Women's experiences of maternity waiting homes in sub-Saharan Africa: a qualitative systematic review

This review aimed to synthesize women's experiences of maternity waiting homes (MWHs) in sub-Saharan Africa.

Globally, most maternal deaths occur in low-resource settings, with three-fourths of them occurring in sub-Saharan Africa. MWHs have been promoted as an approach to improving maternal health outcomes in these settings; however, utilization rates are low, and evidence is lacking on women's experiences of MWHs in sub-Saharan Africa.

This review considered studies of women residing in sub-Saharan Africa who had experiences with MWHs during the final weeks of pregnancy or the first 2 weeks after childbirth. Qualitative studies conducted in English between January 2000 and July 2025 were considered for inclusion if they exclusively used qualitative research methods, including phenomenology, grounded theory, ethnography, action research, or feminist research.

PubMed, Web of Science, Scopus, HINARI, Google Scholar, and MedNar databases were searched in July 2025. The standardized JBI tool was used to critically appraise the eligible studies. The meta-aggregative approach was used to synthesize the findings, and the ConQual approach was used to assess confidence in the findings.

Ten studies were included for data extraction and synthesis. The review yielded a total of 78 findings with illustrations. These findings were grouped into 13 categories based on similarity in meaning and were subjected to in-depth analysis. The review generated 5 synthesized findings: i) Positive perceptions and attitudes motivate women to use MWHs; ii) Fear of complications, high-risk pregnancies, and lack of awareness affect women's decision to use MWHs; iii) Family support motivates the use of MWHs, whereas women's lack of autonomy and household chores affect their decisions to use MWHs; iv) Health facility-level factors, such as lack of basic amenities and respectful care, affect access to MWHs; and v) Geographic barriers, such as long distance and poor road conditions, impede women's access to MWHs.

Positive perceptions and attitudes motivated women to use MWHs; however, lack of autonomy, household chores, lack of awareness, lack of basic facilities, and geographic barriers affected women's decisions to use MWHs. The findings from this review can be used to inform policies, practices, and research to improve women's access to maternal health services, including MWHs, in sub-Saharan Africa.

PROSPERO CRD42022306003.