Community-based prevention of maternal and neonatal morbidity and mortality: a narrative review of the role of maternity waiting homes in Latin America.

Objective: Maternity waiting homes (MWHs) are residential facilities where pregnant women live during the last few weeks of their gestation and can easily be transported to a hospital equipped to provide obstetric emergency care or skilled birth attendance. The expansion of MWHs has been associated with the prevention of obstetric complications. This paper examines how MWHs have been implemented across Latin America, analyzing their evolution, the specific needs they address in different countries, and their impact on maternal and neonatal health outcomes throughout the region. Methods: The methodology of this study was based on a comprehensive narrative review of the literature available from the online databases PubMed, Google Scholar, EBSCOhost, and SciELO in Spanish, English, and Portuguese, using a keyword search that included the Latin American region and country names, and on discussions with key informants in Cuba. Results: The findings show that, in Latin America, MWHs were first implemented in Cuba in 1962, followed years later by Chile, Nicaragua, Guatemala, Honduras, Peru, Brazil, Panama, Paraguay, Mexico, and Colombia. In all these countries, MWHs were established as a strategy to reduce maternal mortality, albeit through various funding models and with varying levels of quality and consistency of services. Community engagement, cultural responsiveness, funding sustainability, women's autonomy, breadth and quality of services, and the evolution of MWHs beyond their original purpose are among the emergent themes in our findings. While countries such as Chile, Panama, and Peru have modified MWH designs and operations to incorporate indigenous traditional birthing practices and cultural preferences, countries such as Brazil, Cuba, and Paraguay have focused on practices that prioritize numerical outcomes over women's experiences and autonomy. Conclusions: The findings suggest a critical gap between the theoretical design of MWH programs and their practical implementation. The evolution of MWHs suggests that they address a spectrum of needs beyond their original purposes, such as providing culturally responsive maternal support and psychosocial and early childhood support. MWHs may be effective in reducing maternal and neonatal mortality when incorporated as part of wider maternal health strategies. Countries with persistently high maternal mortality, especially those with significant geographical barriers to care, could benefit from incorporating MWHs. Remarkably, we did not find MWHs in any of the countries with the highest maternal mortality ratios in the region: Haiti, Venezuela, Bolivia, Jamaica, and the Dominican Republic.