Referral management is an integral part of clinical practice. However in low resource settings referrals are often delayed. Rural women are at higher risk of dying from pregnancy and its complication.94% of global maternal deaths occur in low resource setting and India alone accounts for 12% of maternal deaths . Most of maternal deaths can be prevented by strengthening the referral system of country. WHO categorizes 3 type of referral delays: delay in seeking care, delay in reaching care and delay in getting adequate care.There are various factors which are responsible for these delays. The factors are categorized in two categories 1. Health system factors . 2. Client factors.Using two case studies of maternal referrals (from low resource state in India), this article shows how these factors are responsible for referral delays and ultimately maternal death. Existing referral system can be modified by timely identification of signal functions, adherence to established guidelines or standards,timely, free or low cost transportation, adequate documentation, staff accompaniment and prompt care by competent healthcare providers in the receiving facility.

Keywords: Maternal Mortality, Referral Delays, Health Care System