Maternity waiting homes in rural districts in Africa: A cornerstone of safe motherhood?

Utilisation of maternal health services is low and pregnancy outcome poor in many rural, poor districts in sub-Saharan Africa. Long distances, poor transport facilities and inadequate distribution of health care facilities are responsible for low utilisation of health care services. In addition, a range of social, economic, and cultural factors also contribute to women's poor health during pregnancy and childbirth. Provision of a maternity waiting home (MWH), a residential facility, located near a medical facility providing comprehensive emergency obstetric care, where women can await birth, is a possible intervention. A systematic literature review of effectiveness of MWHs is presented. MWHs have proven to be effective in several studies. Pitfalls, however, are to be anticipated. The accessibility of the MWH itself, the risk identification process, the quality of community education and antenatal care and the quality of service delivery at the District Hospital are factors to be considered.