BackgroundTraditional birth attendants retain an important role in reproductive and maternal health in Tanzania. The Tanzanian Government promotes TBAs in order to provide maternal and neonatal health counselling and initiating timely referral, however, their role officially does not include delivery attendance. Yet, experience illustrates that most TBAs still often handle complicated deliveries. Therefore, the objectives of this research were to describe (1) women’s health-seeking behaviour and experiences regarding their use of antenatal (ANC) and postnatal care (PNC); (2) their rationale behind the choice of place and delivery; and to learn (3) about the use of traditional practices and resources applied by traditional birth attendants (TBAs) and how they can be linked to the bio-medical health system.MethodsQualitative and quantitative interviews were conducted with over 270 individuals in Masasi District, Mtwara Region and Ilala Municipality, Dar es Salaam, Tanzania.ResultsThe results from the urban site show that significant achievements have been made in terms of promoting pregnancy- and delivery-related services through skilled health workers. Pregnant women have a high level of awareness and clearly prefer to deliver at a health facility. The scenario is different in the rural site (Masasi District), where an adequately trained health workforce and well-equipped health facilities are not yet a reality, resulting in home deliveries with the assistance of either a TBA or a relative.ConclusionsInstead of focusing on the traditional sector, it is argued that more attention should be paid towards (1) improving access to as well as strengthening the health system to guarantee delivery by skilled health personnel; and (2) bridging the gaps between communities and the formal health sector through community-based counselling and health education, which is provided by well-trained and supervised village health workers who inform villagers about promotive and preventive health services, including maternal and neonatal health.
Analysis of societal dimensions is increasingly receiving attention in socialecological resilience research. This study investigates the impacts of neo-liberal marine conservation and economic policies, and environmental changes on the livelihoods of two fishing communities in Mafia Island Marine Park, Tanzania, and their response strategies towards attempting to maintain livelihood resilience. These communities are in similar geographical and administrative settings but differ in their proximity to Park headquarters, conformity to Park regulations and engagement in fish trade. Data were collected through in-depth interviews, focus group discussions, direct observation and questionnaire surveys. Interviewees from both villages reported increasing poverty in terms of reduced capacity to meet their basic needs, and decreases in numbers of meals per day, variety of foods and fish consumption, reduced access to resources, low productivity and prices of local produce. Women experienced raised household responsibilities for food security and meeting other household needs. Their main responses to these changes included loan seeking, reduction of expenditures, skipping meals, selling assets, collective fishing, livelihoods diversification, change of fishing techniques and gears, abandoning of fishing activity and outward migration. Their responses only contributed to survival without resolving the challenges. Paying attention to these societal experiences is therefore necessary, if resilience of socialecological systems in a marine conservation area is to be maintained or enhanced.
Marilyn Porter, Rosemarie Mwaipopo, Richard Faustine and Max Mzuma draw on data collected in two fishing communities in Tanzania to illustrate the global nature of the issues that women and coastal communities face. Coastal communities, such as Somanga and Songosongo, often suffer disproportionately from processes of interactive restructuring, and women are especially at risk. Development (2008) 51, 193–198. doi:10.1057/dev.2008.4
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