Understanding the preference for homebirth; an exploration of key barriers to facility delivery in rural Tanzania

Moshi, Fabiola Vincent; Nyamhanga, Tumaini

doi:10.1186/s12978-017-0397-z

Cited by 34 publications

(70 citation statements)

References 16 publications

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“…Similar findings have been reported by a similar study done in Ethiopia [14]. The possible reason history of uneventful childbirth assisted with unskilled attendants which lower their risk perception towards childbirth [9].…”

Section: Discussionsupporting

confidence: 89%

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Determinants of preference for home childbirth over health facility childbirth among Women of Reproductive Age in Tanzania: An Analysis of Data from the 2015-16 Tanzania HIV and Malaria Indicators Survey

Moshi¹,

Mbotwa²

2020

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Background While evidence has shown an association between place of childbirth and birth outcomes, still factors contributing to the choice of home childbirth have not been adequately investigated.Childbirth assisted by unskilled birth attendants has been cited as a contributing factor for the high maternal and neonatal mortalities in low resources countries. This study aimed at determining determinants of preference for home childbirth assisted by unskilled attendants in Tanzania. MethodThe study used the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2015-16 TDHS-MIS) dataset. A total of 2286 women of reproductive age (15-49 years) who had childbirth within one year preceding the survey were included in the analysis. Both univariate and multivariable regression analysis was used to determine predictors for home-based childbirth.Results A total of 805(35.2%) of women had home childbirth assisted by unskilled providers. After adjusting for confounders, the determinants of preference for home childbirth were the level of education (primary education, AOR=0.666; p=0.001; secondary and higher education, AOR=0.417; p<0.001); not owning mobile phone, AOR= 1.312; p=0.018; parity (parity 2-4, AOR=1.594; p=0.004; Parity 5 and above, AOR=2.158; p<0.001); inadequate antenatal visits, AOR=1.406; p=0.001; wealth index (poorest, AOR=9.395; p<0.001; poorer, AOR=7.701; p<0.001; middle, AOR=5.961; p<0.001; richer, AOR=2.557; p<0.001) and Zones (Southern Highlands, AOR=0.189; p<0.001; Southern, AOR=0.225; p<0.001; Zanzibar, AOR=2.55; p<0.001).Conclusion There are large proportions of women who use home childbirth assisted by unskilled birth attendant's mainly traditional birth attendants (TBA). Predictors for home-based childbirth were being illiterate women, poor access to communication, inadequate antenatal visits, low socio-economic status and those from Zanzibar. Innovative strategies targeting these groups are highly needed to increase the use of health facilities for childbirth and hence reduce maternal and neonatal mortalities in Tanzania. BackgroundMaternal mortality remains a public health problem worldwide. In 2015 maternal mortality was the second leading cause of mortalities among women of reproductive age worldwide [1]. The majority of

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Section: Discussionsupporting

confidence: 89%

“…Home delivery is a risk factor for the health of both a mother and a newborn [9]. Most of the complications that arise when the woman is giving birth may lead to maternal and neonatal deaths [10].…”

mentioning

confidence: 99%

Determinants of preference for home childbirth over health facility childbirth among Women of Reproductive Age in Tanzania: An Analysis of Data from the 2015-16 Tanzania HIV and Malaria Indicators Survey

Moshi¹,

Mbotwa²

2020

Preprint

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“…The reason could be that male partners avoid financial implications associated with health facility childbirth. Avoidance of financial responsibility may be attributed to gender norms which influence men not to prioritize access to skilled birth attendance as pregnancy and childbirth are perceived to be women's affairs [22].. The access to maternal and child health in Tanzania is free [23] but there are some hidden cost associated with decision to choose health facility for childbirth.…”

Section: Discussionmentioning

confidence: 99%

“…Low risk perception towards pregnancy and childbirth could be another reason for some male partners to prefer home childbirth over health facility childbirth [22]. When they perceive pregnancy and childbirth is a normal process and not associated with risks may lower their intention to use health facility for childbirth.…”

Section: Discussionmentioning

confidence: 99%

Using the theory of planned behavior to explain birth in health facility intention among expecting couples in a rural setting Rukwa Tanzania: a cross-sectional survey

2020

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Background: According to the theory of planned behavior, an intention to carry out a certain behavior facilitates action. In the context of birth in health facility, the intention to use health facilities for childbirth may better ensure better maternal and neonatal survival. Little is known on the influence of the domains of theory of planned behavior on birth in health facility intention. The study aimed to determine the influence of the domains of theory of planned behavior on birth in health facility intention among expecting couples in the rural Southern Highlands of Tanzania. Methods: A community based cross-sectional study targeting pregnant women and their partners was performed from June until October 2017. A three-stage probability sampling technique was employed to obtain a sample of 546 couples (making a total of 1092 study participants). A structured questionnaire based upon the Theory of Planned Behavior was used. The questionnaire explored three main domains of birth in health facility intentions. These three domains included; 1) attitudes towards maternal services utilization, 2) perceived subjective norms towards maternal services utilization and 3) perceived behavior control towards maternal services utilization. Results: The vast majority of study participants had birth in health facility intention. This included 499(91.2%) of pregnant women and 488(89.7%%) of their male partners partner. Only perceived subjective norms showed a significant higher mean score among pregnant women (M = 30.21, SD = 3.928) compared to their male partners (M = 29.72, SD = 4.349) t (1090) = − 1.965 at 95% CI = -0.985 to − 0.002; p < 0.049. After adjusting for the confounders, no intention to use health facility for childbirth decreased as the attitude [pregnant women (B = − 0.091; p = 0.453); male partners (B = − 0.084; p = 0.489)] and perceived behavior control [pregnant women (B = − 0.138; p = 0.244); male partners (B = − 0.155; p = 0.205)] scores increase among both pregnant women and their male partners. Conclusion: Despite the fact that majority of study respondents had birth in health facility intention, the likelihood of this intention resulting into practice is weak because none of the domains of theory of planned behavior showed a significant influence. Innovative interventional strategies geared towards improving domains of intention is highly recommended in order to elicit strong intention to use health facilities for childbirth.

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“…Previous studies undertaken in rural Tanzania have also reported socio-cultural factors as one of the main determinants of maternal preference regarding place of birth [9]. For example, a socio-cultural tradition in some of the tribal cultures in Tanzania requires that when a married woman becomes pregnant for the rst time, she has to go back to her parent's home and the decisions of where to deliver rest on her mother [10].…”

Section: Introductionmentioning

confidence: 99%

Determinants for Choice of Home Birth over Health Facility Birth among Women of Reproductive Age in Tanzania: An Analysis of Data from the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey

Moshi

Mbotwa

2020

Preprint

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Background: While evidence has shown an association between place of birth and birth outcomes, factors contributing to the choice of home birth have not been adequately investigated. In Tanzania more than 30% of deliveries occur out of health facilities with more than 95% of those deliveries are assisted by non-medical providers who are often unskilled. Birth assisted by unskilled birth attendants has been cited as a contributing factor for the high maternal and neonatal mortalities in low-resources countries. This study aimed at identifying determinants of choice for home birth over health facilities in Tanzania.Method: This study used the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2015-16 TDHS-MIS) dataset. A total of 2286 women of reproductive age (15-49 years) who gave birth within one year preceding the survey were included in the analysis. Both univariate and multivariable regression analyses were used to determine predictors for the choice of home-based childbirth over health facility.Results: A total of 805 (35.2%) women had a home birth. After adjusting for confounders, the determinants for choice of home birth were the level of education [primary education, (AOR=0.666; p=0.001); secondary and higher education, (AOR=0.417; p<0.001)]in reference to no formal education; not owning a mobile phone, (AOR= 1.312; p=0.018); parity [parity 2-4, (AOR=1.594; p=0.004); parity 5 and above, (AOR=2.158; p<0.001)] in reference to parity 1; inadequate antenatal visits, (AOR=1.406; p=0.001); wealth index [poorest, (AOR=9.395; p<0.001); poorer, (AOR=7.701; p<0.001); middle, (AOR=5.961; p<0.001); richer, (AOR=2.557; p<0.001)] in reference to richest women and zones [Southern Highlands, (AOR=0.189; p<0.001); Southern, (AOR=0.225; p<0.001); Zanzibar, (AOR=2.55; p<0.001)] in reference to Western zone.Conclusion: A large proportion of women birth at home. Unskilled providers such as traditional birth attendants (TBAs), relatives or friends attend most of them. Predictors for home-based childbirth were lack of formal education, poor access to communication, poor uptake of antenatal visits, low socio-economic status, and geographical zone. Innovative strategies targeting these groups are needed to increase the use of health facilities for childbirth, thereby reducing maternal and neonatal mortality in Tanzania.

show abstract

Understanding the preference for homebirth; an exploration of key barriers to facility delivery in rural Tanzania

Cited by 34 publications

References 16 publications

Determinants of preference for home childbirth over health facility childbirth among Women of Reproductive Age in Tanzania: An Analysis of Data from the 2015-16 Tanzania HIV and Malaria Indicators Survey

Determinants of preference for home childbirth over health facility childbirth among Women of Reproductive Age in Tanzania: An Analysis of Data from the 2015-16 Tanzania HIV and Malaria Indicators Survey

Using the theory of planned behavior to explain birth in health facility intention among expecting couples in a rural setting Rukwa Tanzania: a cross-sectional survey

Determinants for Choice of Home Birth over Health Facility Birth among Women of Reproductive Age in Tanzania: An Analysis of Data from the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey

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