Barriers in Accessing Emergency Obstetric Service: A Prospective Observational Study at a Tertiary Care Centre

Abstract

Introduction: Despite a drastic reduction in maternal mortality rate, India still contributes to 12% of global maternal deaths. Multiple factors influence access to quality emergency obstetric care that is timely, effective, efficient, equitable, evidence, and client-centric. The present study was carried out to determine the factors influencing access to emergency services by obstetric patients using the Three Delay Model. Methods: This was a prospective, observational, single-center study conducted in the Department of Obstetrics and Gynaecology at a tertiary care hospital from June 1st, 2021 to 31st July 2021. All Pregnant and Postpartum patients admitted from the emergency room were included. A predesigned proforma was used to record the reasons for the delay in receiving emergency care at the time of admission. Results: More than three-fourths of women (75.64%) had a delay of more than four hours from the onset of symptoms to the arrival at the emergency room. Out of these, the majority had Level 1 delay, i.e., there was a delay in deciding to seek care, most commonly due to unawareness of danger signs. The most common reason for level 2 delay, i.e., delay in reaching the facility was the refusal of admission/care at a center visited before reaching our facility. Conclusion: Three-delay model is an effective bottleneck assessment tool for understanding the reasons for delay in receiving emergency obstetric care. For minimizing level 1 delays, strengthening patient education and counseling in the antenatal clinics and engagement of family members in the counseling about the danger signals is important.