Role of transport in accessing maternal health services

The 'three delays' model

The ‘three delays’ model, developed by Thaddeus and Maine (1994), is used to identify factors that affect the interval between the onset of obstetric complications and the receipt of appropriate care in Ghana, Nigeria and Sierra Leone.

Thaddeus and Maine examine how these factors cause delays in reaching adequate care and thus contribute to maternal deaths. They specify three consecutive time periods (phases) during which delays can occur. These are: phase one, delay in deciding to seek medical care on the part of the individual or family; phase two, the delay in reaching a health care facility; phase three, the delay in receiving adequate care. Maternal mortality can be a result of all three phases of delay, or any one phase.

Figure 1 shows Thaddeus and Maine's phases of delay, and the factors affecting utilisation and outcome of maternal health services.

Although not directly specified, the transport and mobility of pregnant women are key components contributing to all three phases of delay (Molesworth, 2005). The next section will focus on how transport and mobility impact at each of these phases.

• Phase one: the decision to seek care
• Phase two: identifying and reaching a medical facility
• Phase three: reciept of adequate and appropriate treatment