At Maternity Worldwide we recognise the complexity and interlinking nature of the many different factors which can prevent women and girls from being able to access high quality maternal and family planning care. Our integrated maternal health approach draws on the Three Delays Model* which recognises the different barriers women face in achieving the timely and effective medical care needed to prevent deaths occurring in pregnancy and childbirth.
The model identifies three groups of factors which may stop women and girls accessing the levels of maternal health care which they need:
Phase 1: 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
Phase 2: 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
How We Use the Three Delays Model
Maternity Worldwide has a rigorous needs assessment framework based on the Three Delays Model. When we begin work in a new area or country we use this framework to identify which of these factors are impacting on maternal mortality and maternal health.
Depending on local circumstances our approach will include several of the following elements:
- Providing women with the opportunity to set up their own businesses, enabling them to increase their financial independence and their status in the community.
- Facilitating delivery of health promotion information in the community so that women and their partners can identify warning signs for when they need to access different levels of maternal health services. We provide family planning information so women can better space their pregnancies and have control over the number of children they have.
- Assessing transport issues and developing effective methods of ensuring that women can reach the level of care they need to enable them to give birth safely.
- Training doctors, nurses and midwives so that they can provide high quality, skilled maternal health care in the community.
- Providing support to upgrade health centre buildings and, where needed, medical equipment and medicines.
We then work with local partners to develop and implement an effective and sustainable programme of activities to address the barriers to accessing maternal health care. We use this as the basis for the implementation of our integrated maternal health approach and for measuring the success of our work.
Our work empowers women so that they can exercise their own choices and enables them to access the services they need to give birth safely
The emphasis of all our work is on engaging in genuine and lasting partnerships with local communities to provide high quality and sustainable maternal health services which are universally and easily accessible. Community involvement and engagement is central to our work. Maternity Worldwide is a secular organisation and so has no religious affiliations. We recognise that faith based organisations often play a leading role in providing health services particularly in the very poorest regions. We are happy to work alongside any partners who share our values and vision.
For all of our projects we begin by involving local communities and particularly seeking the views of the women and girls who will be using the maternal health services. We work closely with key stakeholders who may include local and central government, other charities and aid providers working in the locality (including, faith based organisations) and other decision makers. From the beginning we engage key partners through establishing an overall Steering Group to oversee the work and additional working groups for specific activities e.g. Women’s Income Generation Groups. This helps to increase the capacity and skills of local partners so they can take over management of activities and ensure sustainability of the work so that the lives of women and girls continue to be saved.
*Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med 1994; 38: 1091-1110