Promoting safe motherhood: Tackling the three delays

Worldwide, more than 300,000 women die each year due to complications of pregnancy and childbirth mostly from preventable or treatable causes. Sadly, 99% of these deaths occur in developing countries like Uganda. More so, approximately 2 million newborns also die during their first week of life each year, and an additional 2.6 million are stillborn from complications during pregnancy or delivery.

According to the Uganda Demographic and Health Survey of 2016, maternal and neonatal mortality remains high with 336 deaths/per 100,000 live births and 27deaths/1,000 live births respectively. Yet, the Sustainable Development agenda requires reducing the global maternal and neonatal mortality ratios to less than 70 per 100,000 live births and 12 per 1,000 live births respectively by 2030.

Effective interventions exist to prevent the majority of these deaths; however, these interventions are often unavailable or inaccessible in many countries in sub-Saharan Africa like Uganda where the greatest burden lies. Therefore, ending preventable maternal and perinatal deaths while ensuring health and well-being and enabling environments (i.e., survive, thrive, and transform) are the main priorities for the United Nations’ Sustainable Development Goals and Global Strategy for Women’s, Children’s, and Adolescent’s Health (2016–2030).

Although pregnancy complications constitute the diagnosable conditions that lead to maternal deaths, underlying non-medical factors are also important contributors to maternal mortality in developing countries. A large proportion of women die because of the following;

1. delayed recognition of a pregnancy complication and decision to go to a health facility
2. delays in reaching an emergency obstetric care health facility
3. lack of receipt of timely, adequate, and appropriate obstetric care at a health care facility. 

Therefore, strategies designed to reduce the burden of each of these 3 delays that contribute to maternal deaths can help improve maternal and infant survival. The “Three Delays” model is a useful conceptual and practical framework that can help identify where and when maternal deaths occur and the most appropriate actions on the pathway to preventing future maternal and infant deaths

The Ministry of Health Uganda in collaboration with various associations, institutions and implementing partners among others has therefore organized the second edition of the National Safe Motherhood conference, scheduled for 25^th – 28^th October 2022, under the theme “A responsive health workforce for Safe Motherhood”. During the conference, a lot of maternal and newborn issues will be tackled comprehensively. 

Therefore, some of the innovative ways I recommend to tackle the 3 delays contributing to maternal and neonatal morbidity and mortality include; continuous efforts in promoting safe motherhood messages and facility delivery through community engagement and holding mass media campaigns using radios, TVs, media print among others; encouraging birth preparedness and increasing demand for facility delivery through community outreaches by health workers and providing clean delivery kits and transportation vouchers to reduce financial barriers for facility delivery. 

The author is; Lilian Nuwabaine Luyima; BSc Nurse & MSN-Midwife & Women’s’ Health Specialist working with Aga Khan University & is the Heroes in Health Award Winner-Midwife of the year 2021