The Social and Cultural Factors of Maternal Mortality in the Context of Three Delays: The perspective of Lady Health Workers of South Punjab, Pakistan.


Byline: Sonia Omer


Maternal mortality is a pressing issue and high maternal deaths is the matter of concern for many nations of the world. Globally, nearly 303000 maternal deaths cases are reported and among these almost 99 percent are found in developing countries (Organization 2015). While defining maternal mortality " It is a death of women while pregnant within 42 days of termination of pregnancy irrespective of duration and the site of pregnancy from any cause related to or aggravated by the pregnancy or its management but not from incidental or any accidental causes,"(Organization 2004b)

In developing world, the mothers have high death ratios during pregnancy due to number of reasons like hemorrhage, hypertensive disorder of pregnancy anemia, unsafe abortions or obstructed labor. The significant fact is all these complications are preventable and can be treated at health care centers in an effective manner (Aftab Mazhar Tabassum, Bhutta, and Tajjamul 2014). It is maternal mortality that can portray the true picture of status of women in any country as it is a complex indicator of status of women everywhere (Liljestrand and Sambath 2012). What really bothers policy makers that deaths of women in pregnancy or its related issues are due to certain causes which are highly preventable (Backman et al 2008).

According to latest data received from world CIA fact book, Pakistan stands at 53 out of 181 counties in highest maternal mortality rate after Afghanistan in South Asian region. The maternal mortality rate in Pakistan is 178 deaths/100,000 live births (CIA 2018). The health care system in Pakistan does not reveal a very positive picture. Efforts have been made to address health issues by introducing different policies in the past including the lady health worker program. This program aimed to train women to serve as health providers at community level across the country. The lady health worker render services to communities, most specifically related to mother and child survival. This eventually help women, particularly of rural side to obtain vital information about maternal care and to make plans on their reproductive life as per their wish and desire. (Kabeer 2001).

The present study designed to know the views of lady health workers on socio and cultural factors of maternal mortality in the light of three delays model. The researcher intended to know of those factors which are the actual barriers for rural women in seeking a maternal care, reaching to health care and receiving an adequate service from health centers. The three delay model of maternal mortality by Maine and Thaddeus (1994) has been of great significance to understand maternal deaths beyond the visible biomedical reasons (Maine and Thaddeus 1994). These delay emphasizes that maternal mortality is not only because lack of economic and human resource but significant social, economic and cultural factors, accessibility and approach to quality of care are numerous interwoven factors.


The present study has used the qualitative design to investigate the social phenomenon of maternal deaths. The researcher selected Dera ghazi khan division on the basis of low socio economic and maternal health indicators revealed in multiple indicator cluster survey report of Punjab 2017-18. Focus group discussion (FGD) was used as a tool of data collection and four (FGDs) were conducted from all four districts of Dera Ghazi khan division including Tonsa ,Layyah , Rajunpur and Dera Ghazi Khan itself. For selection of LHWs, the list of LHWs working in each district was obtained from the health department of each district and seven lady health workers were randomly selected for each district of South Punjab. All The focus group discussions were conducted at the each district hospital with the facilitation of in charge District head quarter hospital (DHQ).

After analyzing each of the contribution received from the focus group discussion participant, the researcher proceeded towards the themes emerged from FGD, according to the reality expressed by the focus group discussion participant. The data was analyzed through thematic analysis. Thematic analysis allows the researcher flexibility with a well-defined explanation of what is it and how it is carried out. The author in this paper had tried to incorporate individual experiences, however influence of broader social context was also considered. (Braun and Clarke 2006).


Delay One: Seeking Care

This delay is about seeking maternal care. Studies from developing countries revealed that that 70 to 80 percent of the maternal deaths are taking place because of this first...

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