Giving birth at home greatly increases the risk of death for mother and newborn in the event of complications during delivery. Health centers are equipped to deal with these dangerous complications, thus making delivery at the health center a much safer option than at home. Yet many women in rural Kenya are unable to get to the health center in time to deliver their babies. For example, in Pokot County, a pregnant woman travels an average of three hours to the nearest health center. If she waits until labor starts to travel, she may not make it to a facility in time to deliver. This is one reason that only 28% of mothers in Pokot deliver their babies in health centers.
HealthRight has constructed Maternity Waiting Homes next to three health centers in Pokot County. Maternity Waiting Homes are a free service for pregnant women which encourages them to deliver their babies at the health center instead of at home. Women can travel to the Maternity Waiting Home before labor starts and wait there free of charge until delivery. In the Homes, nurses from the neighboring health center monitor women closely and help with preparations for birth. In addition, community health workers visit the Homes daily to offer education about safe motherhood and newborn care. Mothers can stay in the home again after delivery to recover before the long walk home. This Global Giving project provides funding for maintenance and supplies for the Maternity Waiting Homes as well as health education for the women.
These contributions to the project through Global Giving have provided ongoing support to the three Maternity Waiting Homes which has been essential in garnering community support for their use. Funds were used for community health workers to visit women while they are in Maternity Waiting Homes, offering health education and monitoring for danger signs. In addition, HealthRight was able to use project funds to offer some upgrades and repairs to the infrastructure. In Ortum, windows were repaired prior to the onset of the long rainy season. And in Kapenguria, the project bought solar powered lanterns to provide electricity for women during their stay in the home.
Use of the Homes has been steadily climbing since they were constructed in late 2011. A total of 321 women stayed in one of the Maternity Waiting Homes this year compared to only 278 last year. This represents an increase of 15% in just one year. And, 57 of these women experienced an obstetric complication, a potentially serious problem if they had opted to deliver at home. In part, this increase in use has been a result of facility staff referring women in false labor to the Maternity Waiting Home to await delivery. The increase is also likely to be due to satisfaction among women in the community. 100% of women using a Maternity Waiting Home say they would recommend it to a friend. Finally, data has shown that the homes appeal most to first-time mothers by offering them additional support and, hopefully, establishing a healthy behavior for future pregnancies.[i]
One of the most important lessons HealthRight has learned about the maternity waiting homes is the value of engaging the community health workers to provide education to pregnant women and new mothers during their stay. Many of the women using the homes indicated that the daily educational sessions were very useful for them and was a major benefit to using the Maternity Waiting Home. In the past year, community health workers supported by HealthRight’s project have reached 16,645 community members with information about safe motherhood and the use of the Maternity Waiting Homes. In addition, they offered health education sessions to 4,247 women and family members staying in the three homes this year.
The Project’s Impact:
Women are very satisfied with the maternity waiting homes and speak very highly of them to others in their family and community. This leads to greater use of facility services over time. Here are some testimonials collected in the past year:
- ‘The maternity waiting home takes good care of pregnant mothers. I would have delivered at home just like my other children ‘. Says Rael
- ‘Hospital delivery is safe and clean. The services are good. I would have delivered at home [because] I delivered other children at home ‘. Says Sophia
- I almost died in my previous delivery with [a traditional birth attendant] at home. I fear for my other children that is why I decided to come and wait from the [maternity waiting home]. Says a women using the Ortum home
As a result of this work in Pokot, there has been increased interest in the use of Maternity Waiting Homes in Kenya as a viable method for improving maternal and neonatal health. The facility staff in Ortum, Kapenguria and Kabichbich, where the maternity waiting homes have been constructed, recognize the benefit of the project. This has been manifested in greater collaboration and commitment to the homes. For instance, in Kapenguria, the hospital administration has agreed to provide and launder linens for women staying in the maternity waiting home. And, the County Minister of Health is considering a proposal from the facility staff to distribute food to women during their stay in the maternity waiting home.
The news of the three Maternity Waiting Homes has spread. Health facilities in surrounding communities and neighboring counties have requested assistance from HealthRight to construct and support additional homes. Other international and national organizations have begun to support Maternity Waiting Homes throughout Kenya. In addition, the Ministry of Health has listed Maternity Waiting Homes in their national planning as a possible strategy for reducing maternal and newborn deaths.
HealthRight intends to continue to integrate the use of these three Homes into other project strategies in Kenya. Because of increased interest in the Homes, HealthRight will seek funding from other interested donors to consider expanding the impact and constructing them in other rural districts. From this project, HealthRight staff has a good understanding of how to overcome the most common challenges to establishing and sustaining Maternity Waiting Homes including the need for long-term community engagement, and good collaboration with facility staff. These lessons will be useful when moving forward with the expansion and seeking additional funds.
[i] An Evaluation of Maternal Waiting Homes as a Strategy to Improve Health Outcomes for Mothers and Newborns in the North Rift Valley, Kenya, (unpublished manuscript) HealthRight International; 2010.