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BMC Pregnancy Childbirth. 2017 Aug 31;17(1):269. doi: 10.1186/s12884-017-1444-z.

Understanding the implementation of maternity waiting homes in low- and middle-income countries: a qualitative thematic synthesis.

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School of Public Health, Faculty of Health Sciences, Centre for Health Policy/MRC Health Policy Research Group, Private Bag X3, University of the Witwatersrand, Johannesburg, 2050, Gauteng, South Africa.
Department of Infectious Disease Epidemiology, London School Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Department of Global Health and Development, London School Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
Immpact, Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland.
Department of Maternal, Newborn, Child, Adolescent Health, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland.
Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Department of Obstetrics and Gynaecology, College of Health Sciences, University of Zimbabwe, Mazowe Street, Harare, Zimbabwe.



Maternity waiting homes (MWHs) are accommodations located near a health facility where women can stay towards the end of pregnancy and/or after birth to enable timely access to essential childbirth care or care for complications. Although MWHs have been implemented for over four decades, different operational models exist. This secondary thematic +analysis explores factors related to their implementation.


A qualitative thematic analysis was conducted using 29 studies across 17 countries. The papers were identified through an existing Cochrane review and a mapping of the maternal health literature. The Supporting the Use of Research Evidence framework (SURE) guided the thematic analysis to explore the perceptions of various stakeholders and barriers and facilitators for implementation. The influence of contextual factors, the design of the MWHs, and the conditions under which they operated were examined.


Key problems of MWH implementation included challenges in MWH maintenance and utilization by pregnant women. Poor utilization was due to lack of knowledge and acceptance of the MWH among women and communities, long distances to reach the MWH, and culturally inappropriate care. Poor MWH structures were identified by almost all studies as a major barrier, and included poor toilets and kitchens, and a lack of space for family and companions. Facilitators included reduced or removal of costs associated with using a MWH, community involvement in the design and upkeep of the MWHs, activities to raise awareness and acceptance among family and community members, and integrating culturally-appropriate practices into the provision of maternal and newborn care at the MWHs and the health facilities to which they are linked.


MWHs should not be designed as an isolated intervention but using a health systems perspective, taking account of women and community perspectives, the quality of the MWH structure and the care provided at the health facility. Careful tailoring of the MWH to women's accommodation, social and dietary needs; low direct and indirect costs; and a functioning health system are key considerations when implementing MWH. Improved and harmonized documentation of implementation experiences would provide a better understanding of the factors that impact on successful implementation.


Childbirth; Low and middle-income countries; Maternity waiting homes; Obstetric complications; Referral system; Shelters

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