Access to institutional delivery care and reasons for home delivery in three districts of Tanzania

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Abstract

Introduction

Globally, health facility delivery is encouraged as a single most important strategy in preventing maternal and neonatal morbidity and mortality. However, access to facility-based delivery care remains low in many less developed countries. This study assesses facilitators and barriers to institutional delivery in three districts of Tanzania.

Methods

Data come from a cross-sectional survey of random households on health behaviours and service utilization patterns among women and children aged less than 5 years. The survey was conducted in 2011 in Rufiji, Kilombero, and Ulanga districts of Tanzania, using a closed-ended questionnaire. This analysis focuses on 915 women of reproductive age who had given birth in the two years prior to the survey. Chi-square test was used to test for associations in the bivariate analysis and multivariate logistic regression was used to examine factors that influence institutional delivery.

Results

Overall, 74.5% of the 915 women delivered at health facilities in the two years prior to the survey. Multivariate analysis showed that the better the quality of antenatal care (ANC) the higher the odds of institutional delivery. Similarly, better socioeconomic status was associated with an increase in the odds of institutional delivery. Women of Sukuma ethnic background were less likely to deliver at health facilities than others. Presence of couple discussion on family planning matters was associated with higher odds of institutional delivery.

Conclusion

Institutional delivery in Rufiji, Kilombero, and Ulanga district of Tanzania is relatively high and significantly dependent on the quality of ANC, better socioeconomic status as well as between-partner communication about family planning. Therefore, improving the quality of ANC, socioeconomic empowerment as well as promoting and supporting inter-spousal discussion on family planning matters is likely to enhance institutional delivery. Programs should also target women from the Sukuma ethnic group towards universal access to institutional delivery care in the study area.

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Most cited references 15

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Factors affecting home delivery in rural Tanzania.

Mwifadhi Mrisho, Joanna A Schellenberg, Adiel K Mushi … (2007)

Studies of factors affecting place of delivery have rarely considered the influence of gender roles and relations within the household. This study combines an understanding of gender issues relating to health and help-seeking behaviour with epidemiological knowledge concerning place of delivery. In-depth interviews, focus group discussions and participant observation were used to explore determinants of home delivery in southern Tanzania. Quantitative data were collected in a cross-sectional survey of 21,600 randomly chosen households. Issues of risk and vulnerability, such as lack of money, lack of transport, sudden onset of labour, short labour, staff attitudes, lack of privacy, tradition and cultures and the pattern of decision-making power within the household were perceived as key determinants of the place of delivery. More than 9000 women were interviewed about their most recent delivery in the quantitative survey. There were substantial variations between ethnic groups with respect to place of delivery (P<0.0001). Women who lived in male-headed households were less likely to deliver in a health facility than women in female-headed households (RR 0.86, 95% CI 0.80-0.91). Mothers with primary and higher education were more likely to deliver at a health facility (RR 1.30, 95% CI 1.23-1.38). Younger mothers and the least poor women were also more likely to deliver in a health facility compared with the older and the poorest women, respectively. To address neonatal mortality, special attention should be paid to neonatal health in both maternal and child health programmes. The findings emphasize the need for a systematic approach to overcome health-system constraints, community based programmes and scale-up effective low-cost interventions which are already available.

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User fee exemptions are not enough: out-of-pocket payments for 'free' delivery services in rural Tanzania.

Sandro Galea, Margaret Kruk, Peter C Rockers … (2008)

To identify the main drivers of costs of facility delivery and the financial consequences for households among rural women in Tanzania, a country with a policy of delivery fee exemptions. We selected a representative sample of households in a rural district in western Tanzania. Women who given birth within 5 years were asked about payments for doctor's/nurse's fees, drugs, non-medical supplies, medical tests, maternity waiting home, transport and other expenses. Wealth was assessed using a household asset index. We estimated the proportion of women who cut down on spending or borrowed money/sold household items to pay for delivery in each wealth group. In all, 73.3% of women with facility delivery reported having made out-of-pocket payments for delivery-related costs. The average cost was 6272 Tanzanian shillings (TZS), [95% Confidence Interval (CI): 4916, 7628] or 5.0 United States dollars. Transport costs (53.6%) and provider fees (26.6%) were the largest cost components in government facilities. Deliveries in mission facilities were twice as expensive as those in government facilities. Nearly half (48.3%) of women reported cutting down on spending or borrowing money/selling household assets to pay for delivery, with the poor reporting this most frequently. Out-of-pocket payments for facility delivery were substantial and were driven by high transport costs, unofficial provider payments, and preference for mission facilities, which levy user charges. Novel approaches to financing maternal health services, such as subsidies for transport and care from private providers, are required to reduce the cost barriers to attended delivery.

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Frequency and timing of antenatal care in Kenya: explaining the variations between women of different communities.

M Magadi, N. J. Madise, Daniela Rodrigues (2000)

Appropriate antenatal care is important in identifying and mitigating risk factors in pregnancy but many mothers in the developing world do not receive such care. This paper uses data from the 1993 Kenya Demographic and Health Survey to study the variations in the use of antenatal services in Kenya. The analysis is based on modelling the frequency and timing of antenatal visits using three-level linear regression models. The results show that the use of antenatal care in Kenya is associated with a range of socio-economic, cultural and reproductive factors. The availability and accessibility of health services and the desirability of a pregnancy are also important. Use of antenatal care is infrequent for unwanted and mistimed pregnancies; even women who use antenatal care frequently appear to be less consistent if a pregnancy is mistimed. The results also indicate that women are highly consistent in the use of antenatal care during pregnancies. The intra-woman correlation coefficient for the frequency of antenatal visits ranges between 50% and 80% with greater correlation for wanted pregnancies to women in urban areas.

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Author and article information

Contributors

Amon Exavery

Almamy Malick Kanté

Mustafa Njozi

Kassimu Tani

Henry V Doctor

Ahmed Hingora

James F Phillips

Journal

Journal ID (nlm-ta): Int J Equity Health

Journal ID (iso-abbrev): Int J Equity Health

Title: International Journal for Equity in Health

Publisher: BioMed Central

ISSN (Electronic): 1475-9276

Publication date Collection: 2014

Publication date (Electronic): 16 June 2014

Volume: 13

Page: 48

Affiliations

[1 ]Ifakara Health Institute, Plot 463, Kiko Avenue, Off Mwai Kibaki Road, Mikocheni, P.O. Box 78373, Dar es Salaam, Tanzania

[2 ]Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, USA

[3 ]Jhpiego, Dar es Salaam, Tanzania

[4 ]United Nations Office on Drugs and Crime, United Nations House, Abuja, Nigeria

Article

Publisher ID: 1475-9276-13-48

DOI: 10.1186/1475-9276-13-48

PMC ID: 4069087

PubMed ID: 24934657

SO-VID: 118387f7-d473-4584-b9ed-bc0d8b29968c

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 21 November 2013

Date accepted : 7 June 2014

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Access to institutional delivery care and reasons for home delivery in three districts of Tanzania

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Abstract

Introduction

Methods

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Most cited references 15

Factors affecting home delivery in rural Tanzania.

User fee exemptions are not enough: out-of-pocket payments for 'free' delivery services in rural Tanzania.

Frequency and timing of antenatal care in Kenya: explaining the variations between women of different communities.

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Cited by 42