MATERNAL BEHAVIOR AND UTILIZATION OF MATERNITY WAITING HOMES: COMPARATIVE EVIDENCE FROM MOUNTAINOUS AND ISLAND AREAS IN SOUTH SULAWESI PROVINCE

Abstract

Introduction: Maternity Waiting Homes (MWH) are recommended by the World Health Organization as an effective strategy to reduce maternal mortality, especially in areas with geographical and transportation barriers. However, their utilization is still not optimal, this is caused by many factors including limited health workers, inadequate RTK facilities and infrastructure, low family support and many other problems related to the socio-ecological conditions of the community.

Results: In the mountainous region, 28.7% of mothers utilized MWH, while 28.2% did so in the island region. Adequate knowledge (p = 0.180 vs. p = 0.257) and positive attitudes (p = 0.127 vs. p = 0.061) were not significantly associated with MWH use in either region. Maternal practices showed no significant association in the mountainous region (p = 0.089) but were significantly associated with MWH use in the island region (p = 0.020), where mothers with negative practices were more likely to stay at MWHs. Conclusion: Maternal knowledge and attitudes alone do not predict MWH use in either mountainous or island regions. Rather, maternal practices are key determinants of MWH use in the island context, reflecting adaptive responses to geographic constraints and service access. Therefore, efforts to increase MWH use must move beyond changing information and attitudes to address structural barriers such as transportation, indirect costs, and facility quality and to strengthen the integration of MWH with antenatal and referral services.