Why so late? Distant health facility, woman’s low status, or man’s lack of resources? A study of women with life-threatening obstetric complications (near-miss) at admission in a maternity hospital in Afghanistan

Atsumi Hirose, London School of Hygiene and Tropical Medicine (LSHTM)
Veronique Filippi, London School of Hygiene and Tropical Medicine (LSHTM)

We conducted a cross-sectional survey among women admitted to the maternity ward of Herat Regional Hospital in Afghanistan in near-miss conditions between February 2007 and January 2008, and interviewed 424 women and 440 husbands. Though all women were in life-threatening conditions at admission and therefore experienced some ‘delays’, we postulated that their experiences vary according to woman’s characteristics, family’s social and financial resources, and healthcare accessibility. Data including GIS-modelled travel times are entered into regression models, and factors prolonging durations of the 1st and 2nd delays are identified and the association between delays and neonatal survival explored controlling for confounders. Early findings indicate that different sets of factors influence the durations of the 1st and 2nd delays. The paper will explore how barriers to access can be dealt with and maternal and neonatal survival improved, in the context of high MMR, low woman’s status and difficult access to healthcare.