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Introduction <p>Maternal Mortality Ratio (MMR) of the state of Assam remained consistently high compared to other Indian states. Critics of three-delay model (DM) argue that utilisation of maternal care and delay in curative care seeking during emergencies are equally important in reducing maternal deaths (MDs). This paper attempts to (i) examine the causes of MDs and (ii) explore the contributing factors of MDs in the state of Assam, India.</p> Methodology <p>We selected 10 peripheral healthcare units from three districts of Assam namely Dhubri, Tinsukia, and Hailakandi, based on the reported obstetric vulnerabilities. We identified 30 MDs from these peripheral healthcare units. The close relatives and/or neighbours of the deceased MDs, the frontline workers (FLWs) and the medical professionals of the catchment areas of the peripheral healthcare units were interviewed about the causes and contributory factors of MDs. We transcribed the interviews and applied thematic analysis of the transcription.</p> Results <p>Haemorrhage, eclampsia, and sepsis were the leading causes of MDs. Low utilisation of maternal care (preventive care), delay in care seeking, reaching and receiving adequate care at a health facility (i.e., three delays in curative care) contribute to MDs. We identified a fourth phase of delay in curative care seeking. Recurrent referrals and logistical burdens at tertiary health facilities lead families to Leave Against Medical Advice (LAMA), resulting in one third of the MDs at home or at a lower-level health facility.</p> Conclusion <p>We recommend strengthening of FLWs, referral continuity and addressing LAMA as measures to reduce MDs.</p>

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A qualitative study on the factors that contribute to maternal deaths in rural Assam

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  • 发表日期：

    2025年9月29日

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  • Shromona Dhara,
  • Arupendra Mozumdar,
  • Subho Roy

摘要

Introduction

Maternal Mortality Ratio (MMR) of the state of Assam remained consistently high compared to other Indian states. Critics of three-delay model (DM) argue that utilisation of maternal care and delay in curative care seeking during emergencies are equally important in reducing maternal deaths (MDs). This paper attempts to (i) examine the causes of MDs and (ii) explore the contributing factors of MDs in the state of Assam, India.

Methodology

We selected 10 peripheral healthcare units from three districts of Assam namely Dhubri, Tinsukia, and Hailakandi, based on the reported obstetric vulnerabilities. We identified 30 MDs from these peripheral healthcare units. The close relatives and/or neighbours of the deceased MDs, the frontline workers (FLWs) and the medical professionals of the catchment areas of the peripheral healthcare units were interviewed about the causes and contributory factors of MDs. We transcribed the interviews and applied thematic analysis of the transcription.

Results

Haemorrhage, eclampsia, and sepsis were the leading causes of MDs. Low utilisation of maternal care (preventive care), delay in care seeking, reaching and receiving adequate care at a health facility (i.e., three delays in curative care) contribute to MDs. We identified a fourth phase of delay in curative care seeking. Recurrent referrals and logistical burdens at tertiary health facilities lead families to Leave Against Medical Advice (LAMA), resulting in one third of the MDs at home or at a lower-level health facility.

Conclusion

We recommend strengthening of FLWs, referral continuity and addressing LAMA as measures to reduce MDs.