How Maternity Waiting Home Use Influences Attendance of Antenatal and Postnatal Care

Abstract

Background: In this International Year of the Nurse and the Midwife, access to quality midwifery care is essential to promote maternal-newborn health and improve survival. One intervention aimed at improving maternal-newborn health and reducing underutilization of pregnancy services is the construction of maternity waiting homes (MWHs). The purpose of this study was to assess whether there was a significant change in antenatal care (ANC) and postnatal care (PNC) attendance, family planning (FP) use, and vaccination rates before and after implementation of the Core MWH Model in rural Zambia. Methods: A quasi-experimental controlled before-and-after design was used to evaluate the impact of the Core MWH Model by assessing associations between ANC and PNC attendance, FP use, and vaccination rates for mothers who delivered a child in the past 13 months. Twenty health care facilities received the Core MWH Model and 20 were identified as comparison facilities. Multivariable logistic regression were used to assess the association between MWH use and ANC and PNC attendance. Findings: The total sample include 4711 mothers. Mothers who used a MWH had better ANC and PNC attendance, FP use, and vaccination rates than mothers who did not use a MWH. All mothers appeared to fare better across these outcomes at endline. Interpretation: We found an association between MWHs and better ANC and PNC attendance, FP use, and newborn vaccination outcomes. Maternity waiting homes may serve as a catalyst to improve use of facility services for vulnerable mothers, especially those living the farthest from services. Funding Statement: The study program was developed and is being implemented in collaboration with Merck for Mothers, Merck’s 10-year, $500 million initiative to help create a world where no woman dies giving life. Merck for Mothers is known as MSD for Mothers outside the United States and Canada (MRK 1846-06500.COL). The development of the study article was additionally supported in part by the Bill & Melinda Gates Foundation (OPP1130334) https://www.gatesfoundation.org/How-We-Work/Quick-Links/Grants-Database/Grants/2015/06/OPP1130334 and The ELMA Foundation (ELMA-15-F0010) http://www.elmaphilanthropies.org/the-elma-foundation. Declaration of Interests: The authors have no conflict of interest. Ethics Approval Statement: Institutional review board (IRB) ethical approval was obtained from the University of Michigan, Boston University, and the ERES Converge IRB in Zambia.