Poverty, partner discord, and divergent accounts; a mixed methods account of births before arrival to health facilities in Morogoro Region, Tanzania.
Births before arrival (BBA) to health care facilities are associated with higher rates of perinatal morbidity and mortality compared to facility deliveries or planned home births. Research on such births has been conducted in several high-income countries, but there are almost no studies from low-income settings where a majority of maternal and newborn deaths occur.



Drawing on a household survey of women and in-depth interviews with women and their partners, we examined the experience of BBA in rural districts of Morogoro Region, Tanzania.



Among survey respondents, 59 births (4 %) were classified as BBAs. Most of these births occurred in the presence of a family member (47 %) or traditional birth attendant (24 %). Low socioeconomic status was the strongest predictor of BBA. After controlling for wealth via matching, high parity and a low number of antenatal care (ANC) visits retained statistical significance. While these variables are useful indicators of which women are at greater risk of BBA, their predictive power is limited in a context where many women are poor, multiparous, and make multiple ANC visits. In qualitative interviews, stories of BBAs included themes of partner disagreement regarding when to depart for facilities and financial or logistical constraints that underpinned departure delays. Women described wanting to depart earlier to facilities than partners.



As efforts continue to promote facility birth, we highlight the financial demands associated with facility delivery and the potential for these demands to place women at a heightened risk for BBAs.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205-2179, USA. shannon.mcmahon@jhu.edu.|Institute of Public Health, Heidelberg University, Im Neuenheimer Feld 324, D-69120, Heidelberg, Germany. shannon.mcmahon@jhu.edu.
Shannon A
SA
McMahon
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205-2179, USA.
Rachel P
RP
Chase
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205-2179, USA.
Peter J
PJ
Winch
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205-2179, USA.
Joy J
JJ
Chebet
Monitoring & Evaluation Office, Jhpiego, PO Box 9170, Dar es Salaam, Tanzania.|Independent Consultant, Moshi, Tanzania.
Giulia V R
GVR
Besana
School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania.
Idda
I
Mosha
Independent Consultant, Dar es Salaam, Tanzania.
Zaina
Z
Sheweji
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205-2179, USA.
Caitlin E
CE
Kennedy
D000328:Adult; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000379:methods / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006700:Home Childbirth / Q000379:methods / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D010298:Parity; D011203:Poverty / Q000523:psychology*; D011247:Pregnancy; D011295:Prenatal Care / Q000523:psychology / Q000706:statistics & numerical data; D036301:Qualitative Research; D012747:Sexual Partners / Q000523:psychology*; D013636:Tanzania; D055815:Young Adult
Birth before arrival; Delivery; Maternal health; Newborn health; Poverty; Social class; Spouses; Tanzania
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