A cost-effective intervention

Maternity waiting homes (MWHs) are hardly a new development within global or public health. Rather, they have a relatively long, extensive history. Also known as maternity waiting areas, mother’s shelters, or antenatal villages, MWHs can simply be understood 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.

Taking a closer look at Eritrea

MWHs were first introduced into Eritrea’s national health system nearly two decades ago, in 2007, primarily in order to better serve women residing in remote and hard-to-reach areas. In the years since then, the role and position of MWHs has steadily 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 about 50 MWHs scattered across the country. In addition to offering a much-needed setting where Eritrean women can be comfortable, safely accommodated, and receive timely, high-quality health services during their pregnancy, the network of MWHs in Eritrea 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 assisted by skilled birth attendants.

In areas of the country where malaria is endemic, local health personnel also provide pregnant women with medications and insecticidetreated mosquito nets, while MWHs additionally provide greater opportunities for new mothers to rest, recover, and receive follow-up care following delivery.

Importantly, MWHs have contributed to Eritrea’s achievements in maternal and child health. The country’s maternal mortality ratio has dropped from about 998 per 100,000 live births in 1990 (which was among the highest in the entire world) to less than 200 at present – an overall reduction of greater than 80 percent. Similarly, the country’s underfive mortality rate has been reduced by approximately 75 percent since independence. Of note, the average annual rate of reduction for under-five mortality in Eritrea between 1990 and now is estimated at about 4.5 percent, which is among the fastest anywhere in the world. Collectively, these achievements, with MWHs playing an important role, have distinguished the country positively within the continent and across the wider developing, while also setting a strong foundation for further success moving forward.

A positive reflection of the unwavering commitment to social justice and rights

One of the most important dimensions of Eritrea’s network of MWHs is that they serve as a positive reflection of 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 and gender rights issue. Article 12 of the International Covenant on Economic, Social and Cultural Rights, a key document within the global human rights framework, 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”. Similarly, Article 12 of the Convention on the Elimination of All Forms of Discrimination Against Women, again a prominent document within the collection of international human rights instruments, 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”. Notably, the Sustainable Development Goals (SDGs), agreed to by all nations in 2015, also target sexual and reproductive health services and addressing the barriers and human rights-based dimensions of sexual and reproductive health and reproductive rights.

Ultimately, although sometimes overlooked or forgotten, MWHs are helping to strengthen the health system in Eritrea and responding to maternal and child health needs in the country. In addition to playing a positive role in Eritrea’s ongoing child and maternal health-related progress, MWHs they continue to underscore the country’s longstanding commitment to social justice, as well its unwavering efforts to protecting women and girls’ rights to health.