The chances of women dying because of complications of pregnancy and childbirth are still high in many parts of the world. The main direct causes of maternal and perinatal deaths are unsafe abortion, eclampsia, haemorrhage, obstructed labour, infections and sepsis. Most of these deaths can be prevented with early identification and treatment of complications. The poor utilisation of maternal health services and antenatal care in areas where deaths are high is mainly the result of barriers to access.

A maternity waiting home is a facility that is within easy reach of a hospital or health centre that provides antenatal care with skilled birth attendants and emergency obstetric care. The facility may also provide women with health education about pregnancy, giving birth and infant care. It is mostly women with high-risk pregnancies or those that are living far away that are encouraged to stay in these facilities at the end of their pregnancy. The extent to which women are cared for in the homes and the help that is available to them differs from country to country. A further difficulty is that home delivery is less expensive and women may not be willing to leave their families, who depend on their care, or their farms which are their means of existence.

The review authors could not find any individual or cluster-randomised controlled trials that evaluated the outcomes for women using a maternity waiting facility in low-resource countries. The fact that women who develop a serious obstetric complication need appropriate care in order to survive is clear. The effectiveness of maternity waiting homes in decreasing maternal deaths and stillbirths has been described in general terms in six retrospective population cohort studies. These are likely to describe women who were referred to stay in maternity waiting homes because of risk factors and compared them with women who came to the hospitals for other reasons. The control groups may have been self selected by disaster or women’s ability to access the hospitals in time. The outcomes of births for the women who stayed at home were not known. There is insufficient evidence on which to base recommendations about the effectiveness of maternity waiting homes, and well controlled trials are needed.