Designing for Dignity: A Model for Women and Newborn Healthcare Settings in Honduras

Many women and infants in Honduras, primarily those from low-income and minority populations, lack access to dignified healthcare spaces that support the provision of quality care. Whether it is due to an unreasonable distance to the nearest healthcare facility or poor quality of the infrastructure that results in bypassing behavior, women and infants in Honduras face serious barriers to accessing quality services. This, in turn, results in adverse outcomes such as maternal mortality, low patient and staff satisfaction, and low utilization. This thesis proposes that the culturally relevant, patient-centered, and efficient design of maternity and newborn centers in Honduras can improve utilization and patient satisfaction, support quality care and positively impact desired maternal and infant outcomes. New facilities for women and newborns should be designed to support safe and efficient care, privacy, dignity, cultural sensitivity, and equity because merely addressing the distance people must travel to receive quality care is not enough to achieve the desired outcomes. Focusing on the primary level of care with the goal of providing healthcare services for all women in the country, the aim is to address the quality of the spaces to prevent bypassing behaviors. Furthermore, evidence has shown that the design of labor and delivery spaces can impact the physiological progression of labor. Elements such as access to nature, positive distractions, privacy, visibility of care providers, and daylight can affect women’s levels of stress and anxiety, sense of safety, and experience. While most research on maternity and newborn spaces has been conducted in high-income nations, supportive healthcare design can also be achieved in resource-limited contexts. This thesis used a mixed methods approach. A comprehensive literature review was completed to understand the impact of the built environment on maternal outcomes. Five site visits and six interviews were conducted to understand the needs of Honduran women. Finally, architectural case studies were evaluated to survey best practices for healthcare settings in low-resource contexts. The findings were used to establish design guidelines for maternity and newborn settings in Honduras. Each guideline was developed to include a definition of the issue, the rationale and significance of the guideline based on available evidence and design strategies illustrated by best practices. The guidelines were then used to design a proposal for a small maternity and newborn center as a proof-of-concept demonstration. This project is located in the Department of Intibucá, Honduras, a priority region for maternal health. It includes a maternity waiting home, outpatient services for prenatal and postnatal care, and inpatient services for labor, delivery, and postpartum.