Why give birth in health facility? Users’ and providers’ accounts of poor quality of birth care in Tanzania

Abstract

BackgroundIn Tanzania, half of all pregnant women access a health facility for delivery. The proportion receiving skilled care at birth is even lower. In order to reduce maternal mortality and morbidity, the government has set out to increase health facility deliveries by skilled care. The aim of this study was to describe the weaknesses in the provision of acceptable and adequate quality care through the accounts of women who have suffered obstetric fistula, nurse-midwives at both BEmOC and CEmOC health facilities and local community members.MethodsSemi-structured interviews involving 16 women affected by obstetric fistula and five nurse-midwives at maternity wards at both BEmOC and CEmOC health facilities, and Focus Group Discussions with husbands and community members were conducted between October 2008 and February 2010 at Comprehensive Community Based Rehabilitation in Tanzania and Temeke hospitals in Dar es Salaam, and Mpwapwa district in Dodoma region.ResultsHealth care users and health providers experienced poor quality caring and working environments in the health facilities. Women in labour lacked support, experienced neglect, as well as physical and verbal abuse. Nurse-midwives lacked supportive supervision, supplies and also seemed to lack motivation.ConclusionsThere was a consensus among women who have suffered serious birth injuries and nurse midwives staffing both BEmOC and CEmOC maternity wards that the quality of care offered to women in birth was inadequate. While the birth accounts of women pointed to failure of care, the nurses described a situation of disempowerment. The bad birth care experiences of women undermine the reputation of the health care system, lower community expectations of facility birth, and sustain high rates of home deliveries. The only way to increase the rate of skilled attendance at birth in the current Tanzanian context is to make facility birth a safer alternative than home birth. The findings from this study indicate that there is a long way to go.

Challenges in day-to-day midwifery practice; a qualitative study from a regional referral hospital in Dar es Salaam, Tanzania

“…Other factors of importance were personal struggles, shortage of staff, equipment availability, and unawareness and challenges in society. The feeling of demoralization and lack of motivation is in line with findings from other studies conducted in the region [15–17]. Positive support from supervisors have been demonstrated to be of importance for the quality of services that health workers are able to deliver [18].…”

“…Shortage of staff, equipment and facilities were other reported barriers to providing adequate midwifery care, a finding supported by other studies from the region [16,17]. Delivery attended by skilled personnel with appropriate supplies and equipment has been found to be strongly associated with reduction of child and maternal mortality [23,24].…”

“…Women giving birth in healthcare facilities in Tanzania report limited support, neglect and physical and verbal abuse during labor [17]. A possible way to alter the midwives’ bad reputation is tackling some of the other challenges they face.…”

Factors affecting effective ventilation during newborn resuscitation: a qualitative study among midwives in rural Tanzania

“…Although this comment was directed at only a few individuals, other studies in Tanzania and Kenya have highlighted similar issues, such as midwives’ lack of motivation due to poor working conditions, and the feeling of not being recognized by their supervisors [25–28]. Motivating health-care workers in resource-poor settings can sometimes be a challenge.…”

The Use of Maternal Health Services in Nigeria: Does Ethnicity and Religious Beliefs Matter?

“…Hence, among possible ways to improve pregnancy outcome is by understanding the underlying causes of disparities within a given country or geopolitical region. Religion and ethnicity are part of the fabrics of culture of defined population and has been reported as a pointer to low utilization rate of maternal health services and poor pregnancy outcomes even in developed [14][15][16] and developing countries [17][18][19]. In general, poor pregnancy outcome has been reported to be common among pregnant women with low use of ANC and delivery services [20,21].…”