Maternity waiting homes in Timor-Leste don't improve access.
Article Type: Brief article
Subject: Maternal health services (Management)
Waiting lines (Management)
Pub Date: 05/01/2012
Publication: Name: Reproductive Health Matters Publisher: Elsevier Science Publishers Audience: General Format: Magazine/Journal Subject: Family and marriage; Health; Women's issues/gender studies Copyright: COPYRIGHT 2012 Reproductive Health Matters ISSN: 0968-8080
Issue: Date: May, 2012 Source Volume: 20 Source Issue: 39
Topic: Event Code: 200 Management dynamics Computer Subject: Company business management
Geographic: Geographic Scope: East Timor Geographic Name: East Timor Geographic Code: 9INDO Indonesia
Accession Number: 296571571
Full Text: A before-and-after study in Timor-Leste sought to assess whether the establishment of maternity waiting homes improved access to safe delivery facilities for rural women. Routine data from health centre records in two remote districts compared the number of facility-based births in women who lived at different distances (0-5, 6-25, 26-50 and >50 km) from the health centre, before and after implementation of maternity waiting homes. Population data were used to estimate the percentage of women in each distance category who accessed facility-based care. Of the total 2,235 births recorded at the end of 2007, most facility-based births in the two regions (80% and 62%) were among women who lived within five kilometres of the health centre. There was no significant increase in the number of facility-based births among women in more remote areas following implementation of the maternity waiting homes. The percentage of births in the population that occurred in a health facility was low for both districts (9% and 17%), and use decreased markedly as distance between a woman's residence and the health facilities increased.

Given the failure of maternity waiting homes to improve access for remote women, further research should be conducted to determine which models of care increase coverage and produce the best outcomes for women and neonates. These include maternity transport services, skilled attendance for home births and decentralisation of birthing facilities. The study's distance analysis methodology, which used data that are routinely collected in rural health centres, could be used by other countries to evaluate maternity waiting homes. (1)

(1.) Wild K, Barclay L, Kelly P, et al. The tyranny of distance: maternity waiting homes and access to birthing facilities in rural Timor-Leste. Bulletin of World Health Organization 2012;90:97-103.

Doi: 10.1016/S0968-8080(12)39627-4
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