Maternity waiting homes and institutional birth in Nicaragua: policy options and strategic implications

Abstract

With the aim of promoting institutional births and reducing the high maternal and child mortality rates in rural and poor zones, the government of Nicaragua is supporting the creation of maternity waiting homes. This study analyzes that strategy and examines the factors associated with the use of maternity waiting homes and institutional birth. To that end, we apply a quantitative approach, by means of an econometric analysis of the data extracted from surveys conducted in 2006 on a sample of women and parteras or traditional birth attendants, as well as a qualitative approach based on interviews with key informants. Results indicate that although the operation of the maternity waiting homes is usually satisfactory, there is still room for improvement along the following lines: (i) disseminating information about the homes to both women and men, as the latter frequently decide the course of women's healthcare, and to parteras, who can play an important role in referring women; (ii) strengthening the postpartum care; (iii) ensuring financial sustainability by obtaining regular financial support from the government to complement contributions from the community; and (iv) strengthening the local management and involvement of the regional government. These measures might be useful for health policy makers in Nicaragua and in other developing countries that are considering this strategy.

Understanding the implementation of maternity waiting homes in low- and middle-income countries: a qualitative thematic synthesis

“…The provision of free food by the MWH varied across settings. In Cuba, meals were provided and tailored to the nutritional needs of each woman in consultation with dieticians at the MWH [16], while in other MWHs, food or kitchen facilities were available for the women to arrange their own meals [10, 16, 18, 31, 33]. However, in instances where women and their families were required to provide their own meals, inequalities in terms of volume and quality of food emerged among the women [10, 13, 33, 34].…”

“…Some buildings had several separate rooms, each with a few beds [27], while others had large dormitories [17]. Total bed space ranged from 4 to to 83 [31]. In planning for the construction of a MWH in South Africa, Larsen et al estimated that the size of a MWH should be based on 500 women per 1000 births in a district, with each stay averaging two weeks [35].…”

“…Three studies noted that there were no regular visits by health care providers to the MWH and that referral from the MWH to the facility was not smooth [10, 29, 36]. In other sites, women regularly attended the nearby health facility, or were visited in the MWH by staff from the facility [14, 26, 31]. Standard guidelines for care processes, including criteria for admissions, diagnostic and clinical guidelines for identifying risk factors, and protocols for treatment in MWH settings, were reported in Cuba [16].…”

“…Finally, on the issue of cultural norms, concerns were expressed by women in Guatemala around health workers belonging to a different cultural group to those attending MWH, and the potential for this to pose linguistic challenges and also to undermine respect for a woman’s cultural beliefs [17, 31]. …”

“…Community involvement was important to identify cultural factors that affected the use of the MHW; for example, family members, namely the husband or mother-in-law, would not “allow” women to use the MWH or to be away from the household for an extended length of time due to childcare and other household duties [17, 27, 31, 36, 37]. Awareness building efforts were especially important in places where community members had little knowledge of the MWH, which in itself constituted an important barrier to MWH use [17, 28, 36].…”