Community-based birth waiting homes in Northern Sierra Leone: Factors influencing women’s use

Objective: to explore the factors influencing women's use of birth waiting homes in the Northern Bombali district, Sierra Leone.

Design: this was a descriptive exploratory study using qualitative research methodology, which included in depth interviews, key informant interviews, focus group discussions, document review and observations.

Setting: two chiefdoms in the Northern Bombali district, Sierra Leone.

Participant: eight interviews were conducted with women who had delivered in the past one year and used birth waiting homes; eight key informant interviews with a project manager, birth waiting homes hosts, and community members; thirteen women who delivered in the past year without using birth waiting homes (four interviews and two focus group discussions).

Findings: there are several factors influencing the use of birth waiting homes (BWHs) including: past experience of childbirth, promotion of the birth waiting homes by traditional birth attendance, distance and costs of transport to the homes, child care and other family commitments, family's views of the importance of the homes, the costs of food during women's stay, and information given to women and families about when and how to use the homes.

Key conclusions and implications for practice: some barriers, especially those related to family commitments and costs of food, are challenging to solve. In order to make a BWH a user-friendly and viable option, it may be necessary to adjust ways in which BWHs are used. Good linkage with the health system is strength of the programme. However, further strengthening of community participation in monitoring and managing the BWHs is needed for the long term success and sustainability of the BWHs.