Dataset for "Barriers and facilitators to facility-based delivery in rural Zambia: A qualitative study of women’s perceptions after implementation of an improved Maternity Waiting Homes intervention"

This is the publicly accessible qualitative dataset for the Maternity Homes Alliance impact evaluation.Objectives: Women in sub-Saharan Africa face well-documented barriers to facility-based deliveries. An improved maternity waiting homes (MWH) model was implemented in rural Zambia to bring pregnant women closer to facilities for delivery. We qualitatively assessed whether MWHs changed perceived barriers to facility delivery among remote-living women. Design: We administered in-depth interviews (IDIs) to a randomly-selected subsample of women in intervention (n=78) and control (n=80) groups who participated in the primary quasi-experimental evaluation of an improved MWH model. The IDIs explored perceptions and preferences of delivery location. We conducted content analysis to understand perceived barriers and facilitators to facility delivery. Setting and participants: Participants lived in villages 10+ kilometers from the health facility and had delivered a baby in the previous 12 months. Intervention: The improved MWH model was implemented at 20 rural health facilities. Results: Over 96% of participants in the intervention arm and 90% in the control arm delivered their last baby at a health facility. Key barriers to facility delivery were distance and transportation, and costs associated with delivery. Facilitators included no user fees, penalties for home delivery, desire for safe delivery, and availability of MWHs. Most themes were similar between study arms. Both discussed the role MWHs have in improving access to facility-based delivery. Intervention arm participants expressed that the improved MWH model encourages use and helps overcome the distance barrier. Control arm participants either expressed a desire for an improved MWH model or did not consider it in their decision-making. Conclusions: Even in areas with high facility-based delivery rates in rural Zambia, barriers to access persist. MWHs may be useful to address the distance challenge, but no single intervention is likely to address all barriers experienced by rural, low-resourced populations. MWHs should be considered in a broader systems approach to improving access in remote areas. Trial Registration: ClinicalTrials.gov Identifier: NCT02620436This programme was developed and implemented in collaboration with Merck for Mothers, Merck’s 10-year, $500 million initiative to help create a world where no woman dies giving life. Merck for Mothers is known as MSD for Mothers outside the USA and Canada (MRK 1846-06500. COL). The development of this article was also supported in part by the Bill & Melinda Gates Foundation (OPP1130334) https://www. gatesfoundation. org/ How- We- Work/ Quick- Links/ Grants- Database/ Grants/ 2015/ 06/ OPP1130334 and The ELMA Foundation (ELMA-15- F0010) http://www. elmaphilanthropies. org/ the- elma- foundation/. Funding for Online Open publication supported by Chronos Support through the Bill & Melinda Gates Foundation. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The content is solely the responsibility of the authors and does not necessarily reflect positions or policies of Merck, the Bill & Melinda Gates Foundation or The ELMA Foundation