Beyond the Three Delays: A Case Study of Haiti\u27s Maternal Health Sector

This research seeks to understand how the maternal health sector in Haiti can be understood and perhaps improved through the framework of the Three Delays, developed by Thaddeus and Maine (1994). These delays are (1) the delay in the decision to seek care, (2) the delay in reaching a health facility, and (3) the delay in receiving adequate care at a health facility. The findings of this capstone strongly demonstrated that global health practitioners in Haiti often opt for technical solutions, but in fact there are numerous shadow delays preventing these solutions from taking hold and ameliorating maternal mortality. Tensions between government actors, NGOs, healthcare workers and receivers of care play out in a landscape of imbalanced resources. Efforts lack collaboration and recognition of historical pain felt by Haitians at all levels of society, and NGO stakeholders are frequently oblivious to these dynamics. The research found that Haiti sits at the intersection of global health priorities, local histories of resistance, NGO strategies of community health and public institutional development. Many argue that care should be socialized, subsidized and public, while others admonish the government and advocate for privatized approaches more attuned to local needs. Approaches to maternal mortality must be both collaborative, inside and outside formal institutions, and take a broad view of of the barriers to healthcare and safe birth for women in Haiti, not just in the form of the Three Delays, but in the socio-political histories that dispossess key stakeholders from taking appropriate action