Date Published: May 9, 2019
Publisher: Public Library of Science
Author(s): Rose N. M. Mpembeni, Deodatus C. V. Kakoko, Henriette S. Aasen, Ingvill Helland, Anayda Portela.
Maternal mortality rates are still unacceptably high in many countries, indicating violation of women´s human right to life and health. Access to adequate information about maternal health rights and available services are essential aspects of realizing women´s right to accessible health care. This study aimed at assessing awareness of the right to access maternal health services among women who had recently given birth, and the association between such awareness and the utilization of maternal health services in two districts in Tanzania.
This study was cross sectional in design. Interviews were conducted with women who gave birth within one year prior to the survey in two different district councils (DC) namely Hai DC and Morogoro DC, selected purposively based on the earlier reported rates of maternal mortality. We used a two-stage cluster sampling to select the study sample. Analysis employed Chi-square test and Logistic regression.
A total of 547 respondents were interviewed. Only a third (34.4%) reported to be aware of their right to access maternal health services. Main sources of information on maternal health rights were the media and health care providers. Occupation and education level showed a statistically significant association with awareness of access rights. Hai DC had higher proportion of women aware of their access rights compared to Morogoro DC. Women who were aware of their right of access were almost 5 times more likely to use skilled birth attendants compared to those who were not (AOR 4.61 95% CI: 2.14–8.57).
Awareness of the right to access maternal health services was low in the studied population. To increase awareness and hence uptake of Pregnancy care and skilled birth attendants at delivery we recommend the government and partners to prioritize provision of information, communication and education on women´s human rights, including the right to access maternal health services, especially to women in rural areas.
International human rights norms require states to respect, protect and fulfill women’s right to life and health . The international community address avoidable maternal mortality as a discrimination and violation of women’s right to life and Health . Ninety-nine percent of the global maternal deaths occur in the developing countries most often in poor, rural areas, with sub-Saharan Africa (SSA) contributing over half of these deaths. Most of these deaths are avoidable as the care solutions to prevent and manage complications are well known. Over the last decade we have seen a significant reduction of deaths related to pregnancy and child birth, due to global, regional and national efforts combined. Tanzania is among the countries with high maternal mortality ratio estimated at 398 per 100000 live births . Maternal mortality Rate (MMR) is the health indicator with the highest discrepancy between developed and developing countries. The differences on MMR has been considered to partly be explained by differences in women’s access to adequate maternal health care services including Skilled birth attendances (SBA) . Therefore strengthened state accountability for women’s right to access adequate maternal health services in order to prevent future avoidable maternal deaths is necessary  . SBAs are accredited health professionals such as a midwifes, doctors or nurses who have been educated and trained to proficiency in the skills needed to manage uncomplicated pregnancies, childbirth and the immediate postnatal period. Skilled attendants also have skills needed to identify, manage and refer women and newborns with complications . This is contrary to traditional birth attendants (TBAs) who are women assisting pregnant women during childbirth and who initially acquired their skills by delivering babies themselves or by working with other TBAs. The proportion of women who utilized SBAs is one of the indicators used to monitor progress towards the Sustainable Development Goal number 3 (SDG3) and also is used to monitor implementation of women´s rights to health .
We interviewed 547 out of 558 sampled women, which was a response rate of 98%.
The study may have some limitations that are worth noting. We assume that health system factors, such as quality and friendliness of care provided, do influence the use of skilled birth attendants. However, this study did not take into consideration such factors. The study sample was predominantly rural and most women utilized the public facilities for delivery where care quality is quite similar across facilities and likely to be poor. Therefore, we believe that the influence of health system factors was limited and not significant. The fact that our data is a bit old (2012) should not prevent them from still being relevant to address current challenges regarding maternal health and awareness of rights in rural settings because there has been no reported interventions to improve awareness. We still recognize that our findings relating to level of awareness of right to access maternal health services and the utilization level of such services may not be representative of other districts in Tanzania but do add information which can be used to plan relevant interventions.
Our study show that women´s awareness of the right to access maternal health services was low among the study respondents and differed significantly among respondents from Hai and Morogoro district councils. Respondents in the two districts also differed significantly with regard to level of education, literacy level and regarding distance to the nearest health facility providing maternal care. These are factors known to influence the utilization of SBA and other maternal health services.
The study received ethical clearance from Muhimbili University of Health and Allied Sciences (MUHAS) Ethical Review Committee (Ref. No. MU/RP/AEC/VOL. XIII). Permission to conduct the study was granted from respective regional, district and village level authorities. Women were informed of the objectives of the study and informed that their participation was voluntary, and only those who agreed to participate and signed the consent forms were included in the study. Names of respondents were not recorded on the questionnaires but only identification numbers so as to ensure confidentiality of the information.