Socio-cultural and service delivery dimensions of maternal mortality in rural central India: a qualitative exploration using a human rights lens

Figures & data

Fig. 1 Map of India showing the study area.

Fig. 2 The ‘three delays’ model and lack of elements of a human rights approach to maternal health (59).

Table 1 Profile of deceased women (maternal deaths)

Background characteristics	Number (N=22)
Age (years)
19–26	10
27–34	10
35 and older	2
Education
Illiterate	6
1–5 years	7
6–11 years	9
Caste^a
Scheduled tribe	2
Scheduled caste	9
Others	11
Place of death
Home	1
Health facility	12
En route to health facility	9
Obstetric history
Primiparous	7
Multiparous	15

^aScheduled castes (SCs) and scheduled tribes (STs) are officially recognised by the Government of India as socially and economically backward castes and tribes that are in need of special protection from exploitation and injustice. Other backward class (OBC) is the group of castes that are socially and educationally backward but enjoy higher status than SCs and STs in the caste hierarchy; the government is enjoined to ensure their social and educational development. Any person not belonging to any of these three groups is by default a member of a group classified as a general/forward caste (i.e. having the highest status in the caste hierarchy), and he or she is not eligible for any affirmative discriminatory support by the government.

Table 2 Elements of a human rights approach to maternal health, and factors influencing the delays

Elements of a human rights approach to maternal health	Factors influencing the delays	Delays^a
Availability	– Lack of blood in health care facilities – Unavailability of free transportation – Lack of fuel for Janani Suraksha vehicles	2 and 3
Accessibility (information, economic, physical, and non-discrimination)	– Inaccessibility of information among relatives on the warning signs for obstetric complications – Negative perceptions of families regarding delivery services – Lack of proper information regarding free transportation for institutional deliveries – Gender inequity hindering women's decision-making power	1, 2, and 3
Acceptability	– Negative perceptions of the families regarding delivery services	1
Quality	– Negligence by health staff in providing care – Lack of blood and other emergency obstetric care services – Reluctance of service providers to provide free transportation for referral	1 and 3

^aDelay 1: delay in making the decision to seek care; Delay 2: delay in reaching an appropriate health facility for care; and Delay 3: delay in receiving adequate care after reaching a health facility.

Physicians for Human Rights. Deadly delays: maternal mortality in Peru- a rights based approach to safe motherhood. 2007; Cambridge, MA: Physicians for Human Rights.

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