Beyond the Three Delays: A Policy and Health System Perspective on Maternal Mortality Determinants in Jayapura, Indonesia
DOI:
https://doi.org/10.66168/rf5d0367Keywords:
Maternal mortality, Three delays model, Health system governance, Policy implementation, JayapuraAbstract
Maternal mortality during childbirth remains a critical public health concern in Indonesia, particularly in Eastern regions such as Jayapura, where structural inequalities, geographical barriers, and health system limitations intersect. While the Three Delays Model has been widely used to explain maternal mortality, existing studies often emphasize individual or household-level factors without sufficiently examining broader policy and health system dynamics. This study aims to analyze the determinants of maternal mortality in Jayapura by extending the Three Delays framework through a policy and health system perspective. Using a qualitative descriptive design, data were collected through in-depth interviews, observations of health facilities, and case documentation involving health workers, policymakers, community leaders, and families of patients. Thematic analysis reveals that Delay I is strongly influenced by limited maternal health literacy, cultural decision-making patterns, and financial considerations; Delay II is dominated by transportation constraints, geographical distance, and referral access barriers; while Delay III reflects systemic issues, including shortages of medical personnel, facility readiness, and bureaucratic referral procedures. The findings suggest that maternal mortality is not merely the result of delayed individual decisions but emerges from structural interactions between social context and institutional capacity. This study contributes by repositioning the Three Delays Model beyond behavioral explanations toward a governance-oriented framework, highlighting the need for integrated interventions encompassing community education, transport infrastructure, and health system strengthening.
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