Bypassing primary care clinics for childbirth: a cross-sectional study in the Pwani region, United Republic of Tanzania

This study assessed facility deliveries in 2011 in Pwani - where facility delivery is high (73%, 2010 DHS). The researchers wanted to discover which factors are associated with women who bypass primary clinics to deliver in a health centre of hospital, without being referred there. They also investigated the associated costs and quality of care received by women who bypassed primary clinics. In total 1989 women were interviewed who had recently delivered at a facility and had not been referred there. The women were asked about the services they had received, their perception of the quality, their satisfaction with services received, payment, and distance travelled. 42% had chosen to bypass their clinic for their most recent delivery,  Bypassers were more likely to be delivering their first child, more likely to have visited their local clinic more than five times in the previous year (for any reason), and more likely to rate the quality of services provided at their local clinic as poor. Bypassers were less likely than non-bypassers to be living near a recently upgraded clinic, or one that was regularly providing signal functions of emergency obstetric care. Bypassers travelled significantly longer and paid more for their delivery services, but were nearly twice as likely be very satisfied with the services received. Bypassing involved substantial transportation challenges and costs, with nearly 16% of bypassers having to borrow money or sell assets to fund the delivery, and so accessing higher-level facilities is inequitable, and difficult for the poorest mothers. To read the full document please click here