Table 4 Themes and illustrative quotes of participants’ responses during FGDs about the facilitators and barriers to use MWH services in Arba Minch zuria district, 2019

1a. Low socioeconomic status

I wanted to go to [the] MWH, not because I was told about the standards of care there, but because I couldn't afford the payment for transportation, even I didn’t have alternative transportation means in case something [unforeseen] happens during childbirth at home. Instead, I preferred to be close to the facility with professional care. [Age 33, MWH user]

1b. Negative childbirth experiences

The very reason I decided to stay in [the] MWH was my shocking experience during my second childbirth. …I was with [a] traditional birth attendant. For some reason I don’t know, I had started bleeding shortly after the child was born and the blood was a lot that the traditional birth attendant couldn’t do anything… my village is quite far, walked long to get there [health center], and I was between life and death when I arrived there. If I had not received professional care at that time I would not be alive. [Age 28, MWH user]

1c. Cultural sensitivity of the services

MWH was built based on our culture, I can say it is exactly the same as my home [home away from home], and it is nearby the health centers where you can get professional care and [be] treated immediately if difficulties occur during childbirth. Also, it is an ideal place where pregnant women could share information among themselves. However, improving the absence of food catering and providing basic supplies for the duration of stay and basic sanitation would possibly satisfy users and increase future uptake of the service. [Age 30, MWH user]

Subtheme 2 Barriers to use MWH services

 2a. Substandard of care and services at MWHs

One of the discussants, a 28-year-old lady, said: I decided to stay in this home [MWH] and I was escorted by two of my relatives. The room had no partition for changing your clothes, was small, and couldn’t occupy more than three people at a time. How do you protect your privacy in this room with no space for the ones that accompanied you? Guess what will happen? You would rather prefer not to come here. [Age 28, MWH user]

There used to be food catering in [MWHs] during the time the community used to contribute for the service. But that stopped, so I brought my own food, but there was no money to continue buying food after two days. I didn’t have other options than to return back home. I also remember there were pregnant women who wanted to prepare their own food, but they couldn't because there were no designated area and utensils to cook. So, they had to buy food. [Age 32, MWH user]

For my last-child, as the health facility is quite far away from my residence and the time was rainy season, I had stayed in the MWH before delivery. It is good to have this kind of home where pregnant women can rest but I had noticed that cleanliness at the home [MWH] was poor and no one was responsible for it. [Age 24, MWH user]

 2b. Negative perception by healthcare providers

Even though we have good health care providers who make us feel as if we are at our home [health center] … I'm sorry to say that… there are few who discourage us from using [the] MWH. Literally, they encourage you to return back to your home as long as you have someone who would escort you to the facility when active labor begins. [Age 32, MWH non-user]

 2c. Lack of women’s autonomy

I knew about the existence of MWHs in my catchment [area] but I had to request my husband’s permission to use it. I and my husband made [a] joint decision about that during my last pregnancy; it would have been unlikely to use [the] MWH without his consent.[Age 20, MWH user]

 3d. Absence of someone to care for children at home

As you leave your home, someone has to take care of all the responsibilities you have at home, including the caring and rearing roles. [Age 20, MWH user]