International Development Planning Review

Attitudinal change and emotional security: informing maternal health policies in rural Tanzania

International Development Planning Review (2017), 39, (2), 143–162.

Abstract

Maternal mortality and health are key development concerns, particularly in rural areas of sub-Saharan Africa. Policy interventions aimed at realising Millennium Development Goals and improving maternal health have had mixed results, indicating the need for contextually sensitive policy interventions. This article explores attitudes and behaviours relating to obstetric care in Moshi Rural District, Tanzania, with a focus on the importance of both individual and collective attitudinal and behaviour change in reducing delays in seeking care and accessing health facilities. Ensuring the emotional security and well-being of expectant mothers for improved uptake of services and health outcomes is noted as a priority for future policy interventions.

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Armstrong, C., Magoma, M. and Ronsmans, C. (2015) ‘Magnitude of maternal and neonatal mortality in Tanzania: a systematic review’, International Journal of Gynecology and Obstetrics, 130, 98–110. Magnitude of maternal and neonatal mortality in Tanzania: a systematic review International Journal of Gynecology and Obstetrics 130 98 110 Google Scholar

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Giacaman, R., Wick, L., Abdul-Rahim, H. and Wick, L. (2005) ‘The politics of childbirth in the context of conflict: policies or de facto practices?’, Health Policy, 72, 129–39. The politics of childbirth in the context of conflict: policies or de facto practices? Health Policy 72 129 39 Google Scholar

Griffiths, P. and Stephenson, R. (2001) ‘Understanding users perspectives of barriers to maternal health care use in Maharashtra, India’, Journal of Biosocial Science, 33, 339–59. Understanding users perspectives of barriers to maternal health care use in Maharashtra, India Journal of Biosocial Science 33 339 59 Google Scholar

Hadjigeorgiou, E., Kouta, C., Papastavrou, R., Papadopoulos, I. and Martensson, L. (2001) ‘Women’s perceptions of their right to choose the place of childbirth: an integrative review’, Midwifery, 28, 380–90. Women’s perceptions of their right to choose the place of childbirth: an integrative review Midwifery 28 380 90 Google Scholar

Hodgkin, D. (1996) ‘Household characteristics affecting where mothers deliver in rural Kenya’, Health Economics, 5, 333–40. Household characteristics affecting where mothers deliver in rural Kenya Health Economics 5 333 40 Google Scholar

Izugbara, C., Ezeh, A and Fotso, J. (2009) ‘The persistence and challenges of homebirths: perspectives of traditional birth attendants in urban Kenya’, Health Policy Planning, 24, 36–45. The persistence and challenges of homebirths: perspectives of traditional birth attendants in urban Kenya Health Policy Planning 24 36 45 Google Scholar

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Kowalewski, M., Mujinja, P. and Jahn, A. (2002) ‘Can mothers afford maternal health care costs? User costs of maternity services in rural Tanzania’, African Journal of Reproductive Health, 6, 65–73. Can mothers afford maternal health care costs? User costs of maternity services in rural Tanzania African Journal of Reproductive Health 6 65 73 Google Scholar

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Moyer, C., Adongo, P., Aborigo, R., Hodgson, A. and Engmann, C. (2014) ‘"They treat you like you are not a human being": Maltreatment during labour and delivery in rural northern Ghana’, Midwifery, 30, 262–68. “They treat you like you are not a human being”: Maltreatment during labour and delivery in rural northern Ghana Midwifery 30 262 68 Google Scholar

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UNICEF (2011) Basic indicators. Statistics, United Republic of Tanzania, http://www.unicef.org/infobycountry/tanzania_statistics.html (accessed 2 August 2011). Google Scholar

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Bonaro, D. and Kroeger, M. (2004) ‘Continuous female companionship during childbirth: a crucial resource in times of stress or calm’, Journal of Midwifery and Women’s Health, 49, 19–27. Continuous female companionship during childbirth: a crucial resource in times of stress or calm Journal of Midwifery and Women’s Health 49 19 27 Google Scholar

Danforth, E., Kruk, M., Rockers, P., Mabaruku, G. and Galea, S. (2009) ‘Household decision making about delivery in health facilities: evidence from Tanzania’, Journal of Health Population and Nutrition, 27, 696–703. Household decision making about delivery in health facilities: evidence from Tanzania Journal of Health Population and Nutrition 27 696 703 Google Scholar

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Hodgkin, D. (1996) ‘Household characteristics affecting where mothers deliver in rural Kenya’, Health Economics, 5, 333–40. Household characteristics affecting where mothers deliver in rural Kenya Health Economics 5 333 40 Google Scholar

Izugbara, C., Ezeh, A and Fotso, J. (2009) ‘The persistence and challenges of homebirths: perspectives of traditional birth attendants in urban Kenya’, Health Policy Planning, 24, 36–45. The persistence and challenges of homebirths: perspectives of traditional birth attendants in urban Kenya Health Policy Planning 24 36 45 Google Scholar

Kowalewski, M., Jahn, A. and Kimatta, S. (2000) ‘Why do at-risk mothers fail to reach referral-level? Barriers beyond distance and cost’, African Journal of Reproductive Health, 4, 100–09. Why do at-risk mothers fail to reach referral-level? Barriers beyond distance and cost African Journal of Reproductive Health 4 100 09 Google Scholar

Kowalewski, M., Mujinja, P. and Jahn, A. (2002) ‘Can mothers afford maternal health care costs? User costs of maternity services in rural Tanzania’, African Journal of Reproductive Health, 6, 65–73. Can mothers afford maternal health care costs? User costs of maternity services in rural Tanzania African Journal of Reproductive Health 6 65 73 Google Scholar

Kruk, M., Mbaruku, G., Rockers, P. and Galea, S. (2008) ‘User fee exemptions are not enough: out-of-pocket payments for “free” delivery services in rural Tanzania’, Tropical Medicine and International Health, 13, 1442–51. User fee exemptions are not enough: out-of-pocket payments for “free” delivery services in rural Tanzania Tropical Medicine and International Health 13 1442 51 Google Scholar

Kruske, S. and Barclay, L. (2004) ‘Effect of shifting policies on traditional birth attendant training’, Journal of Midwifery and Women’s Health, 49, 306–11. Effect of shifting policies on traditional birth attendant training Journal of Midwifery and Women’s Health 49 306 11 Google Scholar

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Likwa, R. (2015) ‘Building capacity for public health and population policy-making: perspectives from Zambia’, International Development Planning Review, 37, 61–76. Building capacity for public health and population policy-making: perspectives from Zambia International Development Planning Review 37 61 76 Google Scholar

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Moyer, C., Adongo, P., Aborigo, R., Hodgson, A. and Engmann, C. (2014) ‘"They treat you like you are not a human being": Maltreatment during labour and delivery in rural northern Ghana’, Midwifery, 30, 262–68. “They treat you like you are not a human being”: Maltreatment during labour and delivery in rural northern Ghana Midwifery 30 262 68 Google Scholar

Mpembeni, R. N., Killewo, J. Z., Leshabari, M. T., Massawe, S. N., Albrecht, J., Mushi, D. and Mwakipa, H. (2007) ‘Use pattern of maternal health services and determinants of skilled care during delivery in Southern Tanzania: implications for achievement of MDG-5 targets’, BMC Pregnancy and Childbirth, 7, doi: 10.1186/1471-2393-7-29. Use pattern of maternal health services and determinants of skilled care during delivery in Southern Tanzania: implications for achievement of MDG-5 targets BMC Pregnancy and Childbirth 7 Google Scholar

Mrisho, M., Schellenberg, J., Mushi, A., Obrist, B., Mshinda, H., Tanner, M. and Schellenbeg, D. (2007) ‘Factors affecting home delivery in rural Tanzania’, Tropical Medicine and International Health, 12, 862–72. Factors affecting home delivery in rural Tanzania Tropical Medicine and International Health 12 862 72 Google Scholar

Mwewa, D. and Michelo, C. (2012) ‘Factors associated with home deliveries in a low income rural setting: observations from Nchelenge district, Zambia’, Medical Journal of Zambia, 37, 234–39. Factors associated with home deliveries in a low income rural setting: observations from Nchelenge district, Zambia Medical Journal of Zambia 37 234 39 Google Scholar

Myer, L. and Harrison, A. (2003) ‘Why do women seek antenatal care late? Perspectives from rural South Africa’, Journal of Midwifery and Women’s Health, 48, 268–72. Why do women seek antenatal care late? Perspectives from rural South Africa Journal of Midwifery and Women’s Health 48 268 72 Google Scholar

Ray, A. and Salihu, H. (2004) ‘The impact of maternal mortality interventions using traditional birth attendants and village midwives’, Journal of Obstetrics and Gynaecology, 24, 5–11. The impact of maternal mortality interventions using traditional birth attendants and village midwives Journal of Obstetrics and Gynaecology 24 5 11 Google Scholar

Richards, H. and Emslie, C., (2000) ‘The “doctor” or “the girl from the university”? Considering the influence of professional roles on qualitative interviewing’, Family Practice, 17, 71–75. The “doctor” or “the girl from the university”? Considering the influence of professional roles on qualitative interviewing Family Practice 17 71 75 Google Scholar

Rijsbergen, B. and D’exelle, B. (2013) ‘Delivery care in Tanzania: a comparative analysis of use and preferences’, World Development, 43, 276–87. Delivery care in Tanzania: a comparative analysis of use and preferences World Development 43 276 87 Google Scholar

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Adjiwanou, V. and Legrand, T. (2014) ‘Gender inequality and the use of maternal healthcare services in rural sub-Saharan Africa’, Health and Place, 29, 67–78. Gender inequality and the use of maternal healthcare services in rural sub-Saharan Africa Health and Place 29 67 78 Google Scholar

Seljeskog, L., Sundby, J. and Chimango, J. (2006) ‘Factors influencing women’s choice of place of delivery in rural Malawi: an explorative study’, African Journal of Reproductive Health, 10, 66–75. Factors influencing women’s choice of place of delivery in rural Malawi: an explorative study African Journal of Reproductive Health 10 66 75 Google Scholar

Agyei-Mensah, S., Owusu, G. and Wrigley-Asante, C (2015) ‘Urban health in Africa: looking beyond the MDGs’, International Development Planning Review, 37, 53–60. Urban health in Africa: looking beyond the MDGs International Development Planning Review 37 53 60 Google Scholar

Some, T., Sombie, I. and Meda, N. (2011) ‘Women’s perceptions of home births in two rural medical districts in Burkina Faso: a qualitative study’, Reproductive Health, 8, 1–7. Women’s perceptions of home births in two rural medical districts in Burkina Faso: a qualitative study Reproductive Health 8 1 7 Google Scholar

Amooti-Kaguna, B. and Nuwaha, F. (2000) ‘Factors influencing choice of delivery sites in Rakai district of Uganda’, Social Science and Medicine, 50, 203–13. Factors influencing choice of delivery sites in Rakai district of Uganda Social Science and Medicine 50 203 13 Google Scholar

Spangler, S. (2011) ‘“To open oneself is a poor woman’s trouble”: Embodied inequality and childbirth in south-central Tanzania’, Medical Anthropology Quarterly, 25, 479–98. “To open oneself is a poor woman’s trouble”: Embodied inequality and childbirth in south-central Tanzania Medical Anthropology Quarterly 25 479 98 Google Scholar

Armstrong, C., Magoma, M. and Ronsmans, C. (2015) ‘Magnitude of maternal and neonatal mortality in Tanzania: a systematic review’, International Journal of Gynecology and Obstetrics, 130, 98–110. Magnitude of maternal and neonatal mortality in Tanzania: a systematic review International Journal of Gynecology and Obstetrics 130 98 110 Google Scholar

Spangler, S. (2012) ‘Assessing skilled birth attendants and emergency obstetric care in rural Tanzania: the inadequacy of using global standards and indicators to measure local realities’, Reproductive Health Matters, 20, 133–41. Assessing skilled birth attendants and emergency obstetric care in rural Tanzania: the inadequacy of using global standards and indicators to measure local realities Reproductive Health Matters 20 133 41 Google Scholar

Bonaro, D. and Kroeger, M. (2004) ‘Continuous female companionship during childbirth: a crucial resource in times of stress or calm’, Journal of Midwifery and Women’s Health, 49, 19–27. Continuous female companionship during childbirth: a crucial resource in times of stress or calm Journal of Midwifery and Women’s Health 49 19 27 Google Scholar

Spangler, S. and Bloom, S. (2010) ‘Use of biomedical obstetric care in rural Tanzania: the role of social and material inequalities’, Social Science and Medicine, 71, 760–68. Use of biomedical obstetric care in rural Tanzania: the role of social and material inequalities Social Science and Medicine 71 760 68 Google Scholar

Danforth, E., Kruk, M., Rockers, P., Mabaruku, G. and Galea, S. (2009) ‘Household decision making about delivery in health facilities: evidence from Tanzania’, Journal of Health Population and Nutrition, 27, 696–703. Household decision making about delivery in health facilities: evidence from Tanzania Journal of Health Population and Nutrition 27 696 703 Google Scholar

Stekelenburg, J., Kyanamina, S., Mukelabai, M., Wolffers, I. and Van Roosmalen, J. (2004) ‘Waiting too long: low use of maternal health services in Kalabo, Zambia’, Tropical Medicine and International Health, 9, 390–98. Waiting too long: low use of maternal health services in Kalabo, Zambia Tropical Medicine and International Health 9 390 98 Google Scholar

Giacaman, R., Wick, L., Abdul-Rahim, H. and Wick, L. (2005) ‘The politics of childbirth in the context of conflict: policies or de facto practices?’, Health Policy, 72, 129–39. The politics of childbirth in the context of conflict: policies or de facto practices? Health Policy 72 129 39 Google Scholar

Stephenson, R., Baschieri, A., Clements, S., Hennink, M. and Madise, N. (2006) ‘Contextual influences on the use of health facilities for childbirth in Africa’, American Journal of Public Health, 96, 84–92. Contextual influences on the use of health facilities for childbirth in Africa American Journal of Public Health 96 84 92 Google Scholar

Griffiths, P. and Stephenson, R. (2001) ‘Understanding users perspectives of barriers to maternal health care use in Maharashtra, India’, Journal of Biosocial Science, 33, 339–59. Understanding users perspectives of barriers to maternal health care use in Maharashtra, India Journal of Biosocial Science 33 339 59 Google Scholar

Straneo, M., Fogliati, P., Azzimonti, G., Mangi, S., and Kisika, F. (2014) ‘Where do the rural poor deliver when high coverage of heath facility delivery is achieved? Findings from a community and hospital survey in Tanzania’, PLos One, 9, 1–17. Where do the rural poor deliver when high coverage of heath facility delivery is achieved? Findings from a community and hospital survey in Tanzania PLos One 9 1 17 Google Scholar

Hadjigeorgiou, E., Kouta, C., Papastavrou, R., Papadopoulos, I. and Martensson, L. (2001) ‘Women’s perceptions of their right to choose the place of childbirth: an integrative review’, Midwifery, 28, 380–90. Women’s perceptions of their right to choose the place of childbirth: an integrative review Midwifery 28 380 90 Google Scholar

Thaddeus, S. and Maine, D. (1994) ‘Too far to walk: maternal mortality in context’, Social Science and Medicine, 38(8), 1091–110. Too far to walk: maternal mortality in context Social Science and Medicine 38 1091 110 Google Scholar

Tomedi, A., Tucker, K. and Mwanthi, M. (2013) ‘A strategy to increase the number of deliveries with skilled birth attendants in Kenya’, International Journal of Gynaecology and Obstetrics, 120, 152–55. A strategy to increase the number of deliveries with skilled birth attendants in Kenya International Journal of Gynaecology and Obstetrics 120 152 55 Google Scholar

Hodgkin, D. (1996) ‘Household characteristics affecting where mothers deliver in rural Kenya’, Health Economics, 5, 333–40. Household characteristics affecting where mothers deliver in rural Kenya Health Economics 5 333 40 Google Scholar

UNICEF (2011) Basic indicators. Statistics, United Republic of Tanzania, http://www.unicef.org/infobycountry/tanzania_statistics.html (accessed 2 August 2011). Google Scholar

Izugbara, C., Ezeh, A and Fotso, J. (2009) ‘The persistence and challenges of homebirths: perspectives of traditional birth attendants in urban Kenya’, Health Policy Planning, 24, 36–45. The persistence and challenges of homebirths: perspectives of traditional birth attendants in urban Kenya Health Policy Planning 24 36 45 Google Scholar

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Singh, Deeva

Hammett, Daniel