Birth preparedness and place of birth in Tandahimba district, Tanzania: what women prepare for birth, where they go to deliver, and why

Abstract

BackgroundAs making preparations for birth and health facility delivery are behaviours linked to positive maternal and newborn health outcomes, we aimed to describe what birth preparations were made, where women delivered, and why.MethodsOutcomes were tabulated using data derived from a repeated sample (continuous) quantitative household survey of women aged 13–49 who had given birth in the past year. Insights into why behaviours took place emerged from analysis of in-depth interviews (12) and birth narratives (36) with recently delivered mothers and male partners.ResultsFive hundred-twenty three women participated in the survey from April 2012–November 2013. Ninety-five percent (496/523) of women made any birth preparations for their last pregnancy. Commonly prepared birth items were cotton gauze (93 %), a plastic cover to deliver on (84 %), gloves (72 %), clean clothes (70 %), and money (42 %). Qualitative data suggest that preparation of items used directly during delivery was perceived as necessary to facilitate good care and prevent disease transmission. Sixty-eight percent of women gave birth at a health facility, 30 % at home, and 2 % on the way to a health facility. Qualitative data suggested that health facility delivery was viewed positively and that women were inclined to go to a health facility because of a perception of: increased education about delivery and birth preparedness; previous health facility delivery; and better availability and accessibility of facilities in recent years. Perceived barriers: were a lack of money; absent health facility staff or poor provider attitudes; women perceiving that they were unable to go to a health facility or arrange transport on their own; or a lack of support of pregnant women from their partners.ConclusionsThe majority of women made at least some birth preparations and gave birth in a health facility. Functional items needed for birth seem to be given precedence over practices like saving money. As such, maintaining education about the importance of these practices, with an emphasis on emergency preparedness, would be valuable. Alongside education delivered as part of focussed antenatal care, community-based interventions that aim to increase engagement of men in birth preparedness, and support agency among women, are recommended.

Unlocking community capabilities for addressing social norms/practices: Behavioural change intervention study to improve birth preparedness and complication readiness among pregnant women in rural Nigeria

“…The proportion that had antenatal care (76.6%) and health facility delivery practices (60%) compares with other studies carried out in Ghana (30) and Tanzania (44). The lower proportion in practice of facility delivery noted in this study could be explained by presence of some barriers common in rural areas such as inaccessibility in terms of distance, transport and cost (46).…”

Factors affecting home delivery among women living in remote areas of rural Zambia: a cross-sectional, mixed-methods analysis

“… 34 In the findings presented here, insufficient time, transportation challenges, and cost barriers were cited as reasons for delivering at home or on the way to a facility, which is highly consistent with existing literature. 10 , 31 , 35 , 36 Additionally, not having appropriate supplies or not being adequately prepared was a common theme among respondents and has also been observed in Tanzania. 36 …”

“… 10 , 31 , 35 , 36 Additionally, not having appropriate supplies or not being adequately prepared was a common theme among respondents and has also been observed in Tanzania. 36 …”

Involving men to improve maternal and newborn health: A systematic review of the effectiveness of interventions

“…Men can provide substantial practical [ 4 ], financial [ 5 ] and emotional [ 6 , 7 ] support to women and children to overcome demand-side barriers to accessing health services. Male involvement programs can also contribute to normalising care-seeking within households and communities [ 8 , 9 ]. Men can adopt, and encourage other household members to adopt, health-promoting behaviours at home such as improved nutrition and hygiene practices [ 10 ].…”