If we build it, will they come? Results of a quasi-experimental study assessing the impact of maternity waiting homes on facility-based childbirth and maternity care in Zambia

IntroductionMaternity waiting homes (MWHs) aim to increase access to maternity and emergency obstetric care by allowing women to stay near a health centre before delivery. An improved MWH model was developed with community input and included infrastructure, policies and linkages to health centres. We hypothesised this MWH model would increase health facility delivery among remote-living women in Zambia.MethodsWe conducted a quasi-experimental study at 40 rural health centres (RHC) that offer basic emergency obstetric care and had no recent stockouts of oxytocin or magnesium sulfate, located within 2 hours of a referral hospital. Intervention clusters (n=20) received an improved MWH model. Control clusters (n=20) implemented standard of care. Clusters were assigned to study arm using a matched-pair randomisation procedure (n=20) or non-randomly with matching criteria (n=20). We interviewed repeated cross-sectional random samples of women in villages 10+ kilometres from their RHC. The primary outcome was facility delivery; secondary outcomes included postnatal care utilisation, counselling, services received and expenditures. Intention-to-treat analysis was conducted. Generalised estimating equations were used to estimate ORs.ResultsWe interviewed 2381 women at baseline (March 2016) and 2330 at endline (October 2018). The improved MWH model was associated with increased odds of facility delivery (OR 1.60 (95% CI: 1.13 to 2.27); p<0.001) and MWH utilisation (OR 2.44 (1.62 to 3.67); p<0.001). The intervention was also associated with increased odds of postnatal attendance (OR 1.55 (1.10 to 2.19); p<0.001); counselling for family planning (OR 1.48 (1.15 to 1.91); p=0.002), breast feeding (OR 1.51 (1.20 to 1.90); p<0.001), and kangaroo care (OR 1.44 (1.15, 1.79); p=0.001); and caesarean section (OR 1.71 (1.16 to 2.54); p=0.007). No differences were observed in household expenditures for delivery.ConclusionMWHs near well-equipped RHCs increased access to facility delivery, encouraged use of facilities with emergency care capacity, and improved exposure to counselling. MWHs can be useful in the effort to increase delivery at advanced facilities in areas where substantial numbers of women live remotely.Trial registration numberNCT02620436.

Maternity waiting home as a potential intervention for reducing the maternal mortality ratio in El Salvador: an observational case study

Background El Salvador is recognized as a country that has effectively reduced its Maternal Mortality Ratio (MMR). While health indicators, such as total fertility rate, adolescent fertility rate, skilled birth attendance, and health expenditures, have improved in El Salvador, this improvement was unremarkable compared to advancements in other developing countries. How El Salvador could achieve an outstanding decrease in MMR despite unexceptional improvements in health and non-health indicators is a question that deserves deep research. We used quantitative methods and an observational case study to show that El Salvador could reduce its MMR more than expected by instituting health policies that not only aimed to reduce the (adolescent) fertility rate, but also provide safe birthing conditions and medical services to pregnant women through maternity waiting homes. Methods We ran pooled ordinary least squares regression and panel regression with fixed effects using MMR as the dependent variable and health and non-health factors as the independent variables. We conducted residual analysis, calculated the predicted value of MMR, and compared it with the observed value in El Salvador. To explain the change in MMR in El Salvador, we carried out an observational case study of maternity waiting homes in that country. Results El Salvador could reduce MMR by improving health factors such as fertility rate skilled birth attendance and non-health factors, such as gross domestic product (GDP) per capita and female empowerment. However, even while considering these factors, the MMR of El Salvador decreased by more than expected. We confirmed this by analyzing the residuals of the regression model. This improvement in MMR, which is larger than expected from the regression results, can be attributed partly to government measures such as maternity waiting homes. Conclusions The reason for the unexplained reduction in El Salvador’s MMR seems to be attributed in part to health policies that not only aim to reduce the fertility rate but also to provide safe birthing conditions and medical services to pregnant women through maternity waiting homes.

Stakeholders’ Perspectives on the Implementation of Maternity Waiting Homes in Rural Ethiopia: A Qualitative Study

Background The rural community in Ethiopia is scattered over a wide geographic area, some regions with difficult mountains, making access to healthcare facilities a great challenge. To overcome geographical barriers and improve access to skilled childbirth care, maternity waiting homes (MWHs), shelters built nearby health facilities, where pregnant women are lodged until labour begins, were introduced decades ago. This study identifies the demand and supply-side determinants of access to MWH services in rural Ethiopia. Methods This descriptive, exploratory study included five focus group discussions and eight in-depth interviews using a semistructured interviewer guide. Field notes were collected, and interviews were audio-recorded. Using Quirkois®, data were coded, transcribed verbatim, translated into English, and analyzed following Penchansky and Thomas’s modified framework of access. Results The study identified several challenges of the implementation of the MWH program in the study area. Subthemes that emerged from the discussions were lack of awareness about the MWH services, geographic inaccessibility, inadequacy of facilities and unaffordability-related issues, substandard and culturally insensitive care at MWHs, and logistic barriers. Most participants rated the MWH quality as poor and requested better MWH services to promote access to skilled birth attendance. Conclusions Several contextual, structural and socio-cultural barriers have been hindering the implementation of MWHs in the study area. To improve women’s access to skilled childbirth, it is crucial to tailor context-based MWH messages, upgrade existing MWHs and ensure that the services are culturally sensitive.

Determinants of Intention To Use Maternity Waiting Homes in Tanzania: A Study Based on Women Using MWH in Dodoma, Iringa and Morogoro

Background Maternal mortality rate (MMR) in Tanzania is still persistently high. The data from Tanzania has revealed that maternal mortality ratio (MMR) has increased from 454 per 100,000 live births in 2010 to 556 per 100,000 live births by the year 2015. Establishment of Maternity Waiting Homes (MWH’s) in a few regions has been one of the efforts for trying to serve lives of pregnant women from pregnancy related complication. Methods The study adopted a cross-sectional study design and a convenience sampling technique for recruiting the respondents. Results The women aged 20–34 are 10 times more likely to use the MWHs in case of future pregnancy (OR = 10.906, p = 0.019) whereas those aged 35 to 49 are 54 times more likely to use MWHs in case of future pregnancy (OR = 54.629, p = 0.006) as compared to those aged 18 to 24 years old. Women who lived 3 to 6 hours of travel to MWH are 11 times more likely to use MWH in case of future pregnancy as compared to those living at the distance of 1 to 3 hours to the MWH (OR = 11.451, p = 0.032). Conclusion The results of this study have revealed some interesting findings in the issues of distance by traveling time and age of the respondent to be highly significant factors in predicting intention to use MWHs in case of future pregnancy.

The Support From Husbands, Parents and Midwives in Pregnancy Care in the Cases of Normal Pregnancy and Unwanted Pregnancy in Maternity Waiting Homes, Wonogiri, Indonesia

Mortality and morbidity of pregnant and maternity women is a big problem in developing countries like Indonesia. The support of husbands, parents, and midwives in taking care of pregnant women is important for the health of mother and baby fetus. One of a problem in taking care of pregnant women, is maintaining the emotional stability and behavior of pregnant women. The strategy to optimize support for pregnant women is to provide Maternity Waiting Homes. The purpose of this study was to analyze the support of husbands, parents and midwives in optimizing the function of Maternity Waiting Homes. This research is qualitative descriptive research. Data collection techniques with in-depth interviews, observation, documentation and Focus Group Discussion. The core informants consist of midwives who managed the Maternity Waiting Homes and doctors, main informants consist of pregnant women, husbands, parents, and midwives, supporting informants consist of public health center nurses and sub-district stakeholders. This research located in Wonogiri Regency (kabupaten), Central Java Province in Indonesia. Based on the results of the study, husband’s, parents and midwives support in the normal pregnancy has a positive impact on the physical and psychological aspects of pregnant women until delivery. While husbands, parents and midwives support in unwanted pregnancies did not have positive impact on pregnant women. The existence of Maternity Waiting Homes has not functioned optimally in supporting the amenities of mothers and babies. Thus, social support (husband, parents and midwife) is a determinant factor of emotional stability and the behavior of pregnant women.

Effectiveness of maternity waiting homes in increasing utilization of facility-based delivery: A systematic review

To reduce the second delay contributing to maternal mortality, maternity waiting homes have been recommended for implementation especially in remote areas to help improve access to facility-based skilled delivery. Evidence of its effectiveness, however, is limited. This systematic review, therefore, aims to assess the effectiveness of the Maternity waiting home strategy in increasing utilization of facility delivery. Search for relevant articles was conducted on PubMed, Scopus, Google Scholar, Ebscohost, and Science Direct from database inception to March 30, 2021. Two reviewers independently screened the articles and assessed the quality of the studies. The identified maternity waiting home interventions and their effectiveness in improving facility-based delivery uptake were narratively synthesized and reported following the preferred reporting items for systematic reviews and meta-analysis reporting guidelines. The search yielded 670 articles of which five studies fulfilled the inclusion criteria. The three of five studies revealed that there is a significant association between Maternity waiting home use and utilization of facility-based delivery. The quality of the Maternity waiting homes significantly improved facility-based delivery uptake. Maternity Waiting Homes appear to be promising in decreasing barriers to skilled delivery attendance however the quality of evidence is low. More interventional studies of robust design are needed to clearly demonstrate its effectiveness.

Households' Willingness To Pay And Associated Factors For The Nutrition Services Provided To Pregnant Women At Maternity Waiting Homes In East Wollega, Western Ethiopia

Background: Maternity waiting home is a housing facility located near qualified medical facilities where a pregnant woman can wait to give birth and provided a nutrition service. In Ethiopia, most (86%) of the maternity waiting homes had no budget allocated from government funds and thus have to rely on communities’ contribution. Yet, very few studies have been conducted so far to evaluate the household’s willingness to pay for the nutrition service. Objective: The study aimed to estimate households’ maximum willingness to pay and its associated factors for the nutrition service provided to a pregnant woman at a maternity waiting homes in East Wollega Zone of Oromia National regional state, Ethiopia, September 2018. Methodology: A community based cross sectional study using double bounded dichotomous choice contingent valuation method was used. Sample size was determined by using single population proportion formula. Data entry and analysis were made using Epi-Data version 3.1 and SPSS for Windows version 20 software respectively. Descriptive statistics of frequency, binary and multivariable logistic regression analysis were performed. The associations between explanatory variables and outcome variable were presented by an Adjusted Odd Ratio and confidence interval. Results: We gathered data from 845 participants (98% response rate). The annual median maximum willingness to pay was 15ETB (US$0.55) per household. Marital status (AOR=3.533, 95% CI=1.007-12.39) and average monthly income (AOR=3.287, 95%CI=1.194-9.049). Moreover, distance from the health facility (AOR = 3.64, 95%CI = 1.256-10.55) and availability of food (AOR=3.714, 95%CI=1.331-10.364), enough beddings (AOR=5.353, 95%CI=2.207-13.010) and cooking utensils (AOR=4.044, 95%CI=1.353-12.088) at a housing facility were found to be predictors. Conclusion and Recommendation: Marital status, monthly income, and distance, availability of food, beddings and cooking utensils at housing facilities were found to be factors influencing maximum willingness to pay. Therefore, health facility managers should avail supplies and equipment at a housing facility.