Access to health: factors associated with maternal healthcare service utilisation among women in Tanzania

Ntemi Tulla, Petro

Access to health: factors associated with maternal healthcare service utilisation among women in Tanzania

Thesis / Dissertation

2026

Publisher

University of Cape Town

Department

Department of Sociology

Faculty

Faculty of Humanities

Abstract

Background: Maternal healthcare remains a critical global and national social issue, with Tanzania experiencing persistently high maternal mortality rates despite policy interventions. This study investigates the factors associated with the utilisation of antenatal care (ANC), skilled birth assistance (SBA), and postnatal care (PNC) services among women aged 15–49 years in Tanzania. The study seeks to identify socio-economic, cultural, and structural factors associated with service utilisation for each of the three components of maternal healthcare, contributing to efforts to reduce maternal mortality and achieve Sustainable Development Goal 5.6 on reproductive healthcare and rights. Methods: The study utilised a quantitative research design, drawing on secondary data from the 2015–2016 Tanzania Demographic and Health Survey and Malaria Indicator Survey. This dataset included a representative sample of Tanzanian women the sample comprised 7,019 participants for ANC visits; 7,050 for SBA, and 8,794 for PNC in the bivariate analyses. The multivariable logistic regressions included 5,705 observations for both ANC and SBA, and 5,658 for PNC. Social action theory conceptualised ANC and SBA service utilisation, while Health Belief Model was used to conceptualise PNC service utilisation. The study employs different theories for different maternal healthcare outcomes because each stage of maternal healthcare service utilisation is associated with distinct factors, necessitating tailored theoretical explanations. Outcome variables included: the number of ANC visits (≥4), SBA assistance during childbirth and PNC within two days of childbirth or after being discharged from health facilities. Women's socio-demographics were used as independent variables. Descriptive statistics, chi-square tests, and multivariate logistic regression analyses were conducted using STATA software. Statistical significance was determined at a p-value < 0.05. Results and theoretical interpretation: Approximately 50.95% of women attended four or more ANC visits, 13.7% received SBA during childbirth, and 39.9% utilised PNC services within two days after childbirth. Higher education, decision-making autonomy, health insurance, media exposure, and wealth were significant positive factors of service utilisation across ANC, SBA and PNC. Geographical disparities were noted, with women in urban areas and certain zones (e.g., Eastern, Southern Highlands) more likely to utilise services than those in rural or marginalised regions. Social Action Theory indicated how socio-economic and cultural factors, such as wealth and decision-making autonomy, shaped rational, traditional, and affective behaviours associating ANC and SBA service utilisation. The Health Belief Model highlighted the role of perceived barriers, motivators, and cues to action, such as media exposure, in utilising PNC services. Conclusions: The study identifies significant socio-economic, cultural, and structural factors associated with maternal healthcare service utilisation in Tanzania. Addressing structural barriers, enhancing education, promoting gender equality, and improving maternal healthcare infrastructure are essential to achieving equitable maternal health outcomes. Policymakers should prioritise targeted interventions to address disparities in maternal healthcare service utilisation, particularly in rural and underserved areas. The study proposes the following actionable recommendations: 1) It emphasises the development of geographically targeted interventions by designing and implementing specific, evidence-based strategies. These interventions should aim to improve maternal healthcare service utilisation by addressing the barriers faced by particular groups of women, especially those in rural, marginalised, or socioeconomically disadvantaged settings. This can be to improve education, expand health insurance coverage, and promote gender equality in decision-making. 2) Invest in rural healthcare infrastructure and ensure the availability of skilled birth attendants. 3) Enhance media campaigns to raise awareness about the importance of maternal healthcare services, particularly in rural and underserved areas, as well as implement poverty alleviation programmes and social protections to reduce disparities in maternal healthcare service utilisation.