May, 2011 - SUPPORT Summary of a systematic review | print this article |
The poor utilisation of maternal health services and antenatal care by women living in rural areas has been associated with high maternal and neonatal mortality. Maternity waiting homes have been advocated as a way of overcoming geographical barriers in such settings and improving access to care and maternal and neonatal outcomes.
A maternity waiting home is a facility within easy reach of a hospital or health centre offering antenatal and emergency obstetric care provided by skilled birth attendants.. Maternity waiting homes seek to overcome barriers to access to obstetric care, particularly in rural and remote areas. Women, particularly those with high risk pregnancies, are encouraged to stay in maternity waiting homes close to health care facilities towards the end of their pregnancies. The aim is to improve access to antenatal care during the late stages of pregnancy, and intranatal care in particular. This ensures that the delivery takes place in an equipped setting where skilled attendance is available.
Some studies have reported a favourable effect of maternity waiting homes on outcomes for women and their newborns. But others have found that utilisation levels are low due to access barriers.
This review assessed the evidence of the effects of waiting homes on maternal and neonatal outcomes in low-resource countries. The authors looked for randomised control trials, including quasi-randomised and cluster randomised trials in low-resource settings.
|Review Objectives: To assess the effects of maternity waiting facilities on maternal and perinatal health in low-resource settings.|
|/||What the review authors searched for||What the review authors found|
Randomised control trials of maternity waiting homes i.e. facilities within a 1 km or a 10 minute walk from a medical facility designated for the lodging of pregnant women awaiting labour
No randomised control trials of maternity waiting facilities in low-resource settings
All pregnant women
Indices of perinatal morbidity and mortality, maternal morbidity and mortality, obstetric intervention and maternal satisfaction
|Date of most recent search: April 2009|
|Limitations: This is a good quality systematic review with only minor limitations|
van Lonkhuijzen L, Stekelenburg J, van Roosmalen J. Maternity waiting facilities for improving maternal and neonatal outcome in low-resource countries. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.:CD006759. See in Cochrane Library
No studies were identified that met the inclusion criteria of the review. Good quality studies are required to evaluate the effectiveness of waiting homes on maternal and perinatal outcomes in low-resource settings.
Although maternity waiting homes could potentially improve access to, and the utilisation of, obstetric care, related literature describes reasons why this may not always be the case. These include:
There is therefore a need to plan maternity waiting homes carefully to ensure that they are positively perceived, that uti-lisation levels are high, and to ensure that they provide access to good quality obstetric care.
|MONITORING & EVALUATION|
Bulatao RA, Ross JA. Which health services reduce maternal mortality? Evidence from ratings of ma- ternal health services. Tropical Medicine and International Health 2003;8:720-1.
Lee A, Lawn J, Cousens S, et al. Linking families and facilities for care at birth: What works to avert intrapartum-related deaths? International Journal of Gynecology and Obstetrics 107 (2009) S65–S88
Bhutta Z, Darmstadt G, Haws R et al. Delivering interventions to reduce the global burden of stillbirths: improving service supply and community demand. BMC Pregnancy and Childbirth 2009, 9(Suppl 1):S7
This summary was prepared by
Dudley, LD, Faculty of Health Sciences, University of Stellenbosch, South Africa
Conflict of interest
None declared. For details, see:
This summary has been peer reviewed by: Luc van Lonkhuijzen, the Netherlands; Joseph Kasonde, Zambia
This summary should be cited as
Dudley LD. Do maternity waiting facilities improve maternal and perinatal outcomes in low resource settings? A SUPPORT Summary of a systematic review. May 2011.