<p class="first" id="d9170007e57">The Prevention of Maternal Mortality Program is
a collaborative effort of Columbia
University's Center for Population and Family Health and multidisciplinary teams of
researchers from Ghana, Nigeria and Sierra Leone. Program goals include dissemination
of information to those concerned with preventing maternal deaths. This review, which
presents findings from a broad body of research, is part of that activity. While there
are numerous factors that contribute to maternal mortality, we focus on those that
affect the interval between the onset of obstetric complication and its outcome. If
prompt, adequate treatment is provided, the outcome will usually be satisfactory;
therefore, the outcome is most adversely affected by delayed treatment. We examine
research on the factors that: (1) delay the decision to seek care; (2) delay arrival
at a health facility; and (3) delay the provision of adequate care. The literature
clearly indicates that while distance and cost are major obstacles in the decision
to seek care, the relationships are not simple. There is evidence that people often
consider the quality of care more important than cost. These three factors--distance,
cost and quality--alone do not give a full understanding of decision-making process.
Their salience as obstacles is ultimately defined by illness-related factors, such
as severity. Differential use of health services is also shaped by such variables
as gender and socioeconomic status. Patients who make a timely decision to seek care
can still experience delay, because the accessibility of health services is an acute
problem in the developing world. In rural areas, a woman with an obstetric emergency
may find the closest facility equipped only for basic treatments and education, and
she may have no way to reach a regional center where resources exist. Finally, arriving
at the facility may not lead to the immediate commencement of treatment. Shortages
of qualified staff, essential drugs and supplies, coupled with administrative delays
and clinical mismanagement, become documentable contributors to maternal deaths. Findings
from the literature review are discussed in light of their implications for programs.
Options for health programs are offered and examples of efforts to reduce maternal
deaths are presented, with an emphasis on strategies to mobilize and adapt existing
resources.
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