UTILIZATION OF MATERNAL HEALTHCARE SERVICES AND PREGNANCY OUTCOMES IN TANZANIA

Abstract

Maternal mortality remains a public health issue, with sub-Saharan Africa accounting for 70% of global maternal deaths. Maternal healthcare utilization is a cost-effective strategy to reduce maternal morbidity and mortality. However, in Tanzania, there are evident and significant disparities in antenatal care (ANC) utilization and pregnancy outcomes between and within regions of the country despite ongoing national efforts. This thesis aims to identify the determinants of ANC utilization and its impact on pregnancy outcomes using both quantitative— the Tanzania Demographic and Health Survey (TDHS) data (2004-2022) and qualitative data —Key Informant Interviews (KIIs) collected in the Simiyu region to answer three research questions. The first research question uses TDHS data to identify determinants of ANC utilization. The second examines the impact of ANC on adverse pregnancy outcomes. Third, a qualitative study based in the Simiyu region explores cultural beliefs and traditional practices that shape maternal healthcare services-seeking behavior. Quantitative findings indicate that women's educational level, household wealth status, women's involvement in decision-making, and media exposure are associated with more ANC use among rural women, but not among urban women. Also, adequate ANC use reduces the risk of adverse pregnancy outcomes by 6.3 to 9.3 percentage points. The qualitative study adds depth by revealing cultural beliefs and traditional practices such as food taboos, secrecy around pregnancy, avoiding iron and folic acid use, and home delivery that influence health-seeking behavior, providing insight into the barriers that national data alone cannot capture. These findings underscore the importance of complementing national policies with regionally tailored strategies. The thesis highlights the need for the provision of culturally sensitive services, and equity-focused health interventions that address both systemic barriers and community-level barriers. Moreover, adequate provision of ANC services needs to be considered in Tanzania where health facilities are widely available to increase their utilization.