Publication:

Waiting for a safe birth: the untapped potential of birth waiting homes in India

Maternal mortality remains a major global health issue, especially in Low- and Middle-Income Countries (LMICs) like India. Each year, around 19,000 Indian women die from mostly preventable pregnancy and childbirth complications. About 90% of these deaths are preventable with timely, quality care. The “three delays” model explains many of these deaths, particularly the delay in recognising the need for care and reaching medical facilities. Women in remote, tribal, and hard-to-reach areas face the greatest risks. Birth Waiting Homes (BWHs) residential facilities near health centres help overcome these barriers. Other LMICs have shown their effectiveness, but India lacks a comprehensive review of their use and impact.  We analysed secondary data from state Records of Proceedings, Common Review Mission reports, the Health Management Information System, Health Dynamics of India, and field visits. Our review identified 733 operational BWHs across 15 states and Union Territories, mostly in tribal regions. Implementation varied widely, from 2 in Bihar to 249 in Madhya Pradesh. Low Mortality States invested more in BWHs, especially in hard-to-reach areas, and showed better outcomes than High Mortality States. Use of BWHs is strongly related to women’s education (p<0.001), proximity (average 3.8 km), and lower income. Key facilitators included quality care and supportive environments, while limited awareness and space acted as barriers. BWHs can significantly reduce maternal mortality by improving institutional deliveries. States should raise awareness and provide quality services around BWHs to ensure their full use.