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‘She needs permission’: A qualitative study to examine barriers and enablers to accessing maternal and reproductive health services among women and their communities in rural Tanzania

Karen Yeates(1), Sidonie Chard(2), Alexa Eberle(3), Alexandra Lucchese(4), Nicola West(5), Melinda Chelva(6), Prisca Dominic Marandu(7), Graeme Smith(8), Sanchit Kaushal(9), Zacharia Mtema(10), Erica Erwin(11), Anna Nswilla(12), Robert Philemon Tillya(13),


(1) Department of Medicine, Queen’s University, Kingston, Ontario, Canada
(2) Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
(3) Center for Clinical Epidemiology, Lady Davis Institute, McGill University, Montreal, QC, Canada
(4) Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada
(5) Pamoja Tunaweza Women’s Centre, Moshi, Tanzania
(6) Department of Medicine, Queen’s University, Kingston, Ontario, Canada
(7) Pamoja Tunaweza Women’s Centre, Moshi, Tanzania
(8) Department of Obstetrics and Gynecology, Queen’s University, Kingston, Ontario, Canada
(9) Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada
(10) Ifakara Health Institute, Tanzania
(11) BORN Ontario/Obstetrics and Maternal Newborn Investigations, Ottawa, Ontario, Canada
(12) Ministry of Health, Department of Policy and Planning, Tanzania
(13) Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Tanzania
Corresponding Author

Abstract


The objective of this study was to examine the factors which serve as barriers and enablers to accessing maternal and reproductive health services among women in rural Tanzania. A qualitative study, utilizing focus group discussions (FGDs), was conducted in three districts. An interview guide was developed that focused on individual or community-based factors affecting women’s access to reproductive and maternal health services. Data was collected during December 2017 and May 2018, and analyzed using a thematic approach. The barriers included a lack of autonomy, lack of knowledge and education, travel and transportation barriers, lack of financial resources, lack of infrastructure, lack of confidentiality, lack of male involvement, cultural beliefs, and the use of traditional birth attendants. In contrast, the increased autonomy for women and the implementation of government policies were identified as enablers. Innovations need to be identified that address these barriers in order to increase access to maternal and reproductive health services in these districts. (Afr J Reprod Health 2021; 25[3s]: 121-134).

References


Shabani J, Todd G, Nswilla A and Mbaruku G. Maternal

mortality in urban and rural Tanzania Social determinants and health system efficiency. Policy brief 40424 | October 2018 International Growth Centre (www.theigc.org)

Ministry of Health, Community Development, Gender,

Elderly and Children (MoHCDGEC) [Tanzania Mainland], Ministry of Health (MoH) [Zanzibar], National Bureau of Statistics (NBS), Office of the Chief Government Statistician (OCGS), and ICF. Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS) 2015-16. Dar es Salaam, Tanzania, and Rockville: MoHCDGEC, MoH, NBS, OCGS, and ICF; 2016.

Shija A, Msovela J and Mboera L. Maternal health in fifty

years of Tanzania independence: Challenges and opportunities of reducing maternal mortality. Tanzania Journal of Health Research. 2012;13(5):352-64.

Maluka S, Joseph C, Fitzgerald S, Salim R and Kamuzora

P. Why do pregnant women in Iringa region in Tanzania start antenatal care late? A qualitative analysis. BMC Pregnancy and Childbirth. 2020;20(1).

Savage A and Hoho L. Knowledge of pre-eclampsia in

women living in Makole Ward, Dodoma, Tanzania. African Health Sciences. 2016;16(2):412.

von Both C, Flebetaa S, Makuwani A, Mpembeni R and

Jahn A. How much time do health services spend on antenatal care? Implications for the introduction of the focused antenatal care model in Tanzania. BMC pregnancy and childbirth. 2006;6(1):6-22.

Nyamtema AS, Bartsch-de Jong A, Urassa DP, Hagen JP

and van Roosmalen J. The quality of antenatal care in rural Tanzania: what is behind the number of visits? BMC pregnancy and childbirth. 2012; 12:70.

Magoma M, Requejo J, Merialdi M, Campbell OM,

Cousens S and Filippi V. How much time is available for antenatal care consultations? Assessment of the quality of care in rural Tanzania. BMC pregnancy and childbirth. 2011; 11:64.

Villar J and Bergsjo P. WHO Antenatal Care Randomized

Trial: Manual for the Implementation of the New Model Geneva: WHO; 2002.

Ndidi EP and Oseremen IG. Reasons given by pregnant

women for late initiation of antenatal care in the Niger delta, Nigeria. Ghana Med J. 2010; 44:47–51.

Magadi MA, Agwanda AO and Obare FO. A comparative

analysis of the use of maternal health services between teenagers and older mothers in sub-Saharan Africa: evidence from Demographic and Health Surveys (DHS). Soc Sci Med. 2007; 64:1311–25.

Kiwuwa MS and Mufubenga P. Use of antenatal care,

maternity services, intermittent presumptive treatment and insecticide treated bed nets by pregnant women in Luwero district, Uganda. Malaria J. 2008; 7:44.

Ndidi EP and Oseremen IG. Reasons given by pregnant

women for late initiation of antenatal care in the Niger delta, Nigeria. Ghana Med J. 2010; 44:47–51.

Bbaale E. Factors influencing the utilisation of antenatal

care in Uganda. AMJ. 2011;4(9):516–26.

https://cdn2.sph.harvard.edu/wp-

content/uploads/sites/32/2014/09/HSPH Tanzania5.pdf

Oppermannt M. Triangulation-A Methodological

Discussion. Int J Tour res. 2000; 2:141-6.

Cresswell JW and Plano Clark VL. Designing and

Conducting Mixed Methods Research. Third Edition. SAGE Publications, Inc. ISBN: 9781483344379. 2018.

Baral YR, Lyons K, Skinner J and van Teijlingen ER.

Determinants of skilled birth attendants for delivery in Nepal. Kathmandu University. Med J. 2010; 8(No. 3|Issue 31):325–332.

Shiferaw S, Spigt M, Godefrooij M, Melkamu Y and

Tekie M. Why do women prefer home births in Ethiopia? BMC Pregnancy Childbirth. 2013; 13:5

Margaret E, Kruk MP, Mbaruku G, de Pinho H and Galea

S. Women’s preferences for place of delivery in rural Tanzania: a population-based discrete choice experiment. Am J Public Health. 2009; 99:1666–1672.

Mgata S and Maluka SO. Factors for late initiation of

antenatal care in Dar es Salaam, Tanzania: A qualitative study. BMC Pregnancy and Childbirth. 2019 Nov 12;19(1).

Maluka SO, Joseph C, Fitzgerald S, Salim R and

Kamuzora P. Why do pregnant women in Iringa region in Tanzania start antenatal care late? A qualitative analysis. BMC Pregnancy and Childbirth. 2020 Feb 24;20(1).

Tancred T, Marchant T, Hanson C, Schellenberg J and

Manzi F. Birth preparedness and place of birth in Tandahimba district, Tanzania: what women prepare for birth, where they go to deliver, and why. BMC Pregnancy Childbirth. 2016;16(65).

Kowalewski M, Jahn A and Kimatta SS. Why do at-risk

mothers fail to reach referral level? Barriers beyond distance and cost. Afr J Reprod Health. 2000 Apr 4(1):100-9.

John T, Mkoka DA, Frumence G and Goicolea I. An

account for barriers and strategies in fulfilling women’s right to quality maternal health care: a qualitative study from rural Tanzania. BMC Pregnancy Childbirth. 2018;18(352).

Guidance on provider-initiated HIV testing and

counselling in health facilities. 1.AIDS serodiagnosis. 2.HIV infections - diagnosis. 3.Counselling. 4.Guidelines. I.World Health Organization. II.UNAIDS. ISBN 978 92 4 159556 8 (NLM classification: WC 503.1)

Nyamtema AS, Bartsch-de Jong A, Urassa DP, Hagen JP,

van Roosmalen J. The quality of antenatal care in rural Tanzania: what is behind the number of visits? BMC pregnancy and childbirth 2012; 12: 70

Maluka SO and Peneza AK. Perceptions on male

involvement in pregnancy and childbirth in Masasi District, Tanzania: a qualitative study. Reprod Health. 2018;15(68).

Ganle JK and Dery I. 'What men don't know can hurt

women's health': a qualitative study of the barriers to and opportunities for men's involvement in maternal healthcare in Ghana. Reprod Health. 2015 Oct 10; 12:93.

Moshi FV, Kibusi SM and Fabian F. The Effectiveness of

Community-Based Continuous Training on Promoting Positive Behaviors towards Birth Preparedness, Male Involvement, and Maternal Services Utilization among Expecting Couples in Rukwa, Tanzania: A Theory of Planned Behavior Quasi-Experimental Study. J Environ Public Health. 2018 Sep 27;1293760.

Scott S, Kendall L, Gomez P, Howie SRC, Zaman SMA,

Ceesay S, D’Alessandro U and Jasseh M. Effect of maternal death on child survival in rural West Africa: 25 years of prospective surveillance data in The Gambia. PLOS ONE. 2017 Feb 22;12(2): e0172286.

Shimpuku Y, Madeni FE, Shimoda K, Miura S and

Mwilike B. Perceived differences on the role of traditional birth attendants in rural Tanzania: a qualitative study. BMC Pregnancy Childbirth. 2021; 21:137.


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