Online Program

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

Monday, November 4, 2013

Christine Chung, Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY
Almamy M. Kante, PhD, Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY
James Phillips, PhD, MSc, Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY
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 services. This study tests the hypothesis that women bypass nearest primary health facility in order to receive better 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 information collected in 2011 in Rufiji, Kilombero and Ulanga Districts. Bypassers are defined as mothers who opt to seek ANC at facilities other than the facility nearest to her home village. Multivariate logistic regression is used to examine maternal and contextual factors associated with odds of bypassing proximate facilities. Results show more than half of women are categorized as 'bypassers'. Bypassers were 5 to 6 times more likely to visit a health center (OR 4.95, p<0.00) or hospital (OR 6.09, p<0.00) than dispensary. Women whose nearest facility was over 1 km away from home village were more likely to bypass than those who had a facility within village (OR 3.96, p<0.00). Evidence that bypassing behavior covaries inversely with educational attainment and directly with relative prosperity suggests that the poor and least educated are less likely to selectively bypass the most convenient 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.

Learning Areas:

Public health or related research

Learning Objectives:
List the main individual characteristics and contextual factors associated with the decision to bypass the nearest facility for antenatal care among pregnant mothers in three rural districts in Tanzania. Describe the extent to which pregnant mothers in the Rufiji, Kilombero and Ulanga districts, Tanzania, bypass the nearest primary care facilities to seek antenatal care at more distant health facilities.

Keyword(s): Maternal Health, Health Behavior

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am lead author or co-author on a number of research papers for the baseline analysis of the Connect Project in Tanzania, focusing on the individual, contextual and geographic determinants of maternal health care utilization and child and newborn survival in three rural districts.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.