The Three Delays Model and our Integrated Approach

Maternity Worldwide uses an integrated approach to address each of the issues women face when trying to access safe childbirth. This is based on the Three Delays Model* which identifies three groups of factors which may stop women and girls accessing the maternal health care they need:

1: Delay in decision to seek care due to;

  • The low status of women
  • Poor understanding of complications and risk factors in pregnancy and when to seek medical help
  • Previous poor experience of health care
  • Acceptance of maternal death
  • Financial implications
Hosp bed

2: Delay in reaching care due to;

  • Distance to health centres and hospitals
  • Availability of and cost of transportation
  • Poor roads and infrastructure
  • Geography e.g. mountainous terrain, rivers
Access to Kiryabutuzi

3: Delay in receiving adequate health care due to;

  • Poor facilities and lack of medical supplies
  • Inadequately trained and poorly motivated medical staff
  • Inadequate referral systems

How we use the Three Delays Model

When we begin work in a new area or country we carry out a detailed needs assessment to identify which of these delays are effecting women accessing safe maternal healthcare.  Our programmes are tailored the specific needs of the area where we are working.  In general we address the issues identified by the Three Delays Model by;

1: Delay in decision to seek care

Provide communities (men and women) with information on pregnancy, childbirth and newborn healthcare so they know when to seek medical help. Facilitate income generation schemes for women to enable them to become financially independent and empowered to make decisions about their own sexual and reproductive health and to become future leaders.

eRanger motorbike - Ethiopia 20122: Delay in reaching care

Improving access to healthcare with the provision of health centres in rural and remote areas as well as outreach healthcare workers visiting villages to provide care.  We build waiting houses next to health centres for expectant mothers to stay in before their due date so when they go into labour assistance is on site.  Provision of motorbike ambulances for mountainous terrain to improve access to health centres.

HSAs during CBMNH training3: Delay in receiving adequate health care

Training local midwives who will remain in rural areas when qualified, training nurses, doctors and healthcare professionals to provide safe births now and for future generations. Ensuring health centres are suitably equipped to provide safe deliveries and improving referral systems between health centres and hospitals.


Demand Side and Supply Side interventions

As part of our Integrated Approach to Maternal Health we address the demand side and supply side interventions.  If services are available but communities are not empowered to access them it will only increase health inequalities. If communities are empowered but there are no facilities there will be no impact. An Integrated Approach makes the biggest, sustainable difference to maternal health.

Demand Side and Supply Side Intervention

*Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med 1994; 38: 1091-1110