Understanding maternal mortality: A multifaceted analysis of demographic, temporal, and contextual factors

Abstract Background Maternal mortality remains a significant public health challenge globally, particularly in low- and middle-income countries. Understanding the factors contributing to maternal deaths is crucial for developing effective interventions. This study aimed to comprehensively analyse demographic, temporal, and contextual factors associated with maternal mortality using the three-delay model framework. Methods A retrospective analysis of secondary data from the Pakistan Maternal Mortality Survey 2018–19 was conducted. The data were extracted from the Pakistan Demographic and Health Survey Verbal Autopsy dataset. Descriptive statistics and stratified analyses were performed to assess demographic characteristics, the timing of maternal deaths, and delays in care-seeking behavior. Results The study included 1,177 maternal deaths, with a mean age of 34 years. The majority of deaths occurred in health facilities (93.4%), primarily due to direct obstetric causes such as hemorrhage and sepsis. Delays in decision-making (mean delay: 3.81 days), accessing care (mean delay: 3.74 hours), and receiving treatment (mean delay: 7.58 minutes) were observed. Notably, 56.2% of deaths occurred within 42 days postpartum. The reasons for delays included financial constraints, geographical challenges, and resource limitations. Conclusions Addressing maternal mortality requires a multifaceted approach that targets sociodemographic disparities and healthcare system deficiencies. Efforts should focus on improving access to timely and quality maternal healthcare services, addressing contextual barriers, and strengthening health systems. Tailored interventions based on the Three Delays Model can contribute to reducing maternal mortality and improving maternal health outcomes in low-resource settings.