Characteristics of women delivering at home in Songea-rural district, Ruvuma region, Tanzania

A cross-sectional survey of 416 women of childbearing age (15-49 years old) was conducted in eight wards of Songea-rural district, from June to August 2001. The aim of the study was to determine factors associated with home deliveries and recommend ways of intervention so as to reduce the rate of home deliveries. A simple random sampling technique was used. Interviews were conducted to find out information regarding women's perception of maternity care provided by health workers, traditional birth attendants; traditional healers’ e.t.c. The questionnaire also elicited women's knowledge of the danger signs during pregnancy and delivery, reasons for non-utilization of health facilities and who determines place of delivery. Of the 416 subjects interviewed, 398 (95.7%) of the respondents had home deliveries. The results showed that majority of the interviewees 133 (32.0%} were aged between 26 years and 30 years and 98 (23.6%) of the respondents were aged between 15 -20 years and only 3 (0.7 %} were below 15 years. The results also showed that 313 (75.2%) of the respondents had attained primary education, 83 (20%) had no formal education. 127 (30.6 %) of the respondents were multiparous having deliveries more than five times. Factors that were seen to be associated with home deliveries were young age, high parity, single women, husbands and parents as decision makers, poor accessibility to funds, perceived poor quality of maternity services, transport. High costs and distance more than 5 kilometers. Distance and level of education did not have any association with home deliveries. Low social-economic status of the women has association with home deliveries. 223 (53.6%) of the respondents had financial problems, so could not seek maternity care. The study revealed that 238 (57.3 %} of the respondents felt highly esteemed when they delivered at home, and 96 (23 %) considered home delivery as a normal act. Results also showed that, husbands 258 (62.0%)had the final decision on the choice of a place of delivery, and 72 (17.8 %) of the respondents, decisions where made by only their In-Laws. Of the 398 who had home deliveries 265 (66.5 %) would prefer to be assisted by a nurse/midwife during delivery. Although, 397 (95.4 %) of the respondents lived within 5 kilometers from the health units however they had delivered at home. Maternity services provided by health workers were perceived to be poor when compared to those provided by TBA's. Most of the deliveries are conducted by TBAs. Accordingly to the findings, it is recommended to: improve the quality of maternity services in the existing health units, improve the facility structures to provide privacy, look into the possibility of supplying supplies e.g. gloves, syringes, cotton-wool free or at subsidized cost, improve communication, and interpersonal relationship of health workers with patients, and relevant authorities to look into ways of improving the socioeconomic status of the community in Songea Rural District.