Abstract
Background Maternal mortality remains a pressing health concern, especially in low‑ and middle‑income countries. Understanding the demographic, temporal, and contextual factors that lead to these deaths is essential for designing effective interventions. This study aimed to examine maternal mortality through the lens of the three delays model using data from Pakistan. Methods We conducted a retrospective analysis of the Pakistan Maternal Mortality Survey 2018‑2019, drawing on the Pakistan Demographic and Health Survey Verbal Autopsy dataset. Descriptive statistics and stratified analyses were used to profile maternal deaths by demographic characteristics, timing, and place of death. We also quantified delays in deciding to seek care, reaching a facility, and receiving treatment. Results Of the 1,177 maternal deaths analyzed, the mean age was 34 years. Most deaths occurred in health facilities and were classified as direct obstetric causes such as hemorrhage and sepsis. Women experienced an average delay of 3.8 days in deciding to seek care, 3.7 hours in reaching a facility, and 7.6 minutes in receiving treatment. More than half of the deaths occurred within 42 days postpartum. Financial hardship, geographic isolation, and limited resources emerged as prominent reasons for delay. Women who reached a health facility were less likely to die on the first day of admission than those who did not. Conclusions Maternal mortality in Pakistan reflects a web of sociodemographic inequalities and systemic shortcomings. Addressing these deaths requires more than clinical solutions. It calls for policies that improve the timeliness and quality of maternal health services, tackle financial and geographic barriers, and strengthen the healthcare system. Interventions grounded in the three delays framework could help reduce maternal mortality and advance maternal health equity in low‑resource settings.