Factors associated with maternal delays in utilising emergency obstetric care in Arsi Zone, Ethiopia

Background. Delay to timely healthcare contributes to high maternal mortality and morbidity in developing countries. The so-called 'Three delays' model has been used extensively to investigate factors relating to maternal mortality. Objective. To investigate factors associated with delayed emergency obstetric care in Arsi Zone, Ethiopia. Methods. A cross-sectional study was conducted across 10 public health facilities in Arsi Zone, Ethiopia. The required sample size was calculated as 847, with the number of participants required at each facility determined proportionally. Results. Data from 775 respondents were used in the analysis. Approximately a quarter of respondents (n=203; 26.2%) reported a delayed decision to seek emergency obstetric care. The mean time for delay was 90 minutes (range 30 minutes - 18 hours). Maternal age, educational level, monthly household income and antenatal visits were significant predictors of this first maternal delay. Close to a third of the respondents (n=234; 30.2%) reported a transport-related delay in reaching a healthcare facility; some respondents walked at least 30 minutes to reach the facility. Approximately a quarter of respondents (n=198; 25.5%) reported that they did not receive timely care after arriving at the healthcare facility. The mean delay was 42.3 minutes. Conclusion. The most common delay was related to difficulty in reaching the healthcare facility. In approximately half of the cases, the woman's husband took the decision to access medical care. This suggests limited independent decision-making power of women in this context. Such factors should be considered in efforts to reduce maternal morbidity and mortality.