During a briefing last week, the Ministry of Health (MoH) branch in the Northern Red Sea Region reported that the number of maternity waiting homes (MWHs) across the region has recently increased, rising from 12 in 2021 to 17 in 2022. Furthermore, this encouraging development was reported to have played a role in promoting positive health outcomes, particularly for women and newborn children. The following article offers an overview of MWHs, and briefly highlights some of Eritrea’s child and maternal health progress.
MWHs are not a new development within global or public health. They have a relatively long, extensive history. Sometimes also referred to as maternity waiting areas, mother’s shelters, or antenatal villages, they may be most simply defined as standalone, safe residential facilities where pregnant women can stay for an extended period prior to the onset of labor or before being transferred to other health facilities for delivery.
A number of empirical studies conducted in an array of settings around the world have demonstrated that MWHs can be a relatively cost-effective, successful strategy to help reduce the risk of adverse birth outcomes and child or maternal mortality, especially within low- and middle-income countries or resource limited settings. Timely, high-quality care during and around the period of delivery is crucial as serious complications and maternal and newborn deaths are heavily concentrated around this time. (In fact, research shows that the majority of maternal and newborn deaths are caused by preventable or treatable complications that take place during labor, delivery and the immediate 24 hours after giving birth.)
MWHs help ensure more high-risk pregnancies can be detected, with these pregnant women subsequently being provided specialized services, further examination, and appropriate care or treatment. As well, MWHs can mean that more pregnant women are delivering with the assistance of skilled birth attendants. In addition to the important role that they perform throughout pregnancy, the academic literature is replete with evidence showing the significant, vital role performed by skilled birth attendants during childbirth and postpartum. During delivery, for instance, skilled birth attendants closely monitor progress of labor, facilitate physiological processes, and help address complications (e.g., obstructed labor, birth asphyxia, and trauma), while in the period shortly following birth, when the risk of mortality for newborns and mothers can be quite high, they help with feeding, managing complications (e.g., postpartum bleeding, infection, or depression), and counseling (e.g., providing information or advice about family planning and birth spacing), along with offering other vital forms of support.
With regard to Eritrea, MWHs were first introduced into the national health system in 2007, primarily in order to better serve women in remote and hard-to-reach areas. Steadily, the role and position of MWHs has expanded to where they now represent an integral link within the continuum of care for maternal and newborn health in the country.
At present, there are close to 50 MWHs distributed around the country. Last week’s MoH press briefing in the NRS Region, revealing that the number of MWHs in the region increased from 12 to 17 just last year, is especially noteworthy as the region has many people living in remote and hard-to-reach areas.
In addition to offering a much-needed setting where women can be comfortable, safely accommodated, and receive timely, high-quality health services during their pregnancy, Eritrea’s nationwide network of MWHs reduces the need for difficult or long distance travel, provides women with critical education, such as learning about healthy behaviors and how to best care for the baby or themselves, offers much-needed social, cultural, emotional, and psychological support or the opportunity to build mutual support networks, and helps to promote births in facilities and assisted by skilled birth attendants. In areas of the country where malaria is endemic, local health personnel also provide pregnant women with medications and insecticide-treated mosquito nets, while MWHs additionally provide greater opportunities for new mothers to rest, recover, and receive follow-up care following delivery.
An important aspect of Eritrea’s growing network of MWHs is that they help to reflect the country’s unwavering commitment to social justice and promoting and protecting women’s rights. For instance, MWHs help to bridge the historically large rural-urban divide in access to care and reduce the need for many women to embark on long, difficult journeys that can increase the risk of complications or even death for both mother and child.
In terms of women’s rights, recall that around the world maternal mortality and morbidity, which MWHs help to reduce and prevent, has increasingly been regarded as a human rights issue. Article 12 of the International Covenant on Economic, Social and Cultural Rights obliges states to “recognise the right of everyone to the enjoyment of the highest attainable standard of physical and mental health” and to take steps to provide for “the reduction of the stillbirth rate and of infant mortality and for the healthy development of the child”, while the Convention on the Elimination of All Forms of Discrimination Against Women, in Article 12, requires states to “ensure, on a basis of equality of men and women, access to health care services, including those related to family planning” and to “ensure to women appropriate services in connection with pregnancy, confinement and the post-natal period, granting free services where necessary, as well as adequate nutrition during pregnancy and lactation”.
Ultimately, MWHs help to emphasize Eritrea’s longstanding commitment and efforts to promote social justice and protect women and girls’ rights to life; to equality; to non-discrimination; and to enjoy the highest attainable standard of physical and mental health, including sexual and reproductive health.
Eritrea’s general progress within neonatal, child, and maternal health
Over the years, there has been an increase in the use of MWHs in Eritrea, with more babies being delivered in these facilities. In 2017 there were 7,699 deliveries in MWHs, while in 2018 and 2019 there were 8,670 and 9,173 deliveries, respectively. This, in combination with a variety of other factors, has played a role in positive maternal, newborn, and child health outcomes.
Eritrea is one of the few countries that entered the United Nations Sustainable Development Goals (UN SDGs) period having achieved most of the United Nations Millennium Development Goals related to health. Since the onset of the UN SDGs period close to a decade ago, the country has continued to make considerable progress in a number of areas, including within neonatal, child, and maternal health.
Nearly all mother-baby pairs receive postnatal care (PNC) within 48 hours of delivery from a skilled health care provider, while there continues to be an improvement in the proportion of pairs that receive PNC within 24 hours of delivery. Moreover, the country’s maternal mortality ratio dropped from 998 per 100,000 live births in 1990 to 228 in 2015, and 184 in 2019 – an overall reduction of approximately 82 percent during the period running from 1990 to 2019. In addition, between 1990 and 2020, the neonatal mortality rate in Eritrea was reduced by about 49 percent, dropping from 35 deaths per 1,000 live births to 18, while the country’s under-five mortality rate was reduced by approximately 75 percent, falling from 153 to 39. Of note, the average annual rate of reduction (AARR) for under-five mortality in Eritrea between 1990 and 2020 is estimated at about 4.5 percent, which is not only considerably ahead of the AARR for the entire Sub-Saharan Africa region (approximately 3.0 percent), but also among the fastest anywhere in the world.
It is well worth recalling that these tremendous strides were achieved despite an array of daunting challenges and myriad significant obstacles for the country, including many years of illegal, unjust sanctions (as well as similar coercive measures), a tough general climate and environmental conditions, and an extremely difficult regional geopolitical context characterized by conflicts and instability.