Evaluating the Impact of Midwife-Led Maternity Waiting Homes on Skilled Birth Attendance in Remote Oromia, Ethiopia: A Pre-Post Intervention Study

Geographical barriers in remote Ethiopia limit access to skilled birth attendance (SBA), contributing to high maternal mortality. While maternity waiting homes (MWHs) are a recommended strategy, evidence for midwife-led, community-based models is limited. This study evaluated the impact of introducing midwife-led MWHs on rates of skilled birth attendance in selected remote villages of the Oromia Region. A pre-post intervention study was conducted. Baseline SBA rates were collected from health facility records for a period prior to the intervention. Midwife-led MWHs were subsequently established in target villages. Follow-up SBA data were then collected for an equivalent period post-implementation. The primary outcome was the change in the proportion of institutional deliveries attended by a skilled professional. Following the intervention, skilled birth attendance increased from a baseline of 24% to 52% in the MWH catchment areas. Qualitative feedback indicated the presence of a resident midwife was a key factor influencing women's decision to use the facility. The introduction of midwife-led maternity waiting homes was associated with a substantial increase in skilled birth attendance in these remote settings. Programme planners should consider scaling up the midwife-led MWH model in remote regions. This requires integrated support for midwife training, sustainable supplies, and community engagement to ensure long-term viability. Maternal health, skilled birth attendance, maternity waiting homes, midwives, Ethiopia, Oromia, pre-post study This study provides original empirical evidence on the effectiveness of a community-based, midwife-led maternity waiting home model in a remote Ethiopian context.