Increasing Facility Delivery Through Maternity Waiting Homes for Women Living Farthest From a Health Facility in Rural Zambia: A Quasi-experimental Study

Objective To report on the effectiveness of a standardized core Maternity Waiting Home (MWH) model to increase facility deliveries among women living \u3e10 km from a health facility. Design Quasi-experimental design with partial randomization at the cluster level. Setting Seven rural districts in Zambia. Population Women delivering at 40 health facilities between June 2016 and August 2018. Methods Twenty intervention and 20 comparison sites were used to test whether MWHs increased facility delivery for women living in rural Zambia. Difference-in-differences (DID) methodology was used to examine the effectiveness of the core MWH model on our identified outcomes. Main outcome measures Differences in the change from baseline to study period in the percentage of women living \u3e10 km from a health facility who: (1) delivered at the health facility, (2) attended a postnatal care (PNC) visit and (3) were referred to a higher-level health facility between intervention and comparison group. Results We detected a significant difference in the percentage of deliveries at intervention facilities with the core MWH model for all women living \u3e10 km away (DID 4.2%, 95% CI 0.6–7.6, P = 0.03), adolescent women (\u3c18 years) living \u3e10 km away (DID 18.1%, 95% CI 6.3–29.8, P = 0.002) and primigravida women living \u3e10 km away (DID 9.3%, 95% CI 2.4–16.4, P = 0.01) and for women attending the first PNC visit (DID 17.8%, 95% CI 7.7–28, P \u3c 0.001). Conclusion The core MWH model was successful in increasing rates of facility delivery for women living \u3e10 km from a healthcare facility, including adolescent women and primigravidas and attendance at the first PNC visit