Delaying factors influencing the maternal health care disparities in developing countries: A scoping review

Abstract

Maternal mortality is a critically significant issue in developing countries, where the lifetime risk for a woman in pregnancy or childbirth is approximately one in six. This elevated risk is often linked to delays in accessing and utilizing maternal health care services. Therefore, the study aims to provide a comprehensive understanding of the delaying factors influencing the maternal health care disparities in developing countries using Thaddeus and Maine's Three Delays Model. Researchers searched Science Direct, Pub Med, Pub Med Central, Embase, Medline, Simantic Scholar and Scopus to extract 69 case study articles published between 2015 and 2023 for this scoping review. The search reveals that among the three primary delay factors (Delay 1- patient, Delay 2- en-route or geographical, and Delay 3- service factors), patient-related factors contribute most to adverse outcomes across Asia, which is often deeply rooted in socio-economic and cultural discrepancy. All three delays significantly hinder maternal health care access in Africa with Delay 2 remaining a persistent challenge. Along with en-route causalities and security risks, many African countries face an acute shortage of emergency obstetric care infrastructure. While, increasing awareness and addressing cultural barriers are essential for achieving better health outcomes across Asia, expanding free maternal health care policies, reducing indirect costs and improving community engagement found to be more significant for African regions. In Latin American countries, Delay 3 is the primary challenge, driven by persistent disparities in health care quality, understaffing, and inconsistent service delivery. The study therefore concludes that bringing structural changes is utmost necessary by framing policies from grass root level understanding to reduce the prevailing maternal health care disparities in developing part of the world.

Keywords: Developing countries; maternal mortality; scoping review; three delays model.