Table 3 Causes of maternal deaths in India

First delay

- Lack of awareness (obstetric risk factors, danger signs, or value of institutional delivery)

- Lack of antenatal care (opportunity to provide information on obstetric risk factors and maternal health care)

- Cost constraints—related to poverty (treatment and indirect costs, travel, perceived affordability, corruption and informal payments at health facilities)

- Social norms considering pregnancy and childbirth as a normal phenomenon

- Gender or women’s low status

- Perceived and/or experienced quality of care

- Fear of cesarean section, surgery, disrespectful behavior, and unfamiliar environment at health facilities

Second delay

- Cost constraints (to arrange money)

- Lack of roads

- Lack of transport, including difficulty in arranging transport at night

- Lack of information (regarding availability of services)

- Geographic location (e.g., tribal settlement in remote areas)

- Difficult terrain (steep hill and water-logged road during rain)

- Referral(s)

Third delay

- Non-availability of services (designated obstetric services at different levels of health system, abortion, and postnatal care)

- Lack of health professionals, including lack of competency or skills among health professionals

- Lack of drugs and supplies, including blood

- Cost constraints (to pay for drugs, blood, and treatment)