Three delay model: to find out the reason for maternal deaths

Neha Agrawal, Seema Patel, Mayank Badkur


Background: Each year in India, roughly 28 million women experience pregnancy and 26 million have a live birth. Of these, an estimated 67,000 maternal deaths and one million new-born deaths occur each year. A woman dies as a result of complication arising during pregnancy and childbirth every 90 seconds in the world, and every 7 minutes in India. The three delay model can be used to find the causes of delays in relation to maternal deaths.

Methods: A retrospective study was carried out in a tertiary care centre. All cases of maternal mortality between July 2010 to June 2016 were included in the study. Then data analysis was done.

Results: Out of the total 382 maternal deaths, Majority of maternal deaths 43% were due to type 1 delay. 150 patients had delay in seeking help, 9 patients refused treatment and 5 patients refused admission to health care centre. 13% maternal deaths were due to type 3 delay which include delay in receiving adequate treatment, Delay in diagnosis and intervention, Lack of facilities etc.

Conclusions: Type-1 delay was major contributors of maternal deaths in the study region. Therefore, to prevent the preventable maternal deaths effective action should be taken.


3 delay, Maternal death, Tertiary care centre

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Trends in Maternal Mortality: 1990 to 2013: estimates by WHO, UNICEF, UNFPA, world bank and the united nations population division. Available at: Accessed May 2014.

World Health Organization (WHO). Maternal Mortality. Fact sheet N 348. Updated November 2015. Available at: Accessed 19 September 2019.

Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, world bank group and the united nations population division. Available at: Accessed November 2015.

Mills S, Lewis G, Say L, Mathews M, Okwero P. Maternal Death Audit as a Tool Reducing Maternal Mortality. Health Nutrition and Population Notes. World Bank, Washington DC. Available at: Accessed March 2011.

Smith JC, Hughes JM, Pekow PS, Rochat RW. An assessment of the incidence of maternal mortality in the United States. Am J Pub Health. 1984 Aug;74(8):780-3.

Ronsmans C, Graham WJ, Lancet Maternal Survival Series steering group. Maternal mortality: who, when, where, and why. Lancet. 2006 Sep 30;368(9542):1189-200.

Pathak D, Chakraborty B, Goswami S, Adhikari S. Changing trends of maternal mortality: a comparative study. J Obstet Gynecol India. 2011 Apr 1;61(2):161-5.

Nour NM. An introduction to maternal mortality. Rev Obstetr Gynecol. 2008;1(2):77-81.

Calvello EJ, Skog AP, Tenner AG, Wallis LA. Applying the lessons of maternal mortality reduction to global emergency health. Bulletin World Health Organization. 2015;93:417-23.

Juneja Y, Rai U. A five years review of maternal mortality. J Obstet Gynecol India. 1993;43:944-9.

Joe W, Sharma S, Sharma J, Shanta YM, Ramanathan M, Mishra US, et al. Maternal mortality in India: a review of trends and patterns. Available at: Accessed September 2015.

Sk MI, Chattopadhyay A, Anand A, Naskar TK, Chakraborty S. Analyzing the etiology behind mortality associated with antepartum, intrapartum, and post-partum cases in a tertiary care teaching hospital of West Bengal. J Turk German Gynecol Assoc. 2018 Jun;19(2):65.

Khandale SN, Kedar K. Analysis of maternal mortality: a retrospective study at tertiary care centre. Int J Reprod Contracept Obstet Gynecol. 2017 Mar 30;6(4):1610-3.

Mgawadere F, Unkels R, Kazembe A, van den Broek N. Factors associated with maternal mortality in Malawi: application of the three delays model. BMC pregnancy and childbirth. 2017 Dec;17(1):219.