title: Improving access to skilled facility-based delivery services: Women's beliefs on facilitators and barriers to the utilisation of maternity waiting homes in rural Zambia.
abstract: BACKGROUND
  Maternity waiting homes (MWHs) are aimed at improving access to facility-based skilled delivery services in rural areas. This study explored women's experiences and beliefs concerning utilisation of MWHs in rural Zambia. Insight is needed into women's experiences and beliefs to provide starting points for the design of public health interventions that focus on promoting access to and utilisation of MWHs and skilled birth attendance services in rural Zambia.
  
  
  METHODS
  We conducted 32 in-depth interviews with women of reproductive age (15-45 years) from nine health centre catchment areas. A total of twenty-two in-depth interviews were conducted at a health care facility with a MWH and 10 were conducted at a health care facility without MWHs. Women's perspectives on MWHs, the decision-making process regarding the use of MWHs, and factors affecting utilisation of MWHs were explored.
  
  
  RESULTS
  Most women appreciated the important role MWHs play in improving access to skilled birth attendance and improving maternal health outcomes. However several factors such as women's lack of decision-making autonomy, prevalent gender inequalities, low socioeconomic status and socio-cultural norms prevent them from utilising these services. Moreover, non availability of funds to buy the requirements for the baby and mother to use during labour at the clinic, concerns about a relative to remain at home and take care of the children and concerns about the poor state and lack of basic social and healthcare needs in the MWHs--such as adequate sleeping space, beddings, water and sanitary services, food and cooking facilities as well as failure by nurses and midwives to visit the mothers staying in the MWHs to ensure their safety prevent women from using MWHs.
  
  
  CONCLUSIONS
  These findings highlight important targets for interventions and suggest a need to provide women with skills and resources to ensure decision-making autonomy and address the prevalent gender and cultural norms that debase their social status. Moreover, there is need to consider provision of basic social and healthcare needs such as adequate sleeping space, beddings, water and sanitary services, food and cooking facilities, and ensuring that nurses and midwives conduct regular visits to the mothers staying in the MWHs.
authors.affiliation: Ministry of Health, Monze District Medical Office, P.O. Box 660144, Monze, Zambia. Cephas.Sialubanje@Maastrichtuniversity.nl.|Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200MD, Maastricht, The Netherlands. Cephas.Sialubanje@Maastrichtuniversity.nl.
authors.forename: Cephas
authors.initials: C
authors.lastname: Sialubanje
authors.affiliation: Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200MD, Maastricht, The Netherlands. karlijn.Massar@maastrichtuniversity.nl.
authors.forename: Karlijn
authors.initials: K
authors.lastname: Massar
authors.affiliation: Department of Global Health, Maastricht University, Faculty of Health, Medicine and Life Science, P.O. Box 616, 6200MD, Maastricht, The Netherlands. m.vanderpijl@maastrichtuniversity.nl.
authors.forename: Marit S G
authors.initials: MS
authors.lastname: van der Pijl
authors.affiliation: Department of Global Health, Maastricht University, Faculty of Health, Medicine and Life Science, P.O. Box 616, 6200MD, Maastricht, The Netherlands. e.kirch@maastrichtuniversity.nl.
authors.forename: Elisa Maria
authors.initials: EM
authors.lastname: Kirch
authors.affiliation: Zambia Centre for Applied Health Research and Development, P.O. Box 30910, Lusaka, Zambia. dhamer@bu.edu.|Centre for Global Health and Development Boston University, Crosstown 3rd floor, 801 Massachusetts Avenue, Boston, MA, 02118, USA. dhamer@bu.edu.|Department of International Health, Boston University School of Public Health, Crosstown 3rd floor, 801 Massachusetts Avenue, Boston, MA, 02118, USA. dhamer@bu.edu.
authors.forename: Davidson H
authors.initials: DH
authors.lastname: Hamer
authors.affiliation: Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200MD, Maastricht, The Netherlands. r.ruiter@maastrichtuniversity.nl.
authors.forename: Robert A C
authors.initials: RA
authors.lastname: Ruiter
mesh_terms: D000293:Adolescent; D000328:Adult; D003469:Culture; D003657:Decision Making; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D006268:Health Facilities; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D000068097:Maternal Health; D008875:Middle Aged; D011247:Pregnancy; D011256:Pregnancy Outcome; D011787:Quality of Health Care; D012424:Rural Population; D063507:Sexism; D012959:Socioeconomic Factors; D055815:Young Adult; D015024:Zambia