Background: Existing evidence suggests that in any population, 10 – 15% percent of pregnant

women will develop life-threatening obstetric conditions during childbirth. More than seventy
percent of maternal deaths are due to the direct obstetric complications occurring during
pregnancy, child birth and postpartum periods. Maternal delay in utilization of emergency obstetric
care is one of the contributing factors for high maternal mortality. Maternal delays are described
as having three levels: delay in making decision to seek care, delay in arrival at a health facility,
and delay in receiving adequate treatment. South western part of Uganda, constituted in part by
Mitooma distinct has one of highest maternal mortality occurring between 23 - 48 hours after
delivery due to Post-Partum Hemorrhage (PPH) and hypertensive disorders (pre-eclampsia and
eclampsia) and 48 hours after delivery due to infection/sepsis.

Objective: To determine the level and factors associated with delay in emergency obstetric care
services among mothers in Mitooma district, Uganda.

Methods: An Institutional based cross sectional design was adopted. The study population were
women who had had maternal complications - such as prolonged and/or obstructed labour,
excessive bleeding, pregnancy-induced hypertension, pre-eclampsia, eclampsia, puerperal
pyrexia, malposition, retained placenta and had sought or had been referred to any health facility
in Mitooma for EmOC services. Simple random sampling was used to select the health facilities
to be included in the study sample. A non-probabilistic sampling method was used to sample the
mothers; this was non proportional quota sampling. The researcher used structured interviews to
collect the quantitative data. In this study, the quantitative data was collected using structured
questionnaires. Data collected was analyzed using SPSS Version 22.0.

Results: The majority mentioned that it took them more than an hour to 271(70.6%).to identify
and reach the health center they were found receiving emergency obstetric care services from.

On grounds of geography / physical access, mothers who took to less than 30 minutes to reach the
nearest health facility which provides maternal health services in the area were twice more likely
not to delay in identifying and reaching a medical facility for emergency obstetric care among
mothers in Mitooma district (AOR = 2.362, CI = 1.064 - 3.046). Mothers who described the nature
and state of roads in the area as Good – passable even when it rains had higher chances of not
delaying to reach a facility (AOR = 1.804, CI = 0.267 - 6.473), and so were those who had a means
of transport (AOR = 1.056, CI = 0.329 - 3.387). Mothers who spent no money on travel to the
health center providing maternal health services in the area were 1.9 times higher chances of not
delaying compared to those who spent money on travel (AOR = 1.911, CI = 0.420 - 6.939).

Mothers who were of parity one (AOR = 1.363, CI = 0.041 - 3.184), Primi gravidas (AOR = 2.495,
CI = 1.458 - 1.552), Mothers who had a history of complications (AOR = 1.427, CI = 0.198 -
1.922), mothers who had a history of a still birth (AOR = 3.315, CI = 1.095 - 4.047) and mother
who had attended one and two ANC visits (AOR = 1.4), had higher chances of not delaying to
identify and reach a facility.

At spousal level, mothers whose spouses were aged between 18 - 24 years had higher chances of
not delaying to identify and reach a medical facility for emergency obstetric care (AOR = 1.122,
CI = 0.705 - 2.703). Mothers whose spouses had lower education levels actually had higher odds
of not delaying to identify and reach a medical facility (AOR = 4.252, CI = 1.410 - 24.090). In
relationships where the spouses let their wives make the decision on reproductive health, mothers
had higher chances of not delaying to identify and reach a medical facility for emergency obstetric
care (AOR = 1.071, CI = 0.288 - 3.985). Mothers who had an excellent level of communication
with their spouses (AOR = 2.708, CI = 1.398 - 18.401), supportive husbands both financially and
otherwise (AOR = 3.333, CI = 1.802 - 5.802) and those who were escorted to the health center
during pregnancy (AOR = 2.656, CI = 1.356 - 7.209) were more likely not to delay.

Conclusion: The second delay (to identify and reach a health facility providing EmOC services)
is a reality among mothers in Mitooma district; the majority reaches the health centers in need for
EmOC services after more than an hour of obstetric complications setting in. In order of strength
of influence, the second delay in Mitooma district significantly influenced by spousal factors,
obstetric and then geographical / physical access factors