Household Decision-making about Delivery in Health Facilities: Evidence from Tanzania

Abstract

This study investigated how partners' perceptions of the healthcare system influence decisions about delivery-location in low-resource settings. A multistage population-representative sample was used in Kasulu district, Tanzania, to identify women who had given birth in the last five years and their partners. Of 826 couples in analysis, 506 (61.3%) of the women delivered in the home. In multivariate analysis, factors associated with delivery in a health facility were agreement of partners on the importance of delivering in a health facility and agreement that skills of doctors are better than those of traditional birth attendants. When partners disagreed, the opinion of the woman was more influential in determining delivery-location. Agreement of partners regarding perceptions about the healthcare system appeared to be an important driver of decisions about delivery-location. These findings suggest that both partners should be included in the decision-making process regarding delivery to raise rates of delivery at facility.

The Role of Social Norms in Institutional Delivery: Findings from A Survey in Makwanpur, Nepal

“…Past literature proposes that women who feel supported by their husbands are more likely to express their opinions about pregnancy and childbirth and participate in institutional delivery. 18,19,20,21 Here, IPC with husband demonstrates that when wives feel comfortable openly communicating with their partners about personal and family matters, they are more likely to participate in institutional delivery. These ndings may also show that families who give birth in institutions are more likely to discuss their options and make decisions jointly in general.…”

“…Interpersonal communication (IPC) with husband can in uence a woman's decision to participate in institutional delivery. 18,19,20,21 IPC with husband was measured using the average score of three items relating to spousal communication on topics of family matters, their child's health, and their personal needs and feelings. Questions were structured as, "In a typical month, how often do you talk to your husband about…" and were measured on a four-point scale from 0 (never) to 3 (more than four times).…”

“…Various studies point to the importance of female autonomy and husband support. 18,19,20,21 For instance, Morrison et al 20 found that some women in Makwanpur, Nepal have less decision-making power in their marital relationships and feel pressure to prioritize the needs and beliefs of their family members over their own, creating a fear of speaking up for institutional delivery. This nding was echoed by Onta et al, 21 who noted how the woman's role in her family could prevent her from delivering in a health facility.…”

Evaluation of a health promotion intervention associated with birthing centres in rural Nepal

“…A study in rural Nepal also established that the decision for uptake of the institutional birth services was influenced more by family members or family members and women and not by women alone [42]. Similarly, husbands' control over decision making regarding the birthplace was found in Tanzania [43] and Bangladesh [44].…”

Investigating Male Presence at Antenatal and Choice of Place for Child Delivery in Ghana

“…For instance, a husband's level of education was found to be associated with wives' use of maternal health care services in Nigeria and Ghana respectively [(10, 11), p. 3]; also, rural residences of males were found to be associated with lower participation in maternal healthcare [(12), p. 153]. However, Danforth et al [(13), p. 701]; Carter and Speizer [(12), p. 153] observed no association between a woman's use of maternal services and her husband's level of education amongst a sample of women in Tanzania. Also associated with maternal healthcare use is the region of the residence of males (10).…”