Emma Williams | October 2015
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Presentation at the Global Maternal Newborn Health Conference, October 20, 2015

Background: Delays in reaching skilled care cause maternal deaths. Over years, Government of Zambia invested in maternity waiting homes (MH). With Merck for Mothers funding, Jhpiego’s formative research in 2014 examined MH use patterns, user/community needs and entrepreneurial models to sustain MHs in Luapula province.

Methods: This study included 21 qualitative focus groups (FGDs) with 180 women and men, 96 key informant interviews and structured surveys, and observational assessments at 17 MHs and 21 health facilities. Participants included pregnant and recently delivered women, antenatal couples, senior women, community volunteers, traditional leaders, partner organization representatives, facility in-charges, district health leaders, and agricultural officers. Multiple analysts coded transcripts for a priori and emergent themes.

Results: Pregnant women are encouraged by leaders and families to deliver in facilities – thanks to high knowledge of obstetric complications and fines for home-delivery. However, many MHs were incompletely constructed and completed MHs were sometimes used as office, storage or exam rooms. Conditions at health facilities and MHs were insufficient due to lack of infrastructure and maintenance, inadequate management, and overcrowding. Barriers to use included concerns about privacy, security, lack of mattresses, food and blankets, and limited cooking space and toilets. In short, the MHs were not ‘homes’ that preserve dignity. Suggested solutions included community-run gardens, aquaponics and/or fish farming to provide nutritious food and generate income to improve and maintain the MHs. Community involvement for labor and transparent management of income-generation funds along with continued facility funds was seen as essential, especially at the start-up phase.

Conclusions: Despite enthusiasm among community leaders and members to promote facility delivery, barriers to use of existing MHs   abound. A broader health system plan for integrating MHs into health facilities and communities is needed to ensure rural women safe childbirth.