The online version of this article (https://doi.org/10.1186/s12884-017-1649-1) contains supplementary material, which is available to authorized users.
Luapula Province has the highest maternal mortality and one of the lowest facility-based births in Zambia. The distance to facilities limits facility-based births for women in rural areas. In 2013, the government incorporated maternity homes into the health system at the community level to increase facility-based births and reduce maternal mortality. To examine the experiences with maternity homes, formative research was undertaken in four districts of Luapula Province to assess women’s and community’s needs, use patterns, collaboration between maternity homes, facilities and communities, and promising practices and models in Central and Lusaka Provinces.
A cross-sectional, mixed-methods design was used. In Luapula Province, qualitative data were collected through 21 focus group discussions with 210 pregnant women, mothers, elderly women, and Safe Motherhood Action Groups (SMAGs) and 79 interviews with health workers, traditional leaders, couples and partner agency staff. Health facility assessment tools, service abstraction forms and registers from 17 facilities supplied quantitative data. Additional qualitative data were collected from 26 SMAGs and 10 health workers in Central and Lusaka Provinces to contextualise findings. Qualitative transcripts were analysed thematically using Atlas-ti. Quantitative data were analysed descriptively using Stata.
Women who used maternity homes recognized the advantages of facility-based births. However, women and community groups requested better infrastructure, services, food, security, privacy, and transportation. SMAGs led the construction of maternity homes and advocated the benefits to women and communities in collaboration with health workers, but management responsibilities of the homes remained unassigned to SMAGs or staff. Community norms often influenced women’s decisions to use maternity homes. Successful maternity homes in Central Province also relied on SMAGs for financial support, but the sustainability of these models was not certain.
Women and communities in the selected facilities accept and value maternity homes. However, interventions are needed to address women’s needs for better infrastructure, services, food, security, privacy and transportation. Strengthening relationships between the managers of the homes and their communities can serve as the foundation to meet the needs and expectations of pregnant women. Particular attention should be paid to ensuring that maternity homes meet quality standards and remain sustainable.
Additional file 1: Field Guide: Focus Group Discussions and Key Informant Interviews – documents used by interviewers to guide the different focus group discussions and key informant interviews. (DOCX 64 kb)12884_2017_1649_MOESM1_ESM.docx
Additional file 2: Maternity Home Assessment Tool – document used to collect data about the structure and amenities available at each maternity home. (DOC 219 kb)12884_2017_1649_MOESM2_ESM.doc
Additional file 3: Service Abstraction Form – document used to extract data on deliveries from maternity home registers. (DOC 31 kb)12884_2017_1649_MOESM3_ESM.doc
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- Experiences with and expectations of maternity waiting homes in Luapula Province, Zambia: a mixed–methods, cross-sectional study with women, community groups and stakeholders
Peggy S. Chibuye
Eva S. Bazant
- BioMed Central
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