Maternal Mortality in Eastern Zambia: Accessing Healthcare for Delivery and Obstetric Emergencies

Abstract

Improving maternal health and survival remains the most elusive of the Millennium Development Goals and the global disparities in maternal mortality are vast, with lifetime risks still in excess of 1 in 10 throughout much of sub-Saharan Africa. The ‘three delays model’, developed by Thaddeus and Maine (1994), identifies delays in recognising need for care, reaching a care facility and receiving care at the facility as crucial obstacles to improving maternal health outcomes. A new motorcycle ambulance-trailer transport intervention being introduced in Eastern Zambia seeks to address the second delay by improving access to emergency obstetric facilities and clinics. However, interventions do not always translate into improved outcomes, since healthcare decision-making is a complex process drawing on multiple factors and perspectives. This paper reports on an anthropological study conducted in six villages in the Lundazi District, Zambia, with the aim of situating the intervention within a framework of current attitudes towards transport and use of transport, health-seeking decision-making processes and practices and barriers to service use. Based on in-depth interviews and focus groups with women of reproductive age and their families, combined with participant observation, this paper demonstrates that while poor transport is an important barrier, taking into account the economic and socio-cultural context is also crucial to improved maternal health. This underlines the importance of detailed qualitative research before project implementation and the benefits of inter-disciplinary collaboration between engineering and social sciences in improving health in the Global South