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Effect of Maternal Waiting Homes on Institutional Delivery among Pregnant Women in Rural Nigeria

Abstract

Institutional delivery is an important component of safe motherhood because childbirth in an appropriately equipped healthcare facility increases access to skilled birth attendants, essential obstetric care, emergency interventions, and timely referral when complications occur. However, pregnant women living in rural communities in Nigeria may face significant barriers to institutional delivery, including long distances to healthcare facilities, poor transportation networks, financial constraints, difficult terrain, insecurity, and limited availability of maternity services. Maternal waiting homes provide temporary accommodation near healthcare facilities for pregnant women, particularly those living far from health facilities or considered at increased risk of obstetric complications, allowing them to stay close to skilled maternity care before labour begins. Maternal waiting homes may reduce geographical and transportation barriers and improve women's ability to access institutional delivery when labour starts. Institutional delivery refers to childbirth occurring in a recognized healthcare facility under the care of skilled healthcare personnel. Against this background, this study investigates the effect of maternal waiting homes on institutional delivery among pregnant women in rural Nigeria. The study will be anchored on Andersen's Behavioral Model of Health Services Use, the Health Systems Framework, and the Three Delays Model. Andersen's Behavioral Model explains healthcare utilization through predisposing, enabling, and need-related factors and provides a framework for understanding how improved access to maternity services may influence institutional delivery. The Health Systems Framework emphasizes service delivery, health workforce, infrastructure, essential medicines, financing, and access to healthcare as important components of an effective health system. The Three Delays Model identifies delays in deciding to seek care, reaching an appropriate healthcare facility, and receiving adequate care as major contributors to poor maternal health outcomes. Maternal waiting homes may particularly address delays associated with reaching healthcare facilities. Collectively, these theoretical perspectives provide a suitable framework for explaining how maternal waiting homes may influence institutional delivery among pregnant women in rural Nigeria. The study will adopt a quantitative cross-sectional research design. Data will be collected from pregnant women and recently delivered women residing in selected rural communities with access to maternal waiting homes across selected locations in Nigeria. A multistage sampling technique will be used to select states, local government areas, rural communities, healthcare facilities with maternal waiting homes, and eligible participants. Maternal waiting home services will be assessed using indicators such as availability of accommodation, geographical proximity to healthcare facilities, number of available spaces, duration of stay, accessibility, affordability, water and sanitation facilities, food and basic support, availability of healthcare personnel, health education, emergency transportation arrangements, referral support, and operational continuity. Institutional delivery will be assessed using indicators such as delivery in a recognized healthcare facility, attendance by skilled birth personnel, facility delivery for the most recent pregnancy, timely arrival at the facility before or during labour, and access to appropriate delivery care. Structured questionnaires, facility assessment checklists, maternal health records, and maternal waiting home registers will be used for data collection where available. Descriptive statistics will be used to summarize participants' characteristics, maternal waiting home availability, and institutional delivery patterns. Inferential statistical techniques, including chi-square tests, correlation analysis, and multiple regression analysis, will be used to determine the effect of maternal waiting homes on institutional delivery. Diagnostic tests will also be conducted to assess the reliability of research instruments and the robustness of the findings. The study is expected to find that access to functional maternal waiting homes has a significant positive effect on institutional delivery among pregnant women in rural Nigeria. Pregnant women who have access to maternal waiting homes are expected to have a higher likelihood of delivering in healthcare facilities than women who must travel long distances from their homes when labour begins. Maternal waiting homes may reduce transportation-related delays and allow women to remain closer to skilled birth attendants and emergency obstetric services during the period surrounding delivery. Access to health education and counselling within waiting homes may also increase awareness of the importance of institutional delivery and encourage timely use of maternity services. Conversely, inadequate accommodation, poor water and sanitation facilities, limited food or social support, lack of trained personnel, high costs, and irregular operation may discourage women from using maternal waiting homes. However, maternal waiting homes alone may not fully determine institutional delivery because household income, women's education, cultural beliefs, partner and family support, perceived quality of healthcare, transportation availability, distance to facilities, and previous experiences with maternity services may also influence delivery decisions. The study is expected to contribute to the literature on maternal waiting homes, institutional delivery, maternal healthcare utilization, safe motherhood, rural health, maternal and child health, reproductive health, community health, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, local government health authorities, hospitals, primary healthcare facilities, maternal and child health programme managers, midwives, community health workers, development partners, and policymakers regarding strategies for improving maternal healthcare access in rural communities. The study will also provide evidence-based recommendations for expanding and strengthening maternal waiting homes, improving accommodation and sanitation facilities, ensuring affordability, providing basic welfare support, strengthening referral and emergency transportation systems, improving health education, and integrating maternal waiting homes into comprehensive maternal and newborn healthcare programmes across rural Nigeria.

Keywords: Maternal waiting homes, institutional delivery, pregnant women, rural Nigeria, maternal health, skilled birth attendance, maternal healthcare utilization, safe motherhood, reproductive health, primary healthcare, maternal and child health, public health.