Facilitators for maternity waiting home utilisation at Attat Hospital: a mixed‐methods study based on 45 years of experience

Abstract

Objective To describe facilitators for maternity waiting home (MWH) utilisation from the perspectives of MWH users and health staff. Methods Data collection took place over several time frames between March 2014 and January 2018 at Attat Hospital in Ethiopia, using a mixed‐methods design. This included seven in‐depth interviews with staff and users, three focus group discussions with 28 users and attendants, a structured questionnaire among 244 users, a 2‐week observation period and review of annual facility reports. The MWH was built in 1973; consistent records were kept from 1987. Data analysis was done through content analysis, descriptive statistics and data triangulation. Results The MWH at Attat Hospital has become a well‐established intervention for high‐risk pregnant women (1987–2017: from 142 users of 777 total attended births [18.3%] to 571 of 3693 [15.5%]; range 142–832 users). From 2008, utilisation stabilised at on average 662 women annually. Between 2014 and 2017, total attended births doubled following government promotion of facility births; MWH utilisation stayed approximately the same. Perceived high quality of care at the health facility was expressed by users to be an important reason for MWH utilisation (114 of 128 MWH users who had previous experience with maternity services at Attat Hospital rated overall services as good). A strong community public health programme and continuous provision of comprehensive emergency obstetric and neonatal care (EmONC) seemed to have contributed to realising community support for the MWH. The qualitative data also revealed that awareness of pregnancy‐related complications and supportive husbands (203 of 244 supported the MWH stay financially) were key facilitators. Barriers to utilisation existed (no cooking utensils at the MWH [198/244]; attendant being away from work [190/244]), but users considered these necessary to overcome for the perceived benefit: a healthy mother and baby. Conclusions Facilitators for MWH utilisation according to users and staff were perceived high‐quality EmONC, integrated health services, awareness of pregnancy‐related complications and the husband's support in overcoming barriers. If providing high‐quality EmONC and integrating health services are prioritised, MWHs have the potential to become an accepted intervention in (rural) communities. Only then can MWHs improve access to EmONC.

Maternity waiting home Utilization and associated factors among women who gave birth in the Digelu and Tijo district of the Arsi Zone, Oromia, Ethiopia

“…Decision making autonomy in a household was more likely to utilize the MWH as compared to a woman who had not the autonomy, this result is in line with the study done in Zambia(15), where women who had decision making autonomy used the MWH better when compared with those who had no decision making autonomy. In this study there is no association between MWH utilization and education level which is not similar with the study done at Attat Hospital southern Ethiopia(22), where educational level was associated with MWH utilization; The difference is might be the participants of this study were nearly in the same educational status ranges.…”

Quality and utilization patterns of maternity waiting homes at referral facilities in rural Zambia: A mixed-methods multiple case analysis of intervention and standard of care sites

“…While our results show that an improved MWH model can result in measurably improved quality across multiple domains, there are likely additional drivers of utilization of MWHs at CEmONC facilities [22]. We observed a steep increase in the numbers of women utilizing any MWH for any reason at intervention sites and a slower increase over time at comparison sites (Fig 1, Table 7), which may be attributed to three key drivers.…”

Intentions to use maternity waiting homes and associated factors in Northwest Ethiopia

“…This could be the reason why women in remote areas are not motivated to come to MWHs because the whole household is dependent on women for all household support [13]. On the contrary, studies in Attat hospital, Ethiopia [26], rural southern Egypt (Upper Egypt) [27], rural Zambia [28] and Sierra Leone [29] reported that husbands played important roles to encourage their wives to use MWHs. They possibly have positive attitudes towards MWHs and perceived benefits from using MWHs, including mitigating long distances and improving access to facility-based delivery care.…”