Award Date

5-1-2022

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Sociology

First Committee Member

Tirth Bhatta

Second Committee Member

David Dickens

Third Committee Member

Georgiann Davis

Fourth Committee Member

Nirmala Lekhak

Number of Pages

158

Abstract

The United Republic of Tanzania (URT) has been experiencing alarming maternal and neonatal mortality rates. While these deaths have decreased over time, they fall short of the World Health Organization's (WHO) standards. Due to their strong associations, understanding maternal healthcare utilization (MHC) is critical for improving our understanding of existing maternal and neonatal mortality patterns. Existing research, primarily focusing on antenatal care (ANC), indicates that utilization of maternal health care (MHC) has steadily increased since 1990. However, very little attention has been paid to period-based changes in other MHC measures (e.g., postnatal care) and how those changes vary across socioeconomic status (SES), residential, and regional contexts in Tanzania. Additionally, there is limited research on period-specific trends in neonatal mortality at those intersections. This dissertation examines overall period-based changes in various measures of MHC (e.g., antenatal, skilled delivery assistance (SDA), and postnatal care (PNC)) and neonatal mortality using cross-sectional data from the Tanzania Demographic Health Surveys (TDHS) from 1991 to 2016 (i.e., 1991-1992, 1996, 1999, 2004, 2010, and 2015-2016). Grounded in dependency theory and an intersectionality framework, I also explored the residential and regional differences in SES inequalities in MHC utilization and neonatal mortality from 1991 to 2016. This study documents the overall period-based patterns of MHC use and neonatal mortality in Tanzania from 1991-1992 to 2015-2016. Overall, there was a total of 30,028 women who had birthed within five years prior to the month of the interview. There was an increase in the percentages of women who utilized 1-3 ANC, SDA, and postnatal care between 1991-2016. The decline in the proportion of women who did not utilize ANC, those who used 4+ ANC, and neonatal mortality were seen between 1991-2016. There was also a decline in the percentages of women with no education and then poorest in 2016 relative to 1991. Women with who were not educated had higher neonatal mortality, lower use of SDA, 4+ANC, and PNCs than women were educated between 1991-2016. On the contrary, women with no education had the highest percentages of utilizing 1-3 ANC and not using ANC. There was also an increase in the use of 1-3 ANC, SDA, before discharging PNC (BDPNC) in all educational and household wealth groups. The decline in all education categories and household wealth quintiles in the use of 4+ANC, neonatal mortality, women with no ANC visits, and after discharging PNC (ADPNC) (only among women with no education) was also observed. More changes in the use of SDA and 4+ANC and neonatal mortality were observed in 1999 and 2004 on the overall sample, between residencies, regions, and years of surveys. There were more rural women (78.08%) than urban women (21.92%) examined between 1991 and 2016 in Tanzania. Fewer women were from the eastern and northern zones (privileged) compared to other regions (unprivileged)(18,488). Generally, there was lower use of all MHC and higher neonatal mortalities in underprivileged regions and rural areas than in women from privileged regions and urban areas between 1991-2016. The decline in the use of 4+ ANC, neonatal deaths, and women who do not utilize and an increase in SDA, BDPNC, ADPNC, and 1-3 ANC was documented in all residencies. Except for the ADPNC, which declined, this same pattern was observed between regions during the 1991-2016 periods. Women from unprivileged regions and rural areas had an increase in the use of 1-3 ANC, SDA, BDPNC in all wealth groups between 1991-2016 compared to their counterparts in privileged regions and urban areas, respectively. The decline in all wealth categories in the use of 4+ANC, neonatal mortality, women with 0 ANC visits, and ADPNC (Only among the poorest and middle wealth women) between 1991-2016 was also noted among the women from rural areas and unprivileged regions as compared to their counterparts. Women from privileged regions, and unprivileged regions had an increase in the use of 1-3 ANC in all education groups in 2016 than 1991. They also had a decline in the utilization of SDA and BDPNC and an increase in neonatal mortality among women with secondary and higher education in 2016 relative to 1991/2009. I observed the decline in all education categories in the use of 4+ANC, neonatal mortality, women with 0 ANC visits, and ADPNC (only among women with primary school and those with no education) in the year 2016 compared to 1991/2009. Rural women had an increase in the use of 1-3 ANC, SDA, BDPNC in all educational groups than urban women in 2016 compared to 1991/2009. The decline in all education categories in the use of 4+ANC, neonatal mortality, women with no ANC visits, and ADPNC (only among women with primary school level of education and the non- education) was also noted in the year 2016 vs. 1991/2009 among rural than urban women. I found a significant intersection between the year of survey and SES in the use of MHC and neonatal mortality. The differences between the odds of women having the lower education levels and those with secondary level of education were significant wider (lower) in the use of 1-3 ANC and 4+ANC in the years 1999 and 2004 as compared to the year 2016. These differences were also significantly wider in the use of BDPNC and significantly narrower (higher) in the use of ADPNC in 2009 compared to 2016. Like wisely, the differences between the odds of the poorest women and the richest were significantly wider in neonatal deaths in 1991, 2004, and 2010 compared to 2016. There existed a residential and regional differences in the effect of SES on the use of MHC and neonatal mortalities in Tanzania from 1991 to 2016. Relative to urban women and women from privileged regions, the differences in the use of SDA and ANC between women with lower/ inadequate education levels and those with secondary and higher/ adequate education from rural areas and underprivileged areas were significantly narrower in 1999 compared to 2004. Such difference in the use of ADPNC was significantly narrower in 2009 compared to 2015-2016. The disparities in ANC utilization between the wealthiest and poorest rural women were significantly higher in 1991 compared to 2016 than for urban women. Similarly, the disparities in SDA were higher for rural women in 1999 compared to 2004 than for urban women. Regarding neonatal deaths, the disparities between women with primary school levels of education and those with secondary and above education were significantly wider in 1999 than in 2016. Wealth disparities in neonatal mortality were significantly narrower among rural and underprivileged women than among urban women and women from privileged regions in 2004 compared to 2016. This study contributes significantly to existing scholarship, focusing on overall period changes in MHC and neonatal mortality while ignoring Tanzania's vast SES, residential, and regional differences. These findings emphasize the importance of considering regional and residential contexts to understand how such contexts modify socioeconomic inequalities in MHC utilization among Tanzanian women. These structural factors are critical for increasing MHC utilization and reducing maternal mortality among women in developing countries.

Controlled Subject

Maternal health services;Tanzania;Africa, East;

Disciplines

Sociology

File Format

pdf

File Size

1290 KB

Degree Grantor

University of Nevada, Las Vegas

Language

English

Rights

IN COPYRIGHT. For more information about this rights statement, please visit http://rightsstatements.org/vocab/InC/1.0/

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