Source of Antenatal Care Influences Facility Delivery in Rural Tanzania: A Population-Based Study

  • Peter C. Rockers
  • Mark L. Wilson
  • Godfrey Mbaruku
  • Margaret E. Kruk


Objective While antenatal care does not directly contribute to reducing maternal mortality, it may play an indirect role by encouraging women to deliver with a skilled birth attendant or in a health facility. We investigated whether the frequency of visits and select characteristics of antenatal care were associated with facility delivery. Methods We selected a population-representative sample of households in a rural district of western Tanzania. Women who had given birth within five years were asked about their most recent delivery and antenatal care. Results Of 1,204 women interviewed, 1,195 (99.3%) made at least one antenatal care visit, while only 438 (36.4%) delivered in a health facility. In adjusted analysis, women were significantly more likely to deliver in a health facility if they attended antenatal care at a government health center (OR 3.17, 95% CI: 1.60–6.30) or a mission facility (OR 2.87, 95% CI: 1.36–6.07), rather than a government dispensary. Women were significantly less likely to deliver in a health facility if their nearest health facility was outside their village (OR 0.38, 95% CI: 0.22–0.66). Conclusion Though facility utilization for antenatal care is frequent, most women who accessed antenatal care did not deliver in a health facility. Women who obtained antenatal care at higher level government facilities or mission facilities, which offered better quality of care, were more likely to deliver in any facility. Improving the quality of antenatal care may improve the health of mothers through encouraging women to return to facilities for delivery.


Maternal health services Antenatal care Child delivery care Maternal mortality 



We thank Professor Sandro Galea for his guidance in the design of the study, and analysis and interpretation of the data. We thank the women from Kasulu District for their willingness to participate in the study. This work was funded by the William Davidson Institute at the Ross School of Business, University of Michigan, the Averting Maternal Death and Disability Program at the Mailman School of Public Health, Columbia University, and the Global Health Program at the School of Public Health, University of Michigan. The funders did not have any involvement in conducting the study or in deciding to submit the manuscript for publication.


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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Peter C. Rockers
    • 1
  • Mark L. Wilson
    • 1
  • Godfrey Mbaruku
    • 2
  • Margaret E. Kruk
    • 3
    • 4
  1. 1.Department of Epidemiology, School of Public HealthUniversity of MichiganAnn ArborUSA
  2. 2.Ifakara Health Research and Development CentreDar-es-salaamTanzania
  3. 3.Department of Health Management and Policy, School of Public HealthUniversity of MichiganAnn ArborUSA
  4. 4.Averting Maternal Death and Disability Program, Heilbrunn Department of Population & Family Health, Mailman School of Public HealthColumbia UniversityNew YorkUSA

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