Addressing both demand and supply factors can improve access to facility-based delivery care and reduce maternal and newborn deaths; finds a new study conducted by scientists at Ifakara Health Institute and the London School of Hygiene and Tropical Medicine (LSHTM).

Published in the Health Economics Review journal, the study emphasizes the need for a comprehensive approach to inform evidence-based interventions, ensuring that all mothers have access to safe and supportive healthcare environments to give birth.

Ifakara Senior Scientist, Health Economist Dr. Peter Binyaruka, contributed to the study and publication as lead author along with Josephine Borghi from the LSHTM. Other contributors include Anna Foss and Rachel Cassidy also from the LSHTM, Abdullah Alibrahim from Kuwait University and Nicholaus Mziray also from Ifakara.

The maternal deaths issue

Maternal death remains a global health issue, with an estimated 223 maternal deaths per 100,000 live births recorded in 2020 globally. Tanzania, like many low-income settings, continues to deal with this challenge whereby in 2016, approximately 556 deaths per 100,000 live births were reported.

The scientists suggest that improving access to facility-based delivery care can play a crucial role in reducing maternal and newborn deaths across various settings. Through the study, they aimed to provide evidence-based insights into the factors affecting facility-based delivery care in Tanzania, particularly those related to demand and supply.

“To inform evidence-based interventions, more evidence is needed especially accounting for demand- and supply-side factors influencing access to facility-based delivery care. This study aimed to broaden the understanding of the factors associated with facility-based delivery care and the relative influence of these factors on how they associate with the demand for facility-based delivery care in the Tanzanian context,” writes the scientists.

Between January and February 2012, the scientists conducted surveys involving 2,846 households, 1,494 patients, and 150 health facilities across 11 districts in the Pwani, Morogoro and Lindi regions of Tanzania.

86% gave birth at health facilities

The study revealed that 86% of women surveyed gave birth in a health facility.  Among the demand-side factors, the study found that women who were educated, of the Muslim faith, wealthier, first-time mothers, and those who attended at least four antenatal care visits were more likely to opt for facility-based births.

In terms of supply-side factors, facilities offering outreach services, longer consultation times, and higher levels of interpersonal quality had higher rates of facility-based births. On the other hand, facilities with longer average waiting times, longer travel times, and a higher likelihood of charging delivery fees saw fewer facility-based births.

Policy recommendations

In light of these findings, the scientists recommend policy reforms that focus on improving the demand and supply factors associated with facility-based delivery care. This includes interventions such as health education to raise awareness among less educated groups and those with higher parity. Additionally, efforts to reduce financial barriers, including time costs, should be implemented to ensure healthcare is accessible. 

Furthermore, the policy interventions should aim to enhance the quality of interpersonal care provided in healthcare facilities to make them more appealing to expectant mothers, emphasized the scientists.

Read the full publication here: https://pubmed.ncbi.nlm.nih.gov/37930445/