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

Abstract

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.

A phenomenological qualitative study of male-partners perspectives of maternity waiting homes in rural Ethiopia

“…In our study, health workers were source of information about MWH. In support of this, other studies stated health workers to be sources of information about MWH [ 8 , 25 ]. This indicates that health workers can be a potential source of information about maternal health services including MWH.…”

Effectiveness of couple-based health education on utilization of maternity waiting homes among pregnant women in rural Ethiopia: A study protocol for cluster-randomized trial

“…However, MWH use was found to be low in Ethiopia [ 6 ], and women's access to it mainly depended on male partner (husbands') decisions [ 7 , 8 ]. Male partners have important responsibilities, such as making decisions and setting up funds for the mother and infant to utilize during MWH stays, as well as for food, cleaning supplies, and transportation [ 9 ].…”

“…This suggests that integrating male partners in women's health could enhance the use of MWHs and other maternal health services. Lack of knowledge of MWHs, opinions of the services as being of low quality, poor providers interactions with MWH users, staffing deficit, and home tasks were among the obstacles to MWHs [ 8 , 12 , 13 ].…”

Effect of couple-based health education on male-partners knowledge and attitude towards maternity waiting homes in rural Ethiopia: a cluster-randomized trial

“…Ethiopia has implemented MWHs over the last several decades 7 . However, the MWH utilization is low in Ethiopia 8 and women’s use of MWHs largely depends on male partners decisions 9 , 10 . Literatures revealed that male partners’ made the decision to stay at MWHs and some women did not use MWHs because their husbands refused to allow them to stay at MWHs 10 , 11 .…”

“…However, the MWH utilization is low in Ethiopia 8 and women’s use of MWHs largely depends on male partners decisions 9 , 10 . Literatures revealed that male partners’ made the decision to stay at MWHs and some women did not use MWHs because their husbands refused to allow them to stay at MWHs 10 , 11 . In addition, an observational study from northern Ethiopia showed that half of the male partners did not involve in MWHs 12 .…”