and solutions can lead to more sustainable improvements in maternal health/well-being in Haiti.