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Too far to walk: Maternal mortality in context

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  • Thaddeus, Sereen
  • Maine, Deborah
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    Abstract

    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 closet 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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    Bibliographic Info

    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 38 (1994)
    Issue (Month): 8 (April)
    Pages: 1091-1110

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    Handle: RePEc:eee:socmed:v:38:y:1994:i:8:p:1091-1110

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    Web page: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description

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    Related research

    Keywords: maternal mortality obstetric complication developing countries health services utilization;

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    Cited by:
    1. Hirose, Atsumi & Borchert, Matthias & Niksear, Homa & Alkozai, Ahmad Shah & Cox, Jonathan & Gardiner, Julian & Osmani, Khadija Ruina & Filippi, Véronique, 2011. "Difficulties leaving home: A cross-sectional study of delays in seeking emergency obstetric care in Herat, Afghanistan," Social Science & Medicine, Elsevier, vol. 73(7), pages 1003-1013.
    2. Premchand Dommaraju & Victor Agadjanian & Scott Yabiku, 2008. "The Pervasive and Persistent Influence of Caste on Child Mortality in India," Population Research and Policy Review, Springer, vol. 27(4), pages 477-495, August.
    3. Kumar, Santosh & Dansereau, Emily & Murray, Chris, 2012. "Does Distance matter for Institutional Delivery in Rural India? An Instrumental Variable Approach," MPRA Paper 45762, University Library of Munich, Germany, revised 01 Jan 2013.
    4. Okeke, Theodora A. & Okeibunor, Joseph C., 2010. "Rural-urban differences in health-seeking for the treatment of childhood malaria in south-east Nigeria," Health Policy, Elsevier, vol. 95(1), pages 62-68, April.
    5. Matsuoka, Sadatoshi & Aiga, Hirotsugu & Rasmey, Lon Chan & Rathavy, Tung & Okitsu, Akiko, 2010. "Perceived barriers to utilization of maternal health services in rural Cambodia," Health Policy, Elsevier, vol. 95(2-3), pages 255-263, May.
    6. De Allegri, Manuela & Ridde, Valéry & Louis, Valérie R. & Sarker, Malabika & Tiendrebéogo, Justin & Yé, Maurice & Müller, Olaf & Jahn, Albrecht, 2011. "Determinants of utilisation of maternal care services after the reduction of user fees: A case study from rural Burkina Faso," Health Policy, Elsevier, vol. 99(3), pages 210-218, March.
    7. G Rama Padma, 2005. "Men's Participation In Reproductive Health: A Study Of Some Villages In Andhra Pradesh," Working Papers id:199, eSocialSciences.
    8. Johnson, Ari & Goss, Adeline & Beckerman, Jessica & Castro, Arachu, 2012. "Hidden costs: The direct and indirect impact of user fees on access to malaria treatment and primary care in Mali," Social Science & Medicine, Elsevier, vol. 75(10), pages 1786-1792.
    9. Arlette Campbell White & Thomas W. Merrick & Abdo S. Yazbeck, 2006. "Reproductive Health—The Missing Millennium Development Goal : Poverty, Health, and Development in a Changing World," World Bank Publications, The World Bank, number 7116, October.
    10. Cook, Cynthia T., 2002. "The effects of skilled health attendants on reducing maternal deaths in developing countries: testing the medical model," Evaluation and Program Planning, Elsevier, vol. 25(2), pages 107-116, May.
    11. Van Rijsbergen, Bart & D’Exelle, Ben, 2013. "Delivery Care in Tanzania: A Comparative Analysis of Use and Preferences," World Development, Elsevier, vol. 43(C), pages 276-287.
    12. Santosh Kumar & Emily Dansereau & Chris Murray, 2014. "Does Distance Matter for Institutional Delivery in Rural India?," Working Papers 1405, Sam Houston State University, Department of Economics and International Business.
    13. Anthopolos, Rebecca & Becker, Charles M., 2010. "Global Infant Mortality: Correcting for Undercounting," World Development, Elsevier, vol. 38(4), pages 467-481, April.

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