Maternal Health: Why Women Die at Birth in Rural Tanzania

Tanzania’s government would like more than 80 percent of births to be overseen by skilled health care providers. 

Evidence shows that delivering in a health facility with a skilled birth attendant with access to medications, supplies and surgery as needed reduces deaths of both mothers and their infants.

The country has limited resources for rural districts. It has very few skilled birth attendants and a shortage of medical supplies.

In rural Rorya region, approximately 40 percent of women aren’t in the care of medical staff at hospitals or clinics when they deliver their babies. Instead they give birth at home, sometimes with a traditional birth attendant.

The region has the one of the lowest facility birth rates in the country. As a result, women die unnecessarily every year from treatable complications such as bleeding after delivery.
40 Percent of Tanzanian Women Lack Proper Maternal Care 

The main problems we identified by speaking to both mothers and fathers were poor transportation, a shortage of medical equipment and supplies and disrespectful medical staff.

We found that community members and policymakers had similar priorities for improving maternal health. These involve social and structural changes such as accessibility to health facilities. Similar barriers have been found in research done in other rural regions of Africa. The challenge is now how to address them.

In November 2015 a research team conducted four discussion groups with couples who had recently had babies, as well as with community leaders from four areas in Rorya, a northern Tanzania district. One discussion group was held with policy makers from the Rorya District Medical Office.

Participants shared their ideas with the whole group. Each group was then split into men and women. This was important because it enabled women to speak freely. Many women in rural Tanzania are not comfortable voicing their opinions in front of men.

The first common theme was transport to health facilities. Many of the villages are located several kilometres from their designated dispensary. One woman described her experience of walking two hours each way to attend prenatal care, which became more difficult as her pregnancy progressed.

Some forms of transport, such as motorcycle taxis, were cited as unaffordable or not available on a regular basis. Community members also reported that it was hard to get an ambulance in an emergency because the patient first had to get to a dispensary.

The second common theme was a lack of equipment, medication and other supplies at health facilities. Women are often required to purchase supplies for their delivery, like gloves and medication, from local pharmacies. This is a cost they cannot afford.

Another concern was the disrespectful attitudes of nurses and midwives at the health facility. Health care providers were said to use negative language towards expectant mothers, for example chastising them for coming late or not being prepared for delivery.

Community members said this problem was severe, common and beyond their capacity to address. In two groups, men said some people paid bribes to health care providers to get their cooperation. Community members also said they needed more health care providers and better education for women about safe delivery.

The policymaker consultation group chose a slightly different process. But they came up with similar priorities to community members for improving women’s access to health care facilities. The group first drew up its priority risks and then ranked them according to severity, probability, and the capacity of a community health worker to deal with the issue. - The Conversation 

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