Maternity Waiting Home Utilization and Associated Factors Among Women Who Had Given Birth in the Hard-to-Reach Region of Western Ethiopia: A Mixed-Study.

Background and Aims: In Ethiopia, Maternal Waiting Homes (MWHs) are a key government strategy to improve maternal and child healthcare access in remote areas, aiming to reduce maternal mortality by ensuring timely skilled care during childbirth. Despite their long-standing implementation, limited research exists on MWH utilization and factors, especially in hard-to-reach regions. This study aims to assess MWH utilization and associated factors in the Bullen District of Benishangul-Gumuz, Ethiopia, 2024. Methods: A community-based cross-sectional study with a qualitative component was conducted from April 1, 2024 to May 30, 2024, involving 957 women who had given birth in Bullen District. Participants were selected using multi-stage and purposive sampling techniques. Quantitative data were collected using a pretested structured questionnaire, while qualitative data were obtained through focus group discussions and in-depth interviews. Data were entered into EpiData version-3.1 and analyzed with SPSS version-25. Binary logistic regression was used to identify associated factors, with adjusted odds ratios (AOR) and 95% confidence intervals (CI). Thematic analysis was applied to qualitative data. Result: The utilization of Maternal Waiting Homes was 26.2% (95% CI: 23.4%-29%). Factors associated with MWH use included having three or fewer household members [AOR:(95% CI) = 2.17(1.24-3.80)], experiencing pregnancy-related complications [AOR:(95% CI) = 2.03(1.25-3.32)], attending at least one ANC visit [AOR:(95% CI) = 3.56(2.25-5.61)], and women independently deciding to use MWH [AOR:(95% CI) = 1.88(1.32-2.68)]. Qualitative findings revealed barriers including lack of privacy, limited decision-making power, and insufficient support at home. Conclusion: The study found low utilization of MWHs (26.2%). Individual and institutional barriers, with key predictors including family size, ANC follow-up, pregnancy complications, and self-decision-making power were identified. Hence, efforts should focus on raising awareness during ANC visits, empowering women in decision-making, and improving privacy, and facility conditions. It will make MWHs more accessible and increase utilization rates, enhancing maternal health outcome.