Difficulties leaving home: A cross-sectional study of delays in seeking emergency obstetric care in Herat, Afghanistan

This study used an analytical cross-sectional design to identify risk factors associated with delays in care-seeking among women admitted in life-threatening conditions to a maternity hospital in Herat, Afghanistan, from February 2007 to January 2008. Disease-specific criteria of ‘near-miss’ were used to identify women in life-threatening conditions. Among 472 eligible women and their husbands, 411 paired interviews were conducted, and information on socio-demographic factors; the woman’s status and social resources; the husband’s social networks; health care accessibility and utilisation; care-seeking costs; and community characteristics were obtained. Decision and departure delays were assessed quantitatively from reported timings of symptom recognition, care-seeking decision, and departure for health facilities. Censored normal regression analyses suggest that although determinants of decision delay were influenced by the nature and symptoms of complications, uptake of antenatal care (ANC) and the birth plan reduced decision delay at the time of the obstetric emergency. Access to care and social networks reduced departure delay. Programmatic efforts may be directed towards exploiting the roles of ANC and social resources in facilitating access to emergency obstetric care.

► Analyzes care-seeking delays among women in life-threatening conditions admitted to a maternity hospital in Afghanistan.
► Stratifies care-seeking durations by exposure to risk factors and examines the interactions with illness characteristics.
► Identifies antenatal care and the planning of a facility-based birth as factors associated with prompt care-seeking.
► Discusses how improving women’s social resources may help them obtain emergency obstetric care more quickly.
► Suggests introducing a financial mechanism to help residents in remote areas access obstetric facilities.