<p>A Culturally Sensitive and Supportive Maternity Care Service Increases the Uptake of Maternity Waiting Homes in Ethiopia</p>

Abstract

Background: Maternal delays in utilization of emergency obstetric care are impacting on a high maternal mortality, especially in the poor resource countries including Ethiopia. Different strategies are designed and employed to reduce those maternal delays, and one of such strategies employed to overcome the geographic barriers and improve maternal and neonatal health outcomes is utilization of maternity waiting homes (MWHs). Studies related to the utilization of MWHs and associated factors are limited in Ethiopia and there were none in the study area. Objective: The aim of this study was to assess the utilization of maternity waiting homes and associated factors. Methods and Materials: A community-based cross-sectional study design was conducted, using multistage sampling technique. Logistic regression analysis with 95% CI for odds ratio (OR) was used to identify significant factors. Results: A total of 379 women participated in this study, making a response rate of 85%. Of the total participants, 42.5% (95% CI=38-48) of women utilized MWHs. After controlling for potential confounders, women's decision-making capacity (AOR=12.74; 95% CI=6.18-26.26), women having someone who can care for their children and/or husband at home (AOR=2.71; 95% CI=1.44-5.09), MWHs offering food service (AOR=4.03; 95% CI=2.07-7.85), offering and/or allowing women to practice their own cultural ceremony (allowing to cook their own food type, porridge, coffee, etc) (AOR=9.55; 95% CI=4.45-20.47), and women's attitude towards MWHs (AOR=0.09; 95% CI=0.03-0.23) were factors significantly associated with the utilization of MWHs. Conclusion: Compared to its contribution in reducing maternal and perinatal mortality, the utilization of MWHs was low in this study area. The integration of culturally sensitive and supportive maternity services, along with community participatory approach, would increase utilization of MWHs and consequently contribute in achieving the SDGs related to maternal and neonatal health.

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

“…There must be adequate facilities at both the MWHs and adjacent HCFs for women to use MWH services [21]. Consistent with previous studies, the study has shown that the adequacy of sleeping areas that take into account the privacy of the users, the availability of beds and mattresses, bathing facilities, food supplies, or kitchen utensils in MWHs are likely to affect whether or not the service is used [20,21,40,41]. Moreover, one qualitative thematic synthesis showed that the MWHs were better used and accepted by women and their families when they provided basic infrastructure and facilities [21].…”

“…We also found that the lack of culturally sensitive care in health centers, including the reluctance of midwives to allow families to exercise their cultural practices during labour, was the reason for the low acceptance of the MWH services. There was also a reluctance to seek professional care among pregnant women, including to stay at MWHs, because there was a misconception that the use of delivery services should be limited to complicated pregnancies and deliveries [33,41]. Furthermore, some women stated that they were not allowed to give birth in the position they preferred, nor were they allowed to accompany a husband or relative to the delivery room, which they described as challenging.…”

“…Consistent with other studies from similar settings, many of the women continued to practice homebirth and did not come to the MWHs because of the lack of culturally appropriate care in the HCFs. Therefore, incorporating cultural practices into the healthcare system as long as they do not harm the women and the new-born, such as allowing women to have the companions of their choice and empowering women by clarifying some misconceptions, need to be considered to improve the acceptance of MWHs in the community [41].…”

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

“…There was also the absence of space or kitchen for family use; therefore, limiting the time that family members could spend with women occupying the facilities. Another possible contributing factor could be the lack of community mobilization and engagement before and during the establishment of the facilities which as reported by other studies, is vital to the success of these facilities [43], [44]. There was also an absence of a control group in this study further limiting the evidence.…”

“…A second cluster RCT found an improvement in FBD with an upgraded MWH combined with community engagement however this finding did not reach statistical significance [40]. As reported by several studies, some of the factors which deter women from utilizing MWHs include poor infrastructure [47], [48], lack of food supplies [43], [48], [49], unavailability of kitchens or cooking utensils [50], [51] Lack of privacy [48], unavailability of space for a family member to stay [44] and so on. To increase FBD uptake through the use of these structures, it is imperative to make them comfortable and inviting for women to be willing to stay in.…”