Maternal health in fifty years of Tanzania independence: Challenges and opportunities of reducing maternal mortality

Abstract

High rate of maternal death is one of the major public health concerns in Tanzania. Most of maternal deaths are caused by factors attributed to pregnancy, childbirth and poor quality of health services. More than 80% of maternal deaths can be prevented if pregnant women access essential maternity care and assured of skilled attendance at childbirth as well as emergency obstetric care. The objective of this review was to analyse maternal mortality situation in Tanzania during the past 50 years and to identify efforts, challenges and opportunities of reducing it. This paper was written through desk review of key policy documents, technical reports, publications and available internet-based literature. From 1961 to 1990 maternal mortality ratio in Tanzania had been on a downward trend from 453 to 200 per 100,000 live births. However, from 1990's there been an increasing trend to 578 per 100,000 live births. Current statistics indicate that maternal mortality ratio has dropped slightly in 2010 to 454 per 100,000 live births. Despite a high coverage (96%) in pregnant women who attend at least one antenatal clinic, only half of the women (51%) have access to skilled delivery. Coverage of emergence obstetric services is 64.5% and utilization of modern family planning method is 27%. Only about 13% of home deliveries access post natal check-up. Despite a number of efforts maternal mortality is still unacceptably high. Some of the efforts done to reduce maternal mortality in Tanzania included the following initiatives: reproductive and child survival; increased skilled delivery; maternal death audit; coordination and integration of different programs including maternal and child health services, family planning, malaria interventions, expanded program on immunization and adolescent health and nutrition programmes. These initiatives are however challenged by inadequate access to maternal health care services. In order to considerably reduce maternal deaths some of recommended strategies include: (i) strengthening the health system to provide skilled attendance during child birth; (ii) upgrading rural health centres to provide emergency obstetric services; (iii) providing adolescent and male friendly family planning services; (iv) strengthening public-private partnership to ensure continuum of care; (v) supporting operational research to answer the immediate concerns of the health system; and (vi) strengthening community participation and women empowerment to take role of their own health and the family at large. In conclusion, maternal mortality ratio in Tanzania is unacceptably high and still very far from reaching the millennium development goals. Maternal health care services should focus on ensuring there is continuum of care through strengthening the health system; provision of good quality of health care in a well organized referral health system and operation research to support programme implementation. _________________________________________________________________________________

Reported Knowledge, Attitude and Practice of Antenatal Care Services among Women in Dodoma Municipal, Tanzania

“…Majority of the pregnant women in the present study 54% reported to have two visit of ANC from their previous pregnancy and about 15.4% only reported to have 4 visits of ANC visits. This observation gives a promising future to attain the Focused Antenatal Care campaign failure to reach a goal of at least 80% visit coverage in pregnant women [20].…”

“…However, the initiation of the program of ANC services requires good knowledge and awareness of appropriate preventive measures among the general public to ensure positive health behavior changes and reproductive health seeking habits in both partners [15].…”

Challenges of Maternal Health Services Utilizations and Provisions from Health Posts in Bale Zone, Oromiya Regional State, Southeast Ethiopia: Qualitative Study

“…Those challenges were; accessibility of maternal health care services is still inadequate particularly in rural and underserved areas, inadequate quality of health services provided by the health care system, the government budget allocation for health sector and inadequate numbers of skilled health workers, and still those available are unevenly distributed [3]. The another study conducted in Ethiopia reflected that Sociodemographics, socio-economic, socio-cultural and personal factors are also another challenges that decrease the communities' utilizations of maternal health care services [10].…”

“…More than 80% of maternal deaths can be prevented if pregnant women access essential maternity care like antenatal care, institutional delivery, postnatal care and assured of skilled attendance at childbirth as well as emergency obstetric care [3].…”

The effects of MCH insurance cards on improving equity in access and use of maternal and child health care services in Tanzania: a mixed methods analysis

“…Most are caused by factors attributed to delays in seeking care, lack of skilled birth attendants, and poor quality of health services [4–7]. More than 80% of deaths can be prevented if pregnant women access essential maternity care and are attended by a skilled provider at childbirth [2, 8, 9]. …”