Parity matters: Multi-Level Analysis of the Determinants of Healthcare Facility Use for Delivery In Rural Tanzania

Parity is an important although understudied predictor of the use of healthcare facility for delivery. We assess the extent to which the use of health care facilities varies by parity, conditional on socio-economic, psychological, and health characteristics. We also assess parity group differences in the determinants of facility delivery, and explore community-level variations in observed relationships. Survey data from a two-stage cluster sample of 1,205 women from a rural district of Tanzania were analyzed using design-based logistic regressions, and multi-level models to assess village-level random-effects. We found use of health facilities for delivery to be low (39%), with odds of facility delivery three-times higher among nulliparas (0 children prior to current delivery) compared to women with 1-4 previous children; and 30% less among women with 5+ children. In parity group analyses, mother's education and more than three antenatal care visits increased the odds of facility delivery among nulliparas. Belief in the importance of facility delivery increased the odds of delivering in a facility among multiparas; so did health insurance for women with 5+ children. We found a significant village-level random-effect for multiparas (1-4 and 5+ children), but not for nulliparas. Parity is a pivotal determinant of the use of health facilities for delivery, hence reproductive life-stage-specific interventions could optimize the use of facilities in Tanzania. In particular, women with children who have lowest facility use, and whose utilization varies based on where they live, should be targeted with education about the importance of maternal health services, and health insurance.