Increasing access to reproductive health services through maternity
waiting homes for women living farthest from a health facility in rural
Zambia: a quasi-experimental study
Abstract
Objective: To report on the effectiveness of a standardized core
Maternity Waiting Home (MWH) model to increase facility deliveries and
access to reproductive health services among women living farthest from
a health facility (>10km) using facility-based data.
Design: Quasi-experimental design. Setting: Seven rural districts in
Zambia. Population: Women delivering at 40 health facilities between
June 2016 to August 2018. Methods: 20 intervention sites and 20
comparison sites were used to test if MWHs increased access to
reproductive health services for women living in rural Zambia. The
difference-in-differences (DID) methodology was used to examine the
effectiveness of the core MWH model on our primary outcomes. Main
Outcome Measures: Differences in the change from baseline to endline in
the percentage of women who: 1) traveled greater than 10 km for
delivery, (2) attended a postnatal visit at 6 days postpartum, and (3)
were referred to a higher-level health facility between intervention and
comparison group. Results: We detected a significant difference for the
percentage of deliveries at intervention facilities with the core MWH
model for all women living >10km away (p=0.03), adolescent
women (<18 years) living >10km away (p=0.002),
and primigravida women living >10km away (p=0.01). There
were no significant differences for women attending a postnatal care
visit at 6 days postpartum (p=0.07) or for women referred to the next
level of care (p=0.29). Conclusion: The core MWH model was successful in
reaching women with historically low rates of facility delivery, those
living >10km from a healthcare facility, including
adolescent women and primigravidas.