Poverty, partner discord, and divergent accounts; a mixed methods account of births before arrival to health facilities in Morogoro Region, Tanzania

BMC Pregnancy and Childbirth

Research Article

Rachel P. Chase¹  Caitlin E. Kennedy¹  Joy J. Chebet¹  Peter J. Winch¹  Shannon A. McMahon²  Zaina Sheweji³  Giulia V. R. Besana⁴  Idda Mosha⁵ 

[1] Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 21205-2179, Baltimore, MD, USA;Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 21205-2179, Baltimore, MD, USA;Institute of Public Health, Heidelberg University, Im Neuenheimer Feld 324, D-69120, Heidelberg, Germany;Independent Consultant, Dar es Salaam, Tanzania;Monitoring & Evaluation Office, Jhpiego, PO Box 9170, Dar es Salaam, Tanzania;Independent Consultant, Moshi, Tanzania;School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania;

关键词: Tanzania;    Birth before arrival;    Maternal health;    Newborn health;    Spouses;    Poverty;    Social class;    Delivery;   

DOI  :  10.1186/s12884-016-1058-x

 received in 2015-02-04, accepted in 2016-09-01,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundBirths before arrival (BBA) to health care facilities are associated with higher rates of perinatal morbidity and mortality compared to facility deliveries or planned home births. Research on such births has been conducted in several high-income countries, but there are almost no studies from low-income settings where a majority of maternal and newborn deaths occur.MethodsDrawing on a household survey of women and in-depth interviews with women and their partners, we examined the experience of BBA in rural districts of Morogoro Region, Tanzania.ResultsAmong survey respondents, 59 births (4 %) were classified as BBAs. Most of these births occurred in the presence of a family member (47 %) or traditional birth attendant (24 %). Low socioeconomic status was the strongest predictor of BBA. After controlling for wealth via matching, high parity and a low number of antenatal care (ANC) visits retained statistical significance. While these variables are useful indicators of which women are at greater risk of BBA, their predictive power is limited in a context where many women are poor, multiparous, and make multiple ANC visits. In qualitative interviews, stories of BBAs included themes of partner disagreement regarding when to depart for facilities and financial or logistical constraints that underpinned departure delays. Women described wanting to depart earlier to facilities than partners.ConclusionAs efforts continue to promote facility birth, we highlight the financial demands associated with facility delivery and the potential for these demands to place women at a heightened risk for BBAs.

【 授权许可】

CC BY   
© The Author(s). 2016