Abstract
BackgroundAlthough Ethiopia is scaling up Maternity Waiting Homes (MWHs) to reduce maternal and perinatal mortality, women’s use of MWHs varies markedly between facilities. To maximize MWH utilization, it is essential that policymakers are aware of supportive and inhibitory factors. This study had the objective to describe factors and perceived barriers associated with potential utilization of an MWH among recently delivered and pregnant women in Southern Ethiopia.MethodsA community-based cross-sectional study was conducted between March and November 2014 among 428 recently delivered and pregnant women in the Eastern Gurage Zone, Southern Ethiopia, where an MWH was established for high-risk pregnant women to await onset of labour. The structured questionnaire contained questions regarding possible determinants and barriers. Logistic regression with 95% Confidence Intervals (CI) was used to examine association of selected variables with potential MWH use.ResultsWhile only thirty women (7.0%) had heard of MWHs prior to the study, 236 (55.1%), after being explained the concept, indicated that they intended to stay at such a structure in the future. The most important factors associated with intended MWH use in the bivariate analysis were a woman’s education (secondary school or higher vs. no schooling: odds ratio [OR] 6.3 [95% CI 3.46 to 11.37]), her husband’s education (secondary school or higher vs. no schooling: OR 5.4 [95% CI 3.21 to 9.06]) and envisioning relatively few barriers to MWH use (OR 0.32 [95% CI 0.25 to 0.39]). After adjusting for possible confounders, potential users had more frequently suffered complications in previous childbirths (adjusted odds ratio [aOR] 4.0 [95% CI 1.13 to 13.99]) and envisioned fewer barriers to MWH use (aOR 0.3 [95% CI 0.23 to 0.38]). Barriers to utilization included being away from the household (aOR 18.1 [95% CI 5.62 to 58.46]) and having children in the household cared for by the community during a woman’s absence (aOR 9.3 [95% CI 2.67 to 32.65]).ConclusionsMost respondents had no knowledge about MWHs. Having had complications during past births and envisioning few barriers were factors found to be positively associated with intended MWH use. Unless community awareness of preventive maternity care increases and barriers for women to stay at MWHs are overcome, these facilities will continue to be underutilized, especially among marginalized women.
Highlights
Ethiopia is scaling up Maternity Waiting Homes (MWHs) to reduce maternal and perinatal mortality, women’s use of MWHs varies markedly between facilities
Each of the selected variables was associated with Potential MWH use, except for being in the age range of 25 to 29, parity and having had complications in previous births
We believe that our results provide valuable insight into the level of awareness of our target population, their attitude towards MWHs, and the barriers that women perceive
Summary
Ethiopia is scaling up Maternity Waiting Homes (MWHs) to reduce maternal and perinatal mortality, women’s use of MWHs varies markedly between facilities. This study had the objective to describe factors and perceived barriers associated with potential utilization of an MWH among recently delivered and pregnant women in Southern Ethiopia. The Maternal Mortality Ratio fell by 44% between 1990 and 2015, from approximately 385 to 216 per 100,000 live births. Despite this reduction, more than 300,000 pregnant and recently delivered women still died in 2015, of whom 200,000 in sub-Saharan Africa [1]. In 2016, only 26% of women in Ethiopia reported that they had given birth to their lastborn at a health facility This rate is among the lowest in the world [5, 6]. Reasons include notions that facility delivery is not necessary or customary, as well as physical distance to the facility and lack of transportation [7]
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