Maternal Health and the Three Delays Model in rural Guatemala - Examining Factors Affecting Maternal Health-Seeking Behaviours and Health Service Utilisation in Quiché

Sammanfattning: Objectives. Guatemala exhibits disastrous maternal and child health outcomes, with the rural, indigenous populations disproportionately impacted by high maternal mortality, chronic malnutrition, and low skilled birth attendance. This study investigates maternal care in rural Guatemala through Thaddeus and Maine’s Three Delays Model (1994) to understand delays to maternal health-seeking behaviours and health service utilisation as a function of socioeconomic and cultural factors, accessibility to healthcare services, and the quality of healthcare facilities in the context of Quiché, Guatemala. This approach offers a comprehensive analysis of the limitations in maternal care provision. Methods. A mixed-methods case study investigation applied the Three Delays Model. Surveys were conducted with 450 mothers and pregnant women, in-depth interviews with 34 biomedical health workers in 10 nearby health facilities held, and ethnographic observational findings collected. Principal Findings. Any solution tackling issues facing Guatemalan maternal care needs to address factors affecting all phases of delay simultaneously for any hope of effective improvements. The thesis’ most actionable insights concern four Phase III flaws: health facility infrastructure; medication distribution and supply; supervision; and, staffing, capacity, and training. An extension of the Three Delays Model is also proposed to be explored, to include delays in identifying the need to seek care.