Table 1 An example of care-seeking patterns in cases of maternal death

Case study for woman 1: a mother started bleeding while at home, and her caregiver started to help her with home remedies as the first point of care-seeking. The second point of care was at the dispensary. But she could not get the required service. The third point of care was at the district hospital. The mother still didn’t get the care she needed due lack of medical supplies and money. The family needed to raise enough money to cover medical expenses and living costs. They were discharged and returned home, where the family mobilized financial resources. While at home the patient used home remedies with some medicine from the facility, but the conditioned worsened. The fifth step of care-seeking was to the mission hospital, where the mother died.

Case study for woman 5: she was eight-months pregnant. She had a high fever, abdominal pain, and was bleeding. Her mother and her husband took her to the dispensary. At the dispensary, the nurse told the family that the facility did not have medicine and equipment to help the patient and referred the mother to the health center. At the health center, the woman was checked by the nurse and the nurse realized that the mother had a stillbirth. At this time, the nurse did not tell the mother or the family of the result of her assessment, instead she referred the patient to the district hospital. On the way, the woman started bleeding and continued to complain about the headache. When they reached at the district hospital, the mother was assessed again and she was told that the baby had died and the blood pressure of the mother was very high. At this point, the mother was unconscious, and the doctor suggested that the patient needed a caesarean section. One day after the surgery, the mother died.