Abstract
In Tanzania, maternal mortality has stagnated over the last 10 years, and some of the areas with the worst indicators are in the Lake and Western Zones. This study investigates the factors associated with institutional deliveries among women aged 15–49 years in two regions of the Lake Zone. Data were extracted from a cross-sectional household survey of 1,214 women aged 15–49 years who had given birth in the 2 years preceding the survey in Mara and Kagera regions. Logistic regression analyses were conducted to explore the influence of various factors on giving birth in a facility. About two-thirds (67.3%) of women gave birth at a health facility. After adjusting for possible confounders, six factors were significantly associated with institutional delivery: region (adjusted odds ratio [aOR], 95% confidence interval [CI]: 0.54 [0.41–0.71]), number of children (aOR, 95% CI: 0.61 [0.42–0.91]), household wealth index (aOR, 95% CI: 1.47 [1.09–2.27]), four or more antenatal care visits (aOR, 95% CI: 1.97 [1.12–3.47]), knowing three or more pregnancy danger signs (aOR, 95% CI: 1.87 [1.27–2.76]), and number of birth preparations (aOR, 95% CI: 6.09 [3.32–11.18]). Another three factors related to antenatal care were also significant in the bivariate analysis, but these were not significantly associated with place of delivery after adjusting for all variables in an extended multivariable regression model. Giving birth in a health facility was associated both with socio-demographic factors and women’s interactions with the health care system during pregnancy. The findings show that national policies and programs promoting institutional delivery in Tanzania should tailor interventions to specific regions and reach out to low-income and high-parity women. Efforts are needed not just to increase the number of antenatal care visits made by pregnant women, but also to improve the quality and content of the interaction between women and service providers.
Highlights
Maternal mortality is one of the most daunting health challenges facing the world today [1]
A small minority of women did not make any antenatal care (ANC) visits (6%) and were significantly less likely to deliver in a facility than women who made at least one ANC visit
Our study shows a significant association between institutional delivery and three socio-demographic variables and three variables reflecting women’ interactions with the health care system
Summary
Maternal mortality is one of the most daunting health challenges facing the world today [1]. One important global strategy to reduce maternal and perinatal deaths in low- and middleincome countries, such as Tanzania, is to increase the number of women giving birth in a health facility [6,7,8,9]. A mid-term review of the national strategic plan to accelerate the reduction in maternal, newborn, and child deaths in Tanzania (2008–2015) showed a disparity in skilled birth attendance coverage across the country’s six zones, with the lowest rates in Western and Lake Zones [6]. The regions of the Lake Zone have some of the worst maternal health indicators in the country and have been prioritized by the government for strategic investments and interventions given their poor coverage of key reproductive, maternal, newborn and child health (RMNCH) interventions, such as skilled birth attendance, postnatal care, and family planning [6]. According to the 2015–16 Tanzania Demographic and Health Survey (TDHS), 97% of women in the Lake Zone attended at least one antenatal care (ANC) visit during pregnancy, but the institutional delivery rate was only 49.8% [3]
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