Direct and opportunity costs related to utilizing maternity waiting homes in rural Zambia.

The survey only reached women who had already accessed a maternity waiting home, so women who could not afford to use one were not included. Answers were reported through maternity waiting home caretakers, which may have made women more likely to report positive views, especially about willingness to pay fees. Questions about food cost and food items brought were added later, so some early participants did not answer them and missing data are shown in the tables. The survey did not collect all cost figures, so precise total direct and opportunity costs could not be fully calculated. The opportunity cost estimate used national average rural income and average days stayed, which may not match each woman's actual work or household duties. Findings come from ten maternity waiting homes in three districts under one parent study model, and other homes may have different food, fee, or companion policies.

This work was supported by Merck for Mothers, the Bill & Melinda Gates Foundation, and the ELMA Foundation. The paper states the funders had no role in study design, data collection and analysis, decision to publish, or manuscript preparation. The authors declare no competing interests.

Do not read the 77.5% willingness to return as evidence that user fees do not deter women. It comes from women already staying at the homes, and the authors note possible social desirability bias.