BIRTH IN A BROKEN HEALTH SYSTEM; HOW ABUSE, NEGLECT, POVERTY AND DISRESPECT UNDERMINE INTRAPARTUM CARE IN MOROGORO REGION, TANZANIA

Despite decades of policies, declarations and interventions, in 2013 more than 289,000 women died from causes related to pregnancy and childbirth, and most of those deaths occurred in Sub-Saharan Africa. Tanzania, which is situated on the east coast of Africa, bears a disproportionately high burden of maternal deaths; it is among ten countries that account for a majority of the world’s maternal deaths. Rates of skilled attendance at birth have remained low (below 52%) for more than 20 years among Tanzanian women. This dissertation sought to explore how women, their partners and relevant community members describe the decisions and experiences related to birth in Morogoro Region, Tanzania. The study drew upon quantitative methods (including a household survey) and qualitative methods (including in-depth interviews). The study found that disrespectful care – feeling neglected, scorned, discriminated against or charged arbitrary fines or fees – permeated respondent accounts of childbirth, and compelled many families to minimize their exposure to the formal health system (detailed in Chapter 5). These experiences undermined respondents’ faith in the health system and shaped decisions that placed mother-baby pairs in danger. Respondents described delaying departure from home to facilities, which in some cases led to births en route (detailed in Chapter 6). They also described departing facilities dangerously early after delivery (detailed in Chapter 7). In conclusion, this study found that disrespectful care has become a normalized yet understudied component of the careseeking experience in Morogoro Region. In presenting not only the dynamics of disrespect but also the nexus between disrespect and careseeking at and around the intrapartum period, we add to a limited but expanding body of literature examining disrespectful care, and the ways in which it undermines efforts to promote careseeking for delivery