TITLE:
Health-System Failures and Maternal Deaths in Pakistan: Testing the Three Delays Model Using PMMS Data
AUTHORS:
Rizwana Timsal
KEYWORDS:
Maternal Mortality, Health-System Failures, Three Delays Model, Pakistan, Maternal Health Services
JOURNAL NAME:
Open Journal of Social Sciences,
Vol.14 No.4,
April
29,
2026
ABSTRACT: Maternal mortality remains a persistent public health challenge in Pakistan, reflecting systemic health-service deficiencies. This study investigates the role of health-system failures in maternal deaths using the Three Delays Model and nationally representative data from the Pakistan Maternal Mortality Survey (PMMS) 2019. A total of 19,899 women of reproductive age were analyzed, with maternal death as the primary outcome variable. Key health-system variables included skilled birth attendance, antenatal care visits, place of delivery, and distance to healthcare facilities. Descriptive statistics summarized demographic, socioeconomic, and health-service characteristics, while binary logistic regression assessed the independent effects of health-system factors on maternal mortality, controlling for socioeconomic and demographic covariates. Findings indicate that delays in reaching healthcare facilities and receiving timely, adequate care at health facilities significantly increased the risk of maternal death. Maternal deaths were more prevalent among women delivering at home, lacking skilled birth attendance, attending fewer than four antenatal visits, or residing in rural and underserved regions. Logistic regression confirmed that health-system variables remained strong predictors of maternal mortality after adjusting for socioeconomic disparities. The study highlights that improving maternal survival in Pakistan requires strengthening health-system readiness, emergency obstetric care, referral mechanisms, and the quality of service delivery, particularly in rural and low-resource settings. These findings provide evidence-based insights to guide health policy, resource allocation, and interventions aimed at reducing preventable maternal deaths and achieving Sustainable Development Goal 3.1.