title: Source of antenatal care influences facility delivery in rural Tanzania: a population-based study.
abstract: OBJECTIVE
  While antenatal care does not directly contribute to reducing maternal mortality, it may play an indirect role by encouraging women to deliver with a skilled birth attendant or in a health facility. We investigated whether the frequency of visits and select characteristics of antenatal care were associated with facility delivery.
  
  
  METHODS
  We selected a population-representative sample of households in a rural district of western Tanzania. Women who had given birth within five years were asked about their most recent delivery and antenatal care.
  
  
  RESULTS
  Of 1,204 women interviewed, 1,195 (99.3%) made at least one antenatal care visit, while only 438 (36.4%) delivered in a health facility. In adjusted analysis, women were significantly more likely to deliver in a health facility if they attended antenatal care at a government health center (OR 3.17, 95% CI: 1.60-6.30) or a mission facility (OR 2.87, 95% CI: 1.36-6.07), rather than a government dispensary. Women were significantly less likely to deliver in a health facility if their nearest health facility was outside their village (OR 0.38, 95% CI: 0.22-0.66).
  
  
  CONCLUSIONS
  Though facility utilization for antenatal care is frequent, most women who accessed antenatal care did not deliver in a health facility. Women who obtained antenatal care at higher level government facilities or mission facilities, which offered better quality of care, were more likely to deliver in any facility. Improving the quality of antenatal care may improve the health of mothers through encouraging women to return to facilities for delivery.
authors.affiliation: Department of Epidemiology, School of Public Health, University of Michigan, 109 Observatory Road, Ann Arbor, MI 48109, USA. prockers@umich.edu
authors.forename: Peter C
authors.initials: PC
authors.lastname: Rockers
authors.forename: Mark L
authors.initials: ML
authors.lastname: Wilson
authors.forename: Godfrey
authors.initials: G
authors.lastname: Mbaruku
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Kruk
mesh_terms: D000293:Adolescent; D000328:Adult; D016000:Cluster Analysis; D036861:Delivery, Obstetric; D005260:Female; D006297:Health Services Accessibility; D006700:Home Childbirth / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008428:Maternal Mortality; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D012424:Rural Population; D011795:Surveys and Questionnaires; D013636:Tanzania; D055815:Young Adult