Maternity waiting homes bring help to vulnerable women in Malawi

February 16, 2017

Maternity waiting homes (MWHs) offer a promising strategy to reduce maternal mortality in Malawi and other low-income countries, according to a study conducted by researchers in the UNC Gillings School of Global Public Health.

Dr. Kavita Singh

Kavita Singh, PhD, research associate professor of maternal and child health and faculty fellow at Carolina Population Center, is first author of the study, which was published online on Oct. 24, 2016, in International Journal of Gynecology & Obstetrics. The article appears in print in the January 2017 issue.

MWHs are designed to reduce maternal mortality by bringing pregnant women—particularly those at high risk of obstetric complications or from rural areas—close to a health facility toward the end of their pregnancy. MWHs are either physical structures close to, or rooms within, a health facility.

The study authors sought to determine whether two MWHs supported by UNC’s Safe Motherhood Initiative (SMI) are reaching the women most vulnerable in terms of previous pregnancy complications, distance from health care and wealth, during the early phases of SMI program implementation. In addition, the researchers aimed to present descriptive information on MWH users and their satisfaction with health education messages and services.

A cross-sectional, interview-based study was conducted among women who attended Area 25 Health Centre in Lilongwe and Kasungu District Hospital in Kasungu, two centers in Malawi with attached MWHs. Between April and June 2015, exit interviews were conducted among MWH users and non-users.

Women with low incomes and at high risk were found to be using the SMI-sponsored MWHs, and women at the Area 25 MWH valued the education they received there. A greater proportion of MWH users at both Area 25 and Kasungu had a prior adverse pregnancy outcome, which suggests that the MWHs are being used by women who might be at risk of a pregnancy complication. Additionally, both MWHs seemed to be reaching women with low incomes.

Satisfaction with the quality of the educational sessions was high among MWH users. Among the 214 women who answered questions about satisfaction with educational messages, more than half were very satisfied, and another one-third replied that they were satisfied.

These findings offer promising evidence on the role that MWHs can have in increasing institutional delivery to support the reduction of maternal mortality in Malawi and other low- and middle-income countries. Community outreach to pregnant women and their families can result in greater use of MWHs.

“Though MWHs have been around for quite some time, there has been little research about them,” said Singh. “We plan to supplement this article with an upcoming article that will include results from an end-line assessment to be conducted later this year.”

In addition to Singh, co-authors from the Gillings School are Ilene Speizer, PhD, research professor of maternal and child health and faculty fellow at Carolina Population Center, and Eunsoo Timothy Kim, MSPH, doctoral student in maternal and child health. Clara Lemani, MPhil Demography, and Ann Phoya, PhD, RNM, from the Safe Motherhood Initiative in Malawi, are also co-authors. Lemani is the monitoring and evaluation officer for the project, and Phoya is director.

The study was funded by the Bill & Melinda Gates Foundation. The Carolina Population Center and its NIH Center grant provided general support for the overall project.

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Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or dpesci@unc.edu