Maternal mortality in Jordan: role of substandard care and delays.

Understanding the factors that operate during pregnancy, delivery and postpartum is the key to success in the prevention of maternal mortality. This cross-sectional survey in Jordan for the years 2007-2008 aimed to identify the role of substandard care and delays in maternal deaths. All maternal deaths among women aged 15-49 years over this period (n = 76) were investigated retrospectively through file review and household interviews in all hospitals (n = 102) and forensic medicine departments in Jordan; elements of substandard care and delays at hospital, home and transport levels were evaluated. Substandard care accounted for 52.6% of deaths, delay in seeking care 55.3%, delay in transport 15.8% and delay in hospital care 17.1%. Women who did not recognize the danger signs of pregnancy (OR 6.32), refused medical advice to terminate the pregnancy (OR 1.78) or at a gestational age > 37 weeks (OR 1.85) were significantly more likely to delay seeking care, as were those with larger mean family size.