Maternal mortality and the problem of accessibility to obstetric care; the strategy of maternity waiting homes

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Abstract

One of the major causes of maternal mortality is the distance and consequent delay in treatment of childbirth complications. Some developing countries are attempting to reduce delays in treatment by moving women at risk into maternity waiting homes (MWHs), located near a hospital, a few days prior to the date of confinement. This paper illustrates some typical examples of MWHs in different countries. The approach of MWHs is appropriate in some settings but it requires a high degree of coordination between peripheral prenatal care services and second and third level health care facilities. This study discusses some of the issues related to the successful functioning of MWHs, and provides an analytical framework for the planning, management and evaluation of these facilities.

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      MWHs have existed in various forms for over 100 years in Europe and North America (Liebmann, 1995). In the developing world, the use of MWHs was mentioned as early as the 1950s when they were introduced in rural Nigeria (Poovan et al., 1990; Liebmann, 1995; Figà-Talamanca, 1996). Beginning in the 1960s the idea of MWHs was reenergised and promoted as a potential intervention to bridge the physical chasm that prevents rural women from receiving skilled maternal health care (van Lonkhuijzen et al., 2012).

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      Annual overheads were estimated in 1990 at US $500 per year to cover maintenance, laundry, and a watchman. In Cuba, the Ministry of Health reported that the average cost of maternity waiting homes in 1988 was about US $10 per day for each pregnant woman [103]. The average user admission fee for a maternity waiting home in Nyanje, Zambia was 1000 Kwacha (US $3), including the cost of hospital birth [104].

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