Tiffany Lo-Art in Tanzania Internship
In Tanzania, there are 566 maternal deaths for every 100,000 live births, which represents the sixth highest maternal mortality ratio in the world, according to the Tanzania Demographic and Health Survey (Gailey and McMillan, 2019). The Kigoma Region, which is located in western Tanzania, has the poorest maternal health outcomes in the country (Gailey and McMillan, 2019).
In Tanzania, public health policy and program implementation is overseen by the Ministry of Health and Social Welfare (MOHSW) (Franz, 2015). The point of entry for mothers and children into the public health system is the community-level dispensary, where patients can access exams, medical supplies, medicines, immunization services and seek advice from a nurse or clinical officer (Franz, 2015). Some dispensaries are also prepared for labor and delivery services, and many also offer HIV treatment options and services for prevention of mother-to-children transmission of HIV (Franz, 2015). However, for more comprehensive healthcare services or physician consultations, mothers must visit a health center, which typically offers a wider range of services than the dispensary and may serve several communities (Franz, 2015).
Most maternal deaths are caused by factors that can be attributed to pregnancy, childbirth, and low quality of health services (Shija et. al, 2011). More than 80% of maternal deaths can be prevented if women have access to essential maternity care and skilled attendance at childbirth as well as emergency obstetric care (Shija et. al, 2011).
Maternal Health Indicators:
Antenatal Care Coverage
Antenatal care can help women adequately prepare for delivery and understand warning signs during pregnancy and childbirth (Unicef, 2020). Essential interventions in antenatal care include identification and management of obstetric complications such as pre-eclampsia, tetanus toxoid, immunization, intermittent preventive treatment for malaria during pregnancy, and identification and management of infections such as HIV, syphilis, and other sexually transmitted infections (STIs) (Lincetto et. al, n.d.). Antenatal care is also an opportunity to promote the usage of skilled attendants at birth and healthy behaviors such as breastfeeding, early postnatal care, and planning for pregnancy spacing (Lincetto et. al, n.d.). There have been large increases in the proportion of Tanzanian women who made one to three antenatal care visits from 26.4% in 1999 to 47.0% in 2016 (Rwabilimbo et. al, 2020). In rural areas, 45% of women made at least 4 antenatal care visits compared to 64% in urban areas (Unicef, n.d.).
Skilled Birth Deliveries
Skilled birth attendance is a key factor in indicating maternal health, however, less than 50% of women in sub-Saharan African countries lack the opportunity to be attended by skilled personnel during childbirth (Ngowi, 2017). Major causes of maternal mortality are preventable if a skilled attendant is present during childbirth, and according to the Tanzania Ministry of Health and Social Welfare (MOHSW), only 63% of women delivered at the health facilities and assisted by health care providers and 37% delivered at home, which is below the national target for health facility delivery to be attended by skilled personnel to go up to 80% by 2015 (Ngowi, 2017). There are also disparities between rural communities and urban communities when it comes to skilled birth deliveries—coverage of skilled attendance at birth is 55% in rural communities compared to 87% in urban areas (Unicef, n.d.). One method for reducing maternal morbidity and mortality in Tanzania includes ensuring that all women have access to skilled personnel during childbirth.
Postnatal Care Coverage
Access to care during the postnatal period, which is the six weeks following delivery, is another indicator of maternal health. The postnatal period is a critical phase in the lives of mothers and newborn babies as most maternal and infant deaths occur during this time (WHO, 2020). High quality postnatal care is essential for maternal health, as it provides an opportunity for healthcare providers to facilitate healthy breastfeeding practices, screen for postpartum depression, treat childbirth-related complications, counsel women about family planning options, among other services (Maternal Health Task Force, 2018). However, this is one of the most neglected periods for the provision of quality care (WHO, 2020). In the 2004-2005 Tanzania Demographic and Health Survey (TDHS), it was reported that only 13% women have the recommended one or more postpartum care visit within two days of delivery, with some regions having rates as low as 2% (Mrisho, 2009). Increasing knowledge of and access to postnatal care is essential to improving maternal health in Tanzania.
Modern Family Planning Use
Family planning is critical for preventing unintended pregnancies and unsafe abortions, both of which contribute to lowering maternal and child mortality rates (DSW, 2017). Family planning also helps in poverty reduction and empowers women and men to choose freely and responsibly the number and spacing of children (DSW, 2017). It is estimated that in Tanzania, the unmet needs for family planning are at 22% among married women aged 15-19 years old (DSW, 2017). In other words, one in five married women have an unmet need for family planning (DSW, 2017). Tanzania has worked to establish policies and reforms in maternal health, however, funding and budget allocation for family planning remains low and there are still many misconceptions about family planning (DWS, 2017).
Improvements in Maternal Healthcare in Tanzania
The government of Tanzania has articulated ambitious plans to reduce maternal mortality rates by launching the Sharpened One Plan and Big Results Now programs, which outlined a three-pronged approach for ending preventable deaths of women, newborns, and children by providing voluntary family planning services (Franz, 2015). These plans focus on serving regions that face the most challenges and aim to focus the attention of national, regional, and district-level authorities on improving maternal, neonatal, and child health outcomes (Franz, 2015). However, despite ambitious health goals, in 2015, the Ministry of Health and Social Welfare estimated a funding gap of $169.5 million for reproductive, maternal, neonatal, and child health services alone (Franz, 2015). Despite improvements, there is still much to be done in improving maternal healthcare infrastructure in Tanzania.
DSW. (2017). Family Planning in Tanzania: A Review of National and District Policies and Budgets. Retrieved March 27, 2021.
Franz, P. (2015, May 07). Maternal, neonatal, and child health in Tanzania. Retrieved March 26, 2021.
Gailey, A., & McMillan, S. (2019, June 20). Improving Maternal Health in Tanzania. Retrieved March 25, 2021.
Lincetto, O., Mothebesoane-Anoh, S., Gomez, P., & Munjanja, S. (n.d.). Antenatal Care. Retrieved March 25, 2021.
Maternal Health Task Force. (2018, January 08). Postnatal Care. Retrieved March 26, 2021
Mrisho, M., Obrist, B., Schellenberg, J. A., Haws, R. A., Mushi, A. K., Mshinda, H., Tanner, M., Schellenberg, D. (2009, March 04). The use of antenatal and postnatal care: Perspectives and experiences of women and health care providers in rural southern Tanzania. Retrieved 26, 2021.
Ngowi, A. F., Kamazima, S. R., Kibusi, S., Gesase, A., & Bali, T. (2017, September 06).
Women’s determinant factors for preferred place of delivery in Dodoma region Tanzania: A cross sectional study. Retrieved March 25, 2021.
Shija, Angela E et al. “Maternal health in fifty years of Tanzania independence: Challenges and opportunities of reducing maternal mortality.” Tanzania journal of health research vol.13,5 Suppl 1 (2011): 352-64. doi:10.4314/thrb.v13i5.5
Rwabilimbo, A. G., Ahmed, K. Y., Page, A., & Ogbo, F. A. (2020, June 03). Trends and factors associated with the utilisation of antenatal care services during the Millennium Development Goals era in Tanzania. Retrieved March 26, 2021.
Unicef. (n.d.). Maternal and Newborn Health Disparities. Retrieved March 26, 2021.
Unicef. (2020, October 27). Antenatal care. Retrieved March 24, 2021.
World Health Organization. (2020, March 20). WHO recommendations on postnatal care of the mother and newborn. Retrieved March 26, 2021.