Indian Journal of Public Health Research & Development

Among multiple other factors that cause preventable maternal deaths, the most significant one has been the ‘third delay’ or the delay in gaining access to quality care. If this third delay is reduced, or in other words, the health care service quality of existing facilities is improved, the avoidable maternal mortality would be significantly reduced.

To determine the causes of maternal deaths, and recognize the substandard care factors, being the potential determinants of the third delays in maternal deaths.

This is a descriptive retrospective study that utilized information from public datasets belonging to the Iraqi Ministry of Health (MOH), Baghdad Health Directorates, for a period of five years (from 1st January 2014 to the end of December 2018). Maternal death was classified according to the three delays model, but the research is focused on Type III delays. Therefore the analysis was provided only for the deaths that occurred within the health facilities

A total of 318 maternal deaths were reported during the study period. Maternal Mortality Ratio (MMR) showed an increasing pattern from 24.23/100000 live birth in 2014 to 30.04/100000 live birth in 2018. The mean age of pregnant women died was (30.1 ± 7.4 years) and the mean gravida number was (3.8 ± 2.3). Three quarters (74.5%) of the cases were caused by direct medical reasons while (21.4%) were having indirect medical reasons. Type III delay was the most common delay, and was identified in 71.4% of cases, and was mostly resulted from equipment shortage, limited availability of drugs and other supplies; delay in proper management; and also the incompetence of the care providers in the health care facilities.