Abstract:
Background: Tanzania is among ten countries that account for a majority of the world’s newborn deaths. However,
data on time-to-discharge after facility delivery, receipt of postpartum messaging by time to discharge and women’s
experiences in the time preceding discharge from a facility after childbirth are limited.
Methods: Household survey of 1267 women who delivered in the preceding 2–14 months; in-depth interviews with
24 women, 12 husbands, and 5 community elders.
Results: Two-thirds of women with vaginal, uncomplicated births departed within 12 h; 90 % within 24 h, and 95 %
within 48 h. Median departure times varied significantly across facilities (hospital: 23 h, health center: 10 h, dispensary:
7 h, p < 0.001).
Quantitative and qualitative data highlight the importance of type of facility and facility amenities in determining timeto-
discharge. In multiple logistic regression, level of facility (hospital, health center, dispensary) was the only significant
predictor of early discharge (p = 0.001). However across all types of facilities a majority of women depart before 24 h
ranging from hospitals (54 %) to health centers (64 %) to dispensaries (74 %). Most women who experienced a delivery
complication (56 %), gave birth by caesarean section (90 %), or gave birth to a pre-term baby (70 %) stayed longer than
24 h. Reasons for early discharge include: facility practices including discharge routines and working hours and facilitybased
discomforts for women and those who accompany them to facilities. Provision of postpartum counseling was
inadequate regardless of time to discharge and regardless of type of facility where delivery occurred.
Conclusion: Our quantitative and qualitative findings indicate that the level of facility care and comforts existing or
lacking in a facility have the greatest effect on time to discharge. This suggests that individual or interpersonal
characteristics play a limited role in deciding whether a woman would stay for shorter or longer periods.
Implementation of a policy of longer stay must incorporate enhanced postpartum counseling and should be sensitive
to women’s perceptions that it is safe and beneficial to leave hospitals soon after birth.
