Abstract:
Background: In Tanzania, half of all pregnant women access a health facility for delivery. The proportion receiving
skilled care at birth is even lower. In order to reduce maternal mortality and morbidity, the government has set out
to increase health facility deliveries by skilled care. The aim of this study was to describe the weaknesses in the
provision of acceptable and adequate quality care through the accounts of women who have suffered obstetric
fistula, nurse-midwives at both BEmOC and CEmOC health facilities and local community members.
Methods: Semi-structured interviews involving 16 women affected by obstetric fistula and five nurse-midwives at
maternity wards at both BEmOC and CEmOC health facilities, and Focus Group Discussions with husbands and
community members were conducted between October 2008 and February 2010 at Comprehensive Community
Based Rehabilitation in Tanzania and Temeke hospitals in Dar es Salaam, and Mpwapwa district in Dodoma region.
Results: Health care users and health providers experienced poor quality caring and working environments in the
health facilities. Women in labour lacked support, experienced neglect, as well as physical and verbal abuse.
Nurse-midwives lacked supportive supervision, supplies and also seemed to lack motivation.
Conclusions: There was a consensus among women who have suffered serious birth injuries and nurse midwives
staffing both BEmOC and CEmOC maternity wards that the quality of care offered to women in birth was
inadequate. While the birth accounts of women pointed to failure of care, the nurses described a situation of
disempowerment. The bad birth care experiences of women undermine the reputation of the health care system,
lower community expectations of facility birth, and sustain high rates of home deliveries. The only way to increase
the rate of skilled attendance at birth in the current Tanzanian context is to make facility birth a safer alternative
than home birth. The findings from this study indicate that there is a long way to go.