Access to institutional delivery care in Tanzania: does socioeconomic status count, given the user-fee exemption policy?

Globally, delivering in health facilities is encouraged as a single most important strategy in preventing maternal and neonatal deaths. However, access to facility-based delivery care remains very low in many developing countries including Tanzania, despite the user-fee exemption policy. The study assesses the relationship between socioeconomic status and place of delivery in three districts in Tanzania.

Data originate from a larger cross-sectional survey of random households conducted in three districts in Tanzania in 2011. Logistic regression model was fitted to examine how socioeconomic status and other factors influence place of delivery.

Overall, 75.5% of all participants delivered in facilities. The wealthier and more educated a woman was, the more likely that she would deliver in a health facility (OR=4.34, 95% CI 1.86-10.13). Also Sukuma and Ngindo ethnic groups were less likely compared to ndengereko to deliver in health facilities (OR=0.60, 95% CI 0.36-0.98) and (OR=0.40, 95% CI 0.18-0.89) respectively. Other significant predictors were gravidity, religion, district and type of residence.

Access to facility-based delivery care in Tanzania is significantly skewed in favor of socioeconomically wealthier and more educated women, despite the user-fee exemption policy for delivery care being operational.