Child and Maternal Mortality
in Islamic Countries
8
Maine (1992) 22 considered socioeconomic and cultural factors as the distal
determinants and four key proximate determinants for maternal mortality: health
status, reproductive status, access to health services, and health care behavior/use of
health services.
● Thaddeus and Maine (1994) proposed the "Three Delays" model23 , which suggests that
pregnancy-related mortality is predominantly due to delays in: (1) deciding to seek
appropriate medical help for an obstetric emergency; (2) reaching a health facility for
emergency obstetric care; and (3) receiving timely and adequate care when a facility is
reached. The delay in decision to seek care is primarily due to low status of women; lack
of knowledge of maternal complications and risk factors in pregnancy and when to seek
medical care; lack of women empowerment; and financial hardship. The delay in
reaching a health facility for care is primarily due to distance to health centers and
hospitals, lack of transportation, poor road infrastructure, and geographical
location/terrain. The delay in receiving adequate health care is primarily due to poor
quality of care, lack of medical supplies and blood transfusion, lack of service providers,
and poor referral services.
● In recent years, researchers have emphasized on “continuum of care” and addressing
neonatal and maternal health care interventions with women’s life-cycle approach.6,24
An example is illustrated below:6
Figure 1.1: Interventions in reproductive, maternal, newborn, child health continuum of care
Source: Bhutta, Z A, S Cabral, C W Chan, and W J Keenan. 2012. “Reducing Maternal, Newborn, and Infant
Mortality Globally: An Integrated Action Agenda.” Int J Gynaecol Obstet 119 Suppl: S13-7.