Do women bypass village services for better maternal health care in clinics? A case study of antenatal care seeking in three rural Districts of Tanzania

In Tanzania, despite the fact that majority of population lives within 5 kilometers of a primary health facility, utilization of these facilities is limited owing to poor quality of primary healthcare. This study tests the hypothesis that women bypass the nearest primary health facility in order to receive better care for antenatal care (ANC) elsewhere and assesses covariates of this behavior. We combine original data on mothers with recent pregnancies from cross-sectional household survey (n=912) with health facility survey collected in 2011 in Rufiji, Kilombero and Ulanga Districts. Bypassers are defined as mothers who opt to seek care at facilities other than the nearest to her home village. Multivariate logistic regression is used to examine the maternal and contextual factors associated with odds of bypassing proximate facilities. Initial results show more than half of women interviewed sought these services at a health facility outside of home village rather than at the closest dispensary. Bypassers were 5 to 6 times more likely to visit health center or hospital than primary dispensary. The strong patterns of bypassing reveal mothers’ preferences for better ANC services, despite additional costs and time involved. This suggests crucial need to improve the quality of community-based ANC services to achieve health equity.