By PPH Foundation

Postpartum haemorrhage often becomes fatal not because treatment is unavailable, but because the decision to seek care is delayed. The time taken at home to recognise danger signs and act immediately, known as the first delay, is one of the leading contributors to maternal deaths. When families hesitate, underestimate bleeding, or wait for symptoms to worsen, a preventable condition quickly turns into a life-threatening emergency.

Evidence from multiple maternal death reviews shows that this delay is widespread and deadly. A study analyzing maternal deaths found that over 75 percent of cases involved delays in deciding to seek care, largely due to failure to recognise danger signs and delayed decision-making at household level. Similarly, research from Myanmar reported that 72.9 percent of maternal deaths were linked to the first delay, with postpartum haemorrhage among the leading causes. These findings reinforce that the first decision point, often made within the family, is critical to survival.

Further studies confirm this pattern across settings. Research examining maternal mortality found that up to 43 percent of deaths were directly associated with delays in seeking care, with many women either waiting too long or failing to seek help altogether. Another study reported that 95.5 percent of maternal deaths involved at least one delay, with the first delay being the most common factor. In many of these cases, postpartum haemorrhage was a leading cause of death, highlighting how quickly bleeding can become fatal when action is delayed.

The reasons behind these delays are complex. Studies identify poor awareness of danger signs, cultural beliefs, financial constraints, and lack of birth preparedness as key drivers. In many households, decision-making is not immediate and may depend on multiple people, further slowing response time. Research also shows that low levels of education, lack of antenatal care, and limited exposure to maternal health information significantly increase the likelihood of delayed action.

Dr Kireki Omanwa, Co-Lead of the End PPH Initiative, underscores the urgency of early decision-making: “Postpartum haemorrhage progresses rapidly. The decision to seek care must be immediate. Delays at home, even for a short time, can cost a mother her life.”

Addressing this challenge requires more than clinical solutions. Community education on danger signs, empowering women to make timely health decisions, and involving families in birth preparedness plans are critical interventions. Health systems must also strengthen antenatal counselling to ensure every mother and family understands when and how to seek help.

Ultimately, preventing deaths from postpartum haemorrhage begins long before a woman reaches a health facility. It starts at home, with awareness, preparedness, and the ability to act without delay. The first decision can be the most important one, and it can mean the difference between life and death.

Sources

Thaddeus S, Maine D. Too far to walk, maternal mortality in context, the three delays model. Social Science and Medicine, 1994, 38(8)

Mgawadere F, Unkels R, Kazembe A, van den Broek N. Factors associated with maternal mortality in Malawi, application of the three delays model. BMC Pregnancy and Childbirth, 2017, 17(1)

Oo MM, Liabsuetrakul T, Htay TT. Maternal mortality in Myanmar and the role of the three delays, a hospital-based study. BMC Pregnancy and Childbirth, 2021, 21(1)

Gabrysch S, Campbell OMR. Still too far to walk, literature review of the determinants of delivery service use. BMC Pregnancy and Childbirth, 2009, 9(1)

Berhan Y, Berhan A. A meta-analysis of socio-demographic factors predicting maternal mortality in developing countries. Ethiopian Journal of Health Sciences, 2014, 24(Suppl)

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