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