Three Delays Model and its Determinants for Maternal Death: A Descriptive Cross- Sectional Study

Background: Despite significant improvements in reducing maternal mortality in Nepal, preventable deaths persist due to gaps in timely care-seeking, access, and service delivery. The ‘Three Delays Model’ offers a framework to examine delays contributing to maternal mortality and guide targeted interventions. This study was done to analyze the types of delays and determinants contributing to these maternal deaths. Methods: A retrospective cohort study of maternal deaths was conducted Patan Hospital, Nepal, from July 2021 to July 2024. Data were extracted from hospital records and maternal mortality audit reports. The ‘Three Delays Model’ was applied to categorize barriers: delay 1-decision to seek care, delay 2-reaching care, and delay 3-receiving adequate care. Descriptive analysis was performed using Microsoft Excel. Results: This study identified 16 maternal deaths over three years, with highest mortality among primigravida women in late pregnancy and postpartum periods. Indirect causes were predominant than direct obstetric causes. Dealy in seeking health care was the predominant followed by the delay in receiving care. Discussion: The main determinants of the Delay 1 were poor health literacy, cultural norms, and institutional mistrust. Comparative evidence from Nepal and other low-resource settings highlighted overlapping delays and facility-level gaps that compounded the risk. In order to reduce preventable maternal deaths, culturally responsive health education, improved community engagement, and strengthened hospital facilities may be helpful. Conclusion: Maternal deaths in Nepal remain influenced by behavioral and systemic factors, with Delay 1 as the most prevalent underlying cause followed by Delay 3.