By Esther Karin Mngodo
Dar es Salaam. In lessening maternal and infant mortality rate, the government of Tanzania and various health stakeholders have made efforts to improve healthcare delivery and encourage women to deliver in health centres. This is one of the 17 sustainable development goals. The target is to reduce the global maternal mortality ratio to less than 70 per 100, 000 live births by 2030.
The maternal mortality rate in Tanzania is still high. The 2015-16 Tanzania Demographic and Health Survey & Malaria Indicator Survey (2015-16 TDHS-MIS) shows that there are 556 deaths per every 100,000 live births. Nevertheless, there are notable measures to increase awareness about the importance of delivering in health facilities. Statistics show that there was a 10 percent increase of the number of women who delivered in health facilities from 2013 to 2014 and a 2 percent decrease of the number of women who deliver at home.
Looking closer, we see through data provided by the Ministry of Health that 1,073,348 women delivered in health facilities in 2013. The number went higher in 2014, up to 1,195,749 women. Furthermore, there were 101,917 women who delivered at home in 2013, and 98,831 women in 2014.
Various digital tools such as the one created by Code4Africa, that help an expecting mother and the society around her, to find a health facility nearby.
Five regions where most women deliver at a health facility
According to the 2015-16 TDHS-MIS report, Tanzanian women deliver in health facilities more than any other location. The data show that 6 out of 10 women deliver in a health facility. More than half (51 percent) go to a public facility.
Dar es Salaam Region is the leading, whereby 128,853 delivered in health facilities (10.8 percent); Mwanza, 79,077 women (7 percent); Mbeya, 78,732 women (7 percent); Dodoma, 63,208 women (5 percent); and Tabora, 61,457 women (5 percent).
HIV care and treatment for expectant women
Mbeya Region has the highest number of HIV care and treatment centres, as there are 317 centres out of 2, 672 available countrywide (11.9 percent).
According to the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) data, collected between October 2014 and September 2015, 7 per cent of pregnant women in Mbeya are HIV positive. Among them, 95 percent were given antiretroviral (ARV) drugs to maximally suppress the HIV virus and stop the progression of HIV disease. The PEPFAR data also shows that Mbarali district in Mbeya region has the most number of pregnant women who are HIV positive, followed by Kyela district that is in the same region.
A BMC Pregnancy and Childbirth report (2016) titled, ‘Birth preparedness and place of birth in Tandahimba district, Tanzania: what women prepare for birth, where they go to deliver, and why’ shows that the society is responding positively to health facility delivery for the safety of the mother and the newborn. This can be credited to “Increased education of mothers and fathers about maternal and newborn health, both received at health facilities during antenatal care; special efforts being made to sensitise women who are young or primiparous or have had five or more children about the necessity of them delivering in a hospital due to their increased risk of complications; women having previously experienced complications and therefore understanding the importance of health facility delivery; women generally having positive experiences at the health facility and choosing to return for future births; the prohibition of homebirths in some villages often through the use of fines for mothers or for traditional birth attendants who may be assisting them; an increased number of facilities and more reliable modes of transportation, namely motorbikes,” reads part of the report.
Five regions with most home deliveries
There are more women in Mara region delivering at home than any other in the country. Statistics show that in 2014, 10,586 women delivered at home (10.7%); Kagera, 9,354 women (9.4%); Simiyu, 8,336 women (8.4%); Dar es Salaam, 7,562 women (7.7%); and Mbeya, 7,171 women (7.3%).
The BMC Pregnancy and Childbirth report also outlines why women deliver at home. It shows that most of them want to deliver at a health facility but end up delivering at home for various reasons, including, instances when their partners have travelled while they are in labour, being left alone at home. In turn, they might fail to pay for their transportation to a nearby health facility. For most of the time, it is the man who takes care of the transportation, including clearing the bill. The study also draws interesting discovery, that in some cases, even if the man has left some money for transportation, the woman would still not go on her own. This shows that at such a time, the expectant mother needs her partner or a close relative to help make crucial decisions quickly.
For those who deliver at home while their partners were present, the study indicates that there would be some dissatisfaction with the quality of care at the health facility that contributed to this decision.
Delivering in urban areas or in the rural, what’s the difference?
There is a huge difference of where women give birth between rural and urban deliveries. The TDHS 2015-16 report shows that 12.8 percent of women who deliver in urban areas, deliver at home, while 86.4 percent deliver in health facilities. On the other hand, there are more women who deliver at home in rural areas (44 percent) compared to urban areas, while 53.7 percent of rural women deliver in health facilities.
A UNICEF report ‘Children and Women in Tanzania’ (2010), shows that women in rural areas face more challenging delivery environment compared to urban women, regardless of where they deliver. Although there are more women who deliver in rural areas (80 percent), urgent care for expecting women is still poor. And only a quarter of health facilities in rural areas are equipped with the right services and infrastructure that a woman needs at the time of delivery.
Five regions with the higher number of deliveries
A 2014 report show that 10 percent of all children in Tanzania are born in Dar es Salaam, where about 141,098 deliveries were done in a year. In Mbeya, there were 90,823 deliveries (6.5 percent); Mwanza, 89,749 deliveries (6 percent); Dodoma, 73,381 deliveries (5 percent); and Tabora, 71,032 deliveries (5 percent).
Five regions with the lowest number of deliveries
On the other spectrum, Katavi has the lowest number of deliveries with 20,491 deliveries a year (1.5 percent); Njombe, 23,887 deliveries (1.7 percent); Lindi, 27131 deliveries (1.9 percent); Iringa, 33651 deliveries (2.4 percent) and Mtwara, 38,264 deliveries (2.7 percent).