Maternity waiting areas – serving all women? Barriers and enablers of an equity-oriented maternal health intervention in Jimma Zone, Ethiopia

ABSTRACT

In Ethiopia, maternal waiting areas (MWAs) – residential areas near health facilities where women can stay while waiting to give birth – are community-based, equity-oriented interventions to improve maternal outcomes among rural populations. In this qualitative study we sought to explore the barriers and enablers that Health Extension Workers (HEWs) encounter when engaging with communities about MWAs. We conducted semi-structured interviews with HEWs across rural sites in Jimma Zone, Ethiopia. Drawing from an ecological model of social determinants of maternal and child health, we analysed data using thematic coding methods. HEWs reported a variety of factors that determined MWA use, including the number of children at home, previous childbirth experiences, community support networks, decision making practices within families, the availability and acceptability of health services, geographical access, and health beliefs. HEWs worked to increase the use of MWAs by engaging with husbands and communities, raising awareness in target groups of women, and managing community participation. Policies and practices that support enhanced training for HEWs, increased resources for communities, and greater opportunities for HEWs to liaise with decision makers at various levels of influence are possible ways forward to improve MWA use, specifically, and maternal and neonatal/child health outcomes more generally.

KEYWORDS:

• Maternity waiting area
• health equity
• maternal health
• social determinants of health
• qualitative research

Acknowledgements

We gratefully acknowledge Jimma Zonal Health Department (especially Gebeyehu Bulcha Duguma and Kunuz Haji Bedru), Safe Motherhood Project coordinators (Yisalemush Asefa, Gemechu Beyene and Corinne Packer), Safe Motherhood Project researchers and research assistants (Muluemebet Abera, Alzahra Hudani and Jaameeta Kurji) and data collectors from Jimma University, for their contributions to the research.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Nicole Bergen http://orcid.org/0000-0002-8161-2599

Additional information

Funding

This work was carried out with grants #108028-001 (Jimma University) and #108028-002 (University of Ottawa) from the Innovating for Maternal and Child Health in Africa initiative (co-funded by Global Affairs Canada (GAC), the Canadian Institutes of Health Research (CIHR) and Canada’s International Development Research Centre (IDRC)); it does not necessarily reflect the opinions of these organisations.