title: The tyranny of distance: maternity waiting homes and access to birthing facilities in rural Timor-Leste.
abstract: OBJECTIVE
  To examine the impact of maternity waiting homes on the use of facility-based birthing services for women in two remote districts of Timor-Leste.
  
  
  METHODS
  A before-and-after study design was used to compare 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. Routine data were collected from health centre records at the end of 2007; they included 249 births in Same, Manufahi district, and 1986 births in Lospalos, Lautem district. Population data were used to estimate the percentage of women in each distance category who were accessing facility-based care.
  
  
  RESULTS
  Most facility-based births in Same (80%) and Lospalos (62%) were among women who lived within 5 km 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 Manufahi district (9%) and Lautem district (17%), and use decreased markedly as distance between a woman's residence and the health facilities increased.
  
  
  CONCLUSIONS
  The maternity waiting homes in Timor-Leste did not improve access to facility-based delivery for women in remote areas. The methods for distance analysis presented in this paper provide a framework that could be used by other countries seeking to evaluate maternity waiting homes.
authors.affiliation: Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory 0811, Australia. kayli.wild@menzies.edu.au
authors.forename: Kayli
authors.initials: K
authors.lastname: Wild
authors.forename: Lesley
authors.initials: L
authors.lastname: Barclay
authors.forename: Paul
authors.initials: P
authors.lastname: Kelly
authors.forename: Nelson
authors.initials: N
authors.lastname: Martins
mesh_terms: D016009:Chi-Square Distribution; D005260:Female; D005843:Geography; D006293:Health Promotion; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006771:Hospitals, Maternity / Q000706:statistics & numerical data*; D006801:Humans; D011247:Pregnancy; D012424:Rural Population / Q000706:statistics & numerical data*; D013997:Time Factors; D014850:Waiting Lists; D016387:Women's Health; D014944:World Health Organization