Table A5.

Studies proposing other changes (N = 3).

					Factors determining the delays
No	Author (ref) Year of publication	Country	Type of study Sample population	Method of data collection Key informants	1st Delay	2nd Delay	3rd Delay	Other changes
1	Castro et al., 2000 To seek a comprehensive knowledge of the characteristics of maternal mortality in this setting, and identify factors that can be modified through concrete interventions	Mexico 3 states: Queretaro, San Luis Potosi, Guerrero urban	Qualitative study 145 maternal deaths	Verbal autopsy with open ended questions Relatives: mother, sister, acquaintance, husband	Illness factor (not actions from women despite presence of danger signs) Women’s status (required partner approval before seeking care) Perceived accessibility (cost for transport, service and medicine) Perceived quality of care (previous negative experience) Beliefs (women’s needs to ensure complications, interpretation of sign and symptoms through a non-medical paradigm addressed via local remedies) Domestic violence	Distance (remoteness, marginality) Lack of means of transport Prolonged transportation time Seeking care at more than 2 facilities	Poorly staffed facilities (lack of staff, limited competencies and training) Inadequate management (incorrect management, early withdraw medications) Long waiting despite serious complications	Classification of factors contributing to the delays into: Subjective Interactional StructuralThese are used to formulate solutions
2	Gabrysch and Campbell, 2009 Explore the scope of determinants of skilled birth attendance, including preventive care seeking for delivery in LMICs.	Multiple countries	Literature review 2 reviews 80 original studies		Socio-cultural factors (maternal age, marital status, ethnicity, religion, traditional beliefs, family composition, mother’s education, women’s autonomy) Perceived need of care (information availability, health knowledge, pregnancy wanted, perceived quality of care, ANC use, previous facility delivery, birth order, complications) Economic accessibility (mother’s occupation, Husband’s occupation, ability to pay) Physical accessibility (region – urban/rural, distance, transport, roads) Perceived quality of care	Economic accessibility (mother’s occupation, Husband’s occupation, ability to pay) Physical accessibility (region – urban/rural, distance, transport, roads)	Quality of care (preventive or emergency)	Distinguish between quality of emergency care from quality of preventive care
3	Sorensen et al., 2011 To analyse the main dynamics and conflicts in attending and providing good quality delivery care in a rural setting in Tanzania	Tanzania Kagera region, nortwest, rural	Qualitative study 31 mothers 32 relatives 19 healthcare providers	Semi-structured interviews and Questionnaire Women, relatives, TBAs	Women’s status (decision-making by husband) Perceived quality of care (perceived incapability of local facilities to manage birth complications, home birth preferred because of closeness to family support) Tradition (trust in TBA to be safe) Fail to follow healthcare providers’ advices due to ignorance and culture	Distance Lack of means of transport Cost for transport for referral Travel at night challenging (fear of thieves and wild animals)	Poorly equipped facilities (limited availability of supplies) Inadequate management (staff not available at night or long wait before arrival)	Suggest a new model (Actantial model) with 4 components: Subject, Aim, Helpers, Obstacles To facilitate the identification of responsible agents and strategies of action to improve access to EmOC.