University of Groningen
Safe Motherhood: Maternity Waiting Homes in Ethiopia to Improve Women’s Access to
Maternity Care
Vermeiden, Catharina Johanna
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Publication date: 2019
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Vermeiden, C. J. (2019). Safe Motherhood: Maternity Waiting Homes in Ethiopia to Improve Women’s Access to Maternity Care. University of Groningen.
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Tienke Vermeiden
Safe Motherhood:
MATERNITY WAITING HOMES IN
ETHIOPIA TO IMPROVE WOMEN’S
ACCESS TO MATERNITY CARE
Design by Nina Mathijsen, takeadetour.eu
Layout and printing by Loes Kema, GVO drukkers & vormgevers B.V. ISBN/EAN: 978-94-034-1680-9 (printed version)
ISBN/EAN: 978-94-034-1681-6 (electronic version) Tienke Vermeiden
Safe Motherhood: Maternity Waiting Homes in Ethiopia to Improve Women’s Access to Maternity Care
Doctoral Dissertation, University of Groningen, The Netherlands.
The research presented in this thesis was carried out at the GZW Global Health – Public Health Research Department of the Research Institute SHARE of the Graduate School of Medical Sciences of the University of Groningen. This research was supported by Laerdal Foundation, Voluntary Service Overseas and Otto Kranendonk Foundation.
The funders had no role in study design, data collection and analyses, decisions to publish, preparation of manuscripts or of this thesis.
Copyright © 2019 Tienke Vermeiden
All rights reserved. No part of this thesis may be reproduced, stored or transmitted in any way or by any means without the prior permission of the author, or when applicable, of the publishers of the scientific papers.
Safe Motherhood:
Maternity Waiting Homes in Ethiopia
to Improve Women’s Access to
Maternity Care
PhD Thesis
to obtain the degree of PhD at the University of Groningen
on the authority of the Rector Magnificus prof. E. Sterken
and in accordance with the decision by the College of Deans. This thesis will be defended in public on
Monday 24 June 2019 at 16.15 hours by
Catharina Johanna Vermeiden
born on 3 October 1976 in Ridderkerk
Supervisor
Prof. J. Stekelenburg Co-supervisor
Prof. T.H. van den Akker Assessment Committee
Prof. S.A. Scherjon
Prof. J.J.M. van Roosmalen Prof. J.E.W. Broerse
CONTENTS
Chapter 1. General introduction 9
Chapter 2. Comparison of pregnancy outcomes between maternity waiting home users and non-users at hospitals with and without a maternity waiting home: a retrospective cohort study
25
Chapter 3. Factors associated with intended use of a maternity waiting home in Southern Ethiopia:
a community-based cross-sectional study
43
Chapter 4. Community and healthcare worker perspectives on maternity waiting homes and facility births in rural Ethiopia: a qualitative study
63
Chapter 5. Facilitators for maternity waiting home utilisation at Attat Hospital: a mixed-methods study based on 45 years of experience
89
Chapter 6. Emergency obstetric care provision in Southern
Ethiopia: a facility-based survey 113 Chapter 7. Commentary: Maternity waiting homes as part of an
integrated program for maternal and neonatal health improvements: women’s lives are worth saving
131
Chapter 8. General discussion and conclusion 145
Summary / samenvatting 175
Curriculum vitae 185
Acknowledgements 187
Research Institute SHARE 191
