Abstract
BackgroundAn increase in the uptake of skilled birth attendance is expected to reduce maternal mortality in low- and middle-income countries. In Tanzania, the proportion of deliveries assisted by a skilled birth attendant is only 64% and the maternal mortality ratio is still 398/100.000 live births. This article explores different aspects of quality of care and respectful care in relation to maternal healthcare. It then examines the influence of these aspects of care on the uptake of skilled birth attendance in Tanzania in order to offer recommendations on how to increase the skilled birth attendance rate.MethodsThis narrative review employed the “person-centered care framework for reproductive health equity” as outlined by Sudhinaraset (2017). Academic databases, search engines and websites were consulted, and snowball sampling was used. Full-text English articles from the last 10 years were included.ResultsUptake of skilled birth attendance was influenced by different aspects of technical quality of maternal care as well as person-centred care, and these factors were interrelated. For example, disrespectful care was linked to factors which made the working circumstances of healthcare providers more difficult such as resource shortages, low levels of integrated care, inadequate referral systems, and bad management. These issues disproportionately affected rural facilities. However, disrespectful care could sometimes be attributed to personal attitudes and discrimination on the part of healthcare providers. Dissatisfied patients responded with either quiet acceptance of the circumstances, by delivering at home with a traditional birth attendant, or bypassing to other facilities. Best practices to increase respectful care show that multi-component interventions are needed on birth preparedness, attitude and infrastructure improvement, and birth companionship, with strong management and accountability at all levels.ConclusionsTo further increase the uptake of skilled birth attendance, respectful care needs to be addressed within strategic plans. Multi-component interventions are required, with multi-stakeholder involvement. Participation of traditional birth attendants in counselling and referral can be considered. Future advances in information and communication technology might support improved quality of care.
Highlights
An increase in the uptake of skilled birth attendance is expected to reduce maternal mortality in lowand middle-income countries
The objective of this article is to review the determinants of quality of care and respectful care in Tanzania, in order to identify the gaps in service delivery that result in low uptake of skilled birth attendance
The aim is to provide a range of recommendations on how to increase the uptake of skilled birth attendance, with a possible positive effect on the reduction of maternal mortality. This narrative review presents part of the unpublished thesis of the first author, titled “Factors influencing the uptake of skilled birth attendance in Tanzania; a literature review”. This complete review was performed from February to August 2019, and presented an analysis of: societal and community factors influencing the uptake of skilled birth attendance; health-seeking behaviour leading to the decision to seek care; and the quality of maternal care in Tanzania
Summary
An increase in the uptake of skilled birth attendance is expected to reduce maternal mortality in lowand middle-income countries. This article explores different aspects of quality of care and respectful care in relation to maternal healthcare. It examines the influence of these aspects of care on the uptake of skilled birth attendance in Tanzania in order to offer recommendations on how to increase the skilled birth attendance rate. The MDG 5 target aimed to reduce the MMR by 75%, and SDG target 3.1 aims at a reduction to less than 70/100.000 live births [7, 8]. To reach these global goals, an accelerated increase in skilled birth attendance needs to take place
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