Why women bypass front-line health facility services in pursuit of obstetric care provided elsewhere: A case study in three rural districts of Tanzania

A. M. Kanté, A. Exavery, J. F. Phillips, E. F. Jackson

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: In the Tanzanian health system, women are expected to first visit their nearest front-line health facility (FLF) for delivery. However, women frequently bypass these FLF. Our study estimates the extent of bypassing for childbirth and assesses factors associated with this behaviour. Methods: Data describing the experiences of 597 women who recently delivered at a facility and the EmONC service capability at 107 health facilities were collected in 2011. Women who did not deliver at their nearest FLF were considered 'bypassers'. Factors associated with bypassing were assessed using multivariate logistic regression models. Three sets of analyses were conducted: among 597 women who delivered at the first facility they visited, among 521 women with no previous complications, and among 407 women not primigravida and without previous complications. Results: More than 75.4% of women bypassed. In the fully adjusted model of all 597 women those who had experienced complications were more likely to bypass for delivery [OR = 6.31 (2.36, 16.86)]. In the fully adjusted model excluding women with previous complications, primigravida women were more likely to bypass [OR = 3.70 (1.71, 8.01)]. Fully adjusted models for each set of analysis found that, for each additional emergency obstetric and newborn care signal function (EmONC SF) available at the nearest FLF, women's odds of bypassing almost halved. Conclusions: Bypassing is highly associated with EmONC SF score at nearest FLF, controlling for individual and community-level factors.

Original languageEnglish (US)
Pages (from-to)504-514
Number of pages11
JournalTropical Medicine and International Health
Volume21
Issue number4
DOIs
StatePublished - Apr 1 2016
Externally publishedYes

Keywords

  • Bypassing
  • Emergency obstetric and newborn care
  • Facility delivery
  • Health-seeking behaviour
  • Multilevel analysis
  • Quality of care
  • Tanzania

ASJC Scopus subject areas

  • Parasitology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Fingerprint Dive into the research topics of 'Why women bypass front-line health facility services in pursuit of obstetric care provided elsewhere: A case study in three rural districts of Tanzania'. Together they form a unique fingerprint.

Cite this