High ANC coverage and low skilled attendance in a rural Tanzanian district: a case for implementing a birth plan intervention

Abstract

BackgroundIn Tanzania, more than 90% of all pregnant women attend antenatal care at least once and approximately 62% four times or more, yet less than five in ten receive skilled delivery care at available health units. We conducted a qualitative study in Ngorongoro district, Northern Tanzania, in order to gain an understanding of the health systems and socio-cultural factors underlying this divergent pattern of high use of antenatal services and low use of skilled delivery care. Specifically, the study examined beliefs and behaviors related to antenatal, labor, delivery and postnatal care among the Maasai and Watemi ethnic groups. The perspectives of health care providers and traditional birth attendants on childbirth and the factors determining where women deliver were also investigated.MethodsTwelve key informant interviews and fifteen focus group discussions were held with Maasai and Watemi women, traditional birth attendants, health care providers, and community members. Principles of the grounded theory approach were used to elicit and assess the various perspectives of each group of participants interviewed.ResultsThe Maasai and Watemi women's preferences for a home birth and lack of planning for delivery are reinforced by the failure of health care providers to consistently communicate the importance of skilled delivery and immediate post-partum care for all women during routine antenatal visits. Husbands typically serve as gatekeepers of women's reproductive health in the two groups - including decisions about where they will deliver- yet they are rarely encouraged to attend antenatal sessions. While husbands are encouraged to participate in programs to prevent maternal-to-child transmission of HIV, messages about the importance of skilled delivery care for all women are not given emphasis.ConclusionsIncreasing coverage of skilled delivery care and achieving the full implementation of Tanzania's Focused Antenatal Care Package in Ngorongoro depends upon improved training and monitoring of health care providers, and greater family participation in antenatal care visits.

Perceptions about the cultural practices of male partners during postpartum care in rural Tanzania: a qualitative study

“…The digitally recorded FGDs were transcribed verbatim and entered into Open Code 3.4 to manage the data and facilitate the analysis [42]. Data were analyzed using qualitative content analysis [40].…”

Study of the Factors Associated with Home Delivery in a Situation of Free Care in Senegal

“…It often happens that women themselves ignore the delivery period. Some women believe that childbirth is an unpredictable event [18] [19]. Particular emphasis should be place on the planning of delivery during ANC.…”

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“…These zones are predominantly belonging to Hausa, Fulani and Kanuri ethnic groups and adherents of the Islam faith constituting well over half the population in these zones. Ethnicity and religious beliefs were reported to have negative influence on the use MHS particularly where there is a lack of female health workers and large gap in knowledge on the benefits of modern obstetric care [18,24]. The impact of cultural beliefs on the use of MHS is exemplified by a study in some parts of North Western Nigeria, where it was reported the lithotomy position is embarrassing and demeaning particularly in the presence of non-family members such as health workers [25].…”

“…Overall this indicates the freedom of movement by married women as a variable to assess her level of autonomy showed variation among cultures of different parts of the world. Several studies have been reported on the poor use of MHS in East [18,29] and West [28,[30][31][32][33][34] African countries had indirectly suggested significant proportion of women are fully dependent on their husband and family in order to pay for services rendered in health facilities. By extension the authors in our opinion have indicated that, these women lack financial independence, incapable to decide on where and when to go and to get medical services as they are dependent on financial and mind set of whoever is going to pay their health bills.…”

“…In order to measure female autonomy in the context of MHS, we have used three variables namely: a) income independence (having a paying job); b) participation in family level decision making process on health issues; and c) freedom to go out of her matrimonial home on health issues without the need to ask for permission from anybody. The influence of these variables on the use of MHS were well documented, however, research in countries with similar challenges on women empowerment and equality was reported to be unequivocal [8,9,17,18]. These studies suggested the need for more community based studies in order to provide better insights on the influence of these variables on MHS.…”