Exploring the use of the Maternal Waiting House (MWH) in Kairuku-Hiri, Central Province: A study in Papua New Guinea.

Abstract

Papua New Guinea’s Maternal Mortality Rate (MMR) stands at 733 per 100,000 live births making it the second highest in the Asia Pacific region (WHO, 2009). Most of the deaths are from the rural areas. While the medical causes of maternal deaths are well known in PNG, very few studies have been undertaken to understand the nonmedical factors which contribute to maternal deaths in rural areas. The study used a qualitative exploratory approach to explore what health professionals and women thought about the causes of maternal deaths and the possible development of a Maternal Waiting House (MWH), and other similar initiatives to improve maternal health outcomes in PNG. The study reveals that in rural areas of Central Province there are many socio-economic, cultural, and environmental constraints as well as health service related problems which prevent women accessing essential obstetric care and contributing to the high maternal mortality rate. Key factors identified included; poverty, scarcity of transport, negative cultural practices pertaining to women, lack of awareness of the risk factors, and the geographical isolation of communities. In addition, health service problems such as the shortage of skilled care providers, deteriorating health facilities and poor outreach programmes are some of the factors which affect the quality of obstetric care provided and prevent the use of maternal health services. The study supports the growing opinion that reaching a health facility in time is the best strategy for reducing maternal deaths. The establishment of a MWH may be an important way to bring women close to health facilities to access timely health care. The study found that in Central Province the MWH is a great need for rural women with problems of geographical access. However, the MWH can only be effective if established and nestled within a functioning health system that provides adequate obstetric services ready to receive women with complications. The evidence from this study reveals that the current problems related with the health services and the health system significantly underscores the value of developing an MWH. Addressing the underlying social determinants, improvements to maternal health services, and strengthening of the district health system are priorities for reducing maternal deaths.