PURPOSE: This article examines maternal mortality in Uganda through the “Three Delays” framework. This framework asserts that maternal mortality in developing countries results from three delays to accessing appropriate health care: (a) the delay in making a timely decision to seek medical assistance, (b) the delay in reaching a health facility, and (c) the delay in provision of adequate care at a health facility.

STUDY DESIGN: This study provides a review and synthesis of literature published about maternal mortality, the “Three Delays” concept, Uganda, and sub-Saharan Africa between 1995 and 2010.

MAJOR FINDINGS: The “Three Delays” framework has relevance in the Ugandan context. This framework allows for an integrated and critical analysis of the interactions between cultural factors that contribute to the first delay and inadequate emergency obstetrical care related to the third delay.

MAJOR CONCLUSION: In order to reduce maternal mortality in Uganda, governments and institutions must become responsive to the cultural and health needs of women and their families. Initiatives that increase educational and financial status of women, antenatal care, and rates of institutional care may reduce maternal mortality in the long term. Improvements to emergency obstetrical services are likely to have the most significant impact in the short term.

This article reviews the implications of disrespect and abuse in maternal health services, the growing movement to humanize childbirth and promote cultural humility, and one strategy to build an online course to address this issue among maternal health workers in Mexico. Reports of disrespect and abuse have been widely reported by women seeking health services, including maternity care, across the globe. Evidence indicates offenders are often health care professionals who do not consider their behavior inappropriate and believe they are acting in the interests of both mother and baby. These same providers are often overworked, underpaid, and have few role models who humanize childbirth and demonstrate cultural humility. Strategies which aim to foster competencies in humanized childbirth and cultural humility among health providers are lacking in current health professional training programs. Using the case of Mexico, the authors describe the template and justification for an online course for novice to expert health professionals to build competencies in humanized childbirth and cultural humility. Recommendations for future work are discussed.

India has large inequalities in maternal health and high maternal mortality and morbidity rates. A social model of maternal health was used as a framework for a broad review of online published literature to appraise the approaches used by India to address these issues and to examine the potential for reducing the country’s maternal health inequalities.

The review found the following:

• An apparent lack of coordinated economic, social, and health strategy and policies focused on improving maternal health

• No acknowledgment in national health policy of the limitations of the medical model of maternal health and little apparent mention of the social model

• No evident national frameworks for quality assurance in maternity care

• Lack of recognition of the importance of woman-centered care

• No evident comprehensive maternal health needs assessment to underpin coordinated multisector working

• An apparent lack of reliable national data collection for setting inequality targets and monitoring progress

• No apparent performance-focused management system for improving maternity care nationally.

Although India has made large increases in maternal health care provision over recent decades, a pragmatic review of government policies, the reports of international agencies, and the findings of published research studies indicate that major barriers exist to reducing maternal health inequalities and to achieving good quality care for disadvantaged women. The main barrier appears to be the widespread use at all levels, including government, of the medical model of maternal health, which focuses mostly on obstetric interventions and fails to address the wider economic and social determinants of maternal health or to use a woman-centered approach to maternity care.

We recommend that Indian governments adopt instead a “social model” approach to maternal health improvement and urgently employ a public health strategy led by a national multisector task force to reduce inequalities in maternal health.