Maternity Waiting Home Interventions as a Strategy for Improving Birth Outcomes: A Scoping Review and Meta-Analysis

Abstract

Background and Objective: Over 300 000 women worldwide die due to pregnancy-related complications annually, with most occurring in developing countries where access to skilled obstetric care is limited. Maternity waiting homes (MWHs) are one intervention designed to increase access to skilled prenatal care in resource-limited settings. MWHs are defined as accommodations at or near a health facility where pregnant women can stay in the final weeks of their pregnancy so they can be easily transferred to the health facility to give birth. While MWHs have existed for decades, evidence regarding their effectiveness in reducing adverse birth outcomes has been mixed. The objective of this study is to comprehensively assess all available MWH research reporting quantitative maternal and childbirth data to determine whether MWHs are an effective maternal health strategy in resource-limited settings. Methodology: We conducted a scoping review and meta-analysis of existing literature on MWHs according to PRISMA guidelines. Descriptive statistics and odds ratios were calculated for the following birth outcomes: maternal mortality, perinatal mortality, and caesarian section. Quantitative analysis was conducted in RStudio and Stata Version 16. Results: One hundred seventy-one records were retrieved from our initial database search, of which 66 were identified as relevant. Only 15 of these records reported quantitative data on the health outcomes of interest and therefore met inclusion criteria for our meta-analysis. All studies reporting maternal mortality demonstrated a protective effect of MWHs (aggregate OR: 0.19 [0.10, 0.40]), as did all studies reporting perinatal mortality (aggregate OR: 0.29 [0.16, 0.53]). Studies reporting caesarian section were more varied and indicated less of a protective effect (aggregate OR: 1.80 [1.18, 2.75]). Conclusions: There is some indication that MWHs are an effective strategy for reducing maternal and perinatal mortality in resource-limited settings. However, our analysis was constrained by the observational design of most prior MWH studies. More rigorous MWH evaluations, ideally in the form of randomized-control trials, are needed to better determine MWH effectiveness.

A Maternity Waiting Home Is an Alternative Approach for the Accessibility of Pregnant Women in an Obstetrically Underserved Area of Korea

“…13 In the meta-analysis by Smith et al in 2022, MWHs have a protective effect on maternal and perinatal mortality but fail to reduce the rate of Cesarean sections. 14 MWH users and non-users suffered no maternal or perinatal mortality in this study because Korea has a relatively better medical healthcare system than other low-income countries and because there was a small data sample.…”

Key Success Factors in Maternity Waiting Home Implementation: A Qualitative Study in Rural Indonesia

“…33 It has been widely proven that collaboration between stakeholders is the key to utilizing MHWs to reduce maternal mortality rates. 15,17,24 Collaboration can be conducted with interdisciplinary health and non-health stakeholders. 25 The WHO revealed that strengthening collaboration among multilateral organizations can be done to accelerate each country's progress toward health-related Sustainable Development Goals.…”

“…Maternity Waiting Homes (MWHs) is an intervention method that aims to aid pregnant women to be closer to delivery facility services. 15 MWHs facilitate pregnant women to stay in a house in their last weeks of pregnancy so that they can be easily transferred to a health facility for delivery with health professionals and receive prompt emergency obstetric care when needed. 15,16 MWHs have been proven to reduce maternal mortality by 80% in developing countries.…”

“…15 MWHs facilitate pregnant women to stay in a house in their last weeks of pregnancy so that they can be easily transferred to a health facility for delivery with health professionals and receive prompt emergency obstetric care when needed. 15,16 MWHs have been proven to reduce maternal mortality by 80% in developing countries. Additionally, more than 70% of stillbirths can be reduced by mothers who use maternity waiting homes.…”

Understanding maternity waiting home uptake and scale-up within low-income and middle-income countries: a programme theory from a realist review and synthesis

“…While recent systematic reviews and meta-analyses report limited, mixed and inconclusive evidence regarding MWH effectiveness,5 7 8 individual studies have associated the MWH-facility birth intervention with increased odds of facility birth9–11; decreased maternal and perinatal mortality12 13; reduced risk of low birth weight14; and increased odds of attendance at all recommended postnatal visits within 6 weeks of birth 15. The intervention remains under-utilised in LMICs,16 which suggests a mismatch between one or more aspects of the implemented MWH-facility birth model and the capacities, expectations, experiences, needs and preferences of its intended beneficiaries.…”