Globally, before 1990, 1600 women were estimated to die each day as a result of complications during pregnancy or childbirth. However, a large proportion of these deaths are preventable (Jowett 2000). In 2015, about 99% of maternal deaths  resulting  from  pregnancy related complications occurred in low and middle income countries where there is a prevalence of high fertility rates, a low skilled birth attendants, and weak health systems (UNICEF, 2009). From this percentage, sub-Saharan Africa  covers  makes  up  66% (WHO, UNICEF,UNFPA, 2015). These maternal deaths result from direct complications during delivery such as hemorrhage, sepsis, obstructed labour, hypertensive disorders of pregnancy and septic abortion (Austin et al., 2014; Biswas et al., 2016; WHO, UNICEF, UNFPA, 2015; World-Health-Organisation n.d.; Valentino and Kenya, 2009; UNICEF, 2009; Thaddeus and Maine, 1994; Singh et al., 2016; Odusola, 2013). The reduction of maternal mortality from obstetric complications cannot be possible unless women exposed to such complications receive timely and adequate obstetric care (Saaka et al., 2017; Ganle, 2016; Broughton et al., 2016; Engmann et al., 2016). Maternal mortality majorly occur due to distance and consequent delay in treatment during childbirth (Irene Figa, 2000). Also, according to 2013 World Health Statistics, showed that there are gaps in maternal mortality between the poor and rich regions. A high number of maternal and newborn deaths in some areas of the world occurs as a result of inequalities to access health services; this indicates the discrepancy between rich and poor(7,8). As a result, an average maternal mortality in countries with low income, lower middle income, upper middle income and high income groups were 410, 260, 53, and 14/100,000 live births, respectively (WHO, UNICEF, UNFPA 2015). 

Similarly, the proportion of mothers that do not survive childbirth compared to those that survive in low and middle income regions is still 14 times higher than that of the developed regions (Action, 2015). From this finding, Sustainable Development Goal (SDG) is working to reduce the global maternal mortality ratio to less than 70 per 100,000 live births and to end preventable deaths of newborns as much as possible to 12 per 1000 live birth in each country until 2030 (Derek et al., 2015). Before 1990 in this country, the maternal mortality was high due to problems emanated from both supply and demand. For supply, lack of qualified health professionals, inaccessibility of health facilities, unavailability of medical supplies, and drugs for those who are in need and hard to reach areas were issues that weaken the health system until the country introduced a 20-year health sector development program in 1977, which is being implemented (Banteyerga, 2011). As regards demand, lack of awareness, negative attitude and poor and harmful traditional practices were prior causes for maternal mortality back in the 1990s (WHO, 2016; WHO, UNICEF, UNFPA, 2015; World-Health-Organisation n.d.). In 1990, it was 1250 per 100,000 live births (WHO, 2016); but currently it has reduced to one third, from 1250 to 412 per 100,000 live births. This puts Ethiopia 31st in the world with average MMR of  412  (273-551)  per  100,  000 live births in 2016 (WHO, 2016; FDRE MOH, 2016). In poor and marginalized areas, cost, distance, and the time needed to access care are major barriers for effective utilization of maternal and child healthcare services (IN HEALTH, 2015). 

A number of innovative strategies to overcome cost, distance, and time barriers to access care were identified and evaluated; they include, community financial incentives, loan/ insurance schemes, and maternity waiting homes. In these areas or regions where maternal and neonatal mortality is high due to inaccessibility of facilities, the strategy to reduce such issue is very vital (World-Health-Organisation n.d.). A maternity waiting home was launched in 1950s and resulted in visible effect to reduce maternal and newborn mortality (WHO, 1996). In Canada, Nicaragua, Guatemala, Timor-Leste Finland carried out major efforts to reduce maternal and neonatal mortality (Cortez, 2012; Ruiz et al., 2013; Singh et al., 2017; WHO, 1996). The alleviation of maternal mortality catastrophe, so named Maternity Waiting Homes (MWHs) or Maternity Waiting Areas (MWAs), has various names at different settings with similar objective. Although there were plenty of challenges from supply and demand, its utilization had positive impacts in the improvement of maternal and child health in countries launched earlier and later. MWH is defined as a residence near a health facility with emergency obstetric care (EmOC) for mothers who are far from facilities to reside there until delivery and a part of postpartum period. In Africa, most western and eastern African countries were started to use MWHs and studies were conducted to assess the gaps, effectiveness and related topics. For instance Ghana in west Africa, Liberia in east Africa Ethiopia, Eritrea, Zambia, Zimbabwe, Kenya, Malawi were MHWs were launched and various studies were conducted to assess the gaps from different perspectives. 

After establishing inclusion and exclusion criteria, six papers met the inclusion and exclusion criteria from all the above databases for further review in the study. All were  facility  based studies  conducted  in  Ethiopia  from  1990s  and late 2000s (Endalew et al., 2016; (Gaym et al., 2012; Kelly et al., 2010; Poovan et al., 1990; Tiruneh et al., 2016). Three assessed the outcome and three were focused on the experience, coverage, predictors and contexts of MWHs in Ethiopia. In 1990, a hospital based prospective cohort with objective of MWHs effects on perinatal and maternal outcome was done (Poovan et al., 1990). Here, 151 mothers used and 635 mothers did not utilize the MWHs, from 1987 to 1990. This study showed that the perinatal mortality among non-utilizers mothers were ten times more than non-utilizers; about 28 and 254 perinatal death per 100,000 live births with RR =0.46 95% CI (0.33-0.66). Also, there is a visible difference in maternal mortality among users and nonusers of MWHs. No mother died among the users and there was 2047 MMR per 100,000 live births. This claimed that there is likely less risk of maternal and perinatal mortality among users than nonusers of MWHs. Another 22 years retrospective hospital based study conducted in Atat hospital was done in 2010. This showed that there is significant association between maternal and perinatal birth with MWHs utilization(Kelly et al. 2010). In this study, in a total of 24,148 deliveries, 6805 mothers attended MWHs and 17343 mothers did not utilize MWHs. 

Maternal mortality was 89.9 per 100 000 live births (95% CI, 41.1–195.2) for women who utilized MWHs and 1333.1 per 100 000 live births (95% CI, 1156.2–1536.7) for non-utilizers; stillbirth rates were 17.6 per 1000 births (95% CI, 14.8–21.0) and 191.2 per 1000 births (95% CI, 185.4–197.1). Consequently, there is a significant difference and advantage in decreasing maternal and perinatal mortality among utilizers than non-utilizers. The third study which was still facility based was done recently in 2012 with objective of describing the existing situations of MWHs in Ethiopia  (Gaym et al., 2012).  The overviews of the last thirty years history of MWHs were described. They only got information from the Federal Ministry of Health about the existing MWHs in five regions of the country. Based on this information, they assessed only nine facilities (eight hospital and one health center) with MWHs. This study tried to assess the admission criteria,  challenges,  numbers  of  utilizers  per each MWHs and duration of the stays. In addition cesarean section rate was higher among utilizers than non-utilizers. The strengths revealed the introduction period of MWHs in Ethiopia as it was started in 1985. The weaknesses in this study and the described issues are not representatives of the country’s status of MWHs phenomena in the last thirty years. This is because they used data from FMoH, which include only five regions, nine MWHs, and have not assessed the maternal and perianal mortality rate mentioned and studied on MWHs.  

Very recently, facility based cross sectional study in 2016 assessed the status quo of MWHs and the experiences and challenges of mothers using waiting homes. It included 134 health centers from four broad regions of the country. More so, it focus mainly on coverage, admission criteria, predictors or challenges as well as prevalence rate of utilization of MWHs among existing and functional MWHs (Tiruneh et al., 2016). However, the study never identified the impact and outcome of MWHs on maternal and perinatal mortality in detail. The last study was cross sectional facility based, aimed with assessing intention to use maternity waiting home among pregnant women in southwest Ethiopia. This showed that 38.7% of mothers had past history of MWHs utilization. About 48% women reported MWHs are very important to get better pregnancy outcome(Endalew et al., 2016). However, only one study revealed different predictors of maternity waiting homes utilization. They were schematized as finance, lack of knowledge, privacy, social support, custom and cultural influences and lack of social support. About 50% of MWHs share the sleeping room and only 6% of MWH have curtains for their privacy. After admission  to  the MWHs,  health  care  workers, especially  midwives,  performed  an  initial  evaluation  of pregnant women.  About 87% MWHs reported that a midwife/nurse made round to mothers primarily to follow-up the current pregnancy  (Gaym et al., 2012).