Identifying and reaching a medical facility

The distance to a health facility is an actual obstacle that prevents women from reaching health facilities as well as a factor influencing the decision to seek care. In many developing countries, facilities are not evenly distributed, with most located in urban areas ( Thaddeus and Maine, 1994). In rural Cambodia, Riddell (2006) shows how it can take up to a day for a patient, relative, or member of the community to reach a health centre before the woman can be transported to the appropriate facility. In this example, the fees for the ambulance cost Riel 30 000 (US$7.50) for one trip.

In rural areas, not only are there fewer facilities, necessitating women to travel further to reach them, but women are also more likely to experience problems arising from scarcity of transportation. In Masvingo, a rural area of Zimbabwe, lack of access to transport accounted for 28 per cent of maternal deaths compared to three per cent in urban areas (Fawcus 1996).

The unavailability of public transportation or prohibitive cost of transport means that many women have to walk or improvise a way to reach health care. A study in Nepal found that the most common means of reaching a health facility was on foot (67 per cent) followed by stretcher (18 per cent), bus and taxi (15 per cent), these figures account for both emergency and non-emergency transport (Borghi et al, 2004). Where traditional means are used, such as stretchers, on the backs of animals or other people, or transport by horse or donkey cart, the way that patients are positioned for travel can cause complications (M'Cormack, 2006). The patient’s condition may deteriorate on the way which makes treatment more difficult, provided the patient is still alive upon arrival (Molesworth, 2005).

Even when appropriate transport is available women may not use it. Shresthova et al, in 'Balancing the Load' (2002) conducted a study of personal and professional transport use among a women’s trade unions association in India. The research reveals that women participating in the study were less likely to hire a rickshaw in cases of personal health emergencies (8 per cent) than for other family members (14 per cent), which illustrates that even where intermediate forms of transport are available to access emergency health services, even better-off professional women are less likely than other family members to use them.

Geographical barriers such as mountainous terrain or poor road conditions also delay access to maternal health care. In Haiti road conditions and geography constrain access to both prenatal care and delivery care for women living in rural areas (Guttmacher Institute, 2007). Poor quality of roads affects travel time, makes it difficult for some modes of transport to pass and can lead to an increase in transport prices (Babinard and Roberts, 2006). Borghi et al (2004) found that the average time it took women to travel to a health facility for delivery in Nepal was 2.8 hours, increasing significantly in the more mountainous regions.