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Use of biomedical obstetric care in rural Tanzania: The role of social and material inequalities

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  • Spangler, Sydney A.
  • Bloom, Shelah S.

Abstract

Despite over 20 years of efforts to improve maternal health, complications of pregnancy and childbirth continue to threaten women's lives in many countries of sub-Saharan Africa. To reduce maternal mortality levels and achieve Millennium Development Goal Five, institutions working for safe motherhood are committed to making biomedical obstetric care more available to women during childbirth. However, implementation of this strategy is not reaching women at the lower end of the socioeconomic spectrum for reasons that are not well understood. Using data from fieldwork conducted between September 2007 and June 2008, this study examines women's use of biomedical obstetric care in two rural districts of south-central Tanzania where this care was being supplied. Specifically, it seeks to explain how social and material inequalities affect decisions and behaviors related to childbirth. In addressing this aim we employed a mixed-methods study design. Effects of sociodemographic characteristics on obstetric care use were examined with logistic regression analysis (n = 1150), while perspectives and experiences of childbearing women were explored with participant observation and in-depth interviews (n = 48). The results from quantitative and qualitative study components were interpreted in light of each other. Statistically significant social and material factors related to use of care included ethnicity, education, parity, and household assets. Qualitative themes involved physical, economic, and social access to health facilities as well as issues of risk perception and self-identity. The overall findings suggest that use of obstetric care is influenced by a complex interplay of factors closely tied to relative status in family and community. As individual agents differentially positioned by multiple markers of power, women pragmatically negotiate amidst a wide array of deterrents and motivators to secure the best care they can. In order to improve use of biomedical obstetric care, interventions aimed at increasing availability of these services should focus on improving access for women who are disadvantaged.

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  • Spangler, Sydney A. & Bloom, Shelah S., 2010. "Use of biomedical obstetric care in rural Tanzania: The role of social and material inequalities," Social Science & Medicine, Elsevier, vol. 71(4), pages 760-768, August.
    • Handle: RePEc:eee:socmed:v:71:y:2010:i:4:p:760-768
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    References listed on IDEAS

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    1. Shelah Bloom & David Wypij & Monica Gupta, 2001. "Dimensions of women’s autonomy and the influence on maternal health care utilization in a north indian city," Demography, Springer;Population Association of America (PAA), vol. 38(1), pages 67-78, February.
    2. Stephenson, R. & Baschieri, A. & Clements, S. & Hennink, M. & Madise, N., 2006. "Contextual influences on the use of health facilities for childbirth in Africa," American Journal of Public Health, American Public Health Association, vol. 96(1), pages 84-93.
    3. Paul, Bimal Kanti & Rumsey, Deborah J., 2002. "Utilization of health facilities and trained birth attendants for childbirth in rural Bangladesh: an empirical study," Social Science & Medicine, Elsevier, vol. 54(12), pages 1755-1765, June.
    4. Glei, Dana A. & Goldman, Noreen & Rodríguez, Germán, 2003. "Utilization of care during pregnancy in rural Guatemala: does obstetrical need matter?," Social Science & Medicine, Elsevier, vol. 57(12), pages 2447-2463, December.
    5. Amooti-Kaguna, B. & Nuwaha, F., 2000. "Factors influencing choice of delivery sites in Rakai district of Uganda," Social Science & Medicine, Elsevier, vol. 50(2), pages 203-213, January.
    6. El-Nemer, Amina & Downe, Soo & Small, Neil, 2006. "'She would help me from the heart': An ethnography of Egyptian women in labour," Social Science & Medicine, Elsevier, vol. 62(1), pages 81-92, January.
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    2. Sochas, Laura, 2019. "Women who break the rules: Social exclusion and inequities in pregnancy and childbirth experiences in Zambia," Social Science & Medicine, Elsevier, vol. 232(C), pages 278-288.
    3. Zahid Memon & Shehla Zaidi & Atif Riaz, 2016. "Residual Barriers for Utilization of Maternal and Child Health Services: Community Perceptions From Rural Pakistan," Global Journal of Health Science, Canadian Center of Science and Education, vol. 8(7), pages 1-47, July.
    4. Kerry L M Wong & Lenka Benova & Oona M R Campbell, 2017. "A look back on how far to walk: Systematic review and meta-analysis of physical access to skilled care for childbirth in Sub-Saharan Africa," PLOS ONE, Public Library of Science, vol. 12(9), pages 1-20, September.
    5. Hackett, Kristy M. & Kazemi, Mina & Sellen, Daniel W., 2018. "Keeping secrets in the cloud: Mobile phones, data security and privacy within the context of pregnancy and childbirth in Tanzania," Social Science & Medicine, Elsevier, vol. 211(C), pages 190-197.
    6. Ivy Kodzi & Øystein Kravdal, 2013. "What has high fertility got to do with the low birth weight problem in Africa?," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 28(25), pages 713-732.

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