Imagine being pregnant, without a car and more than six miles away from the nearest hospital. This is the reality for many women living in rural north-central Tanzania. As a result, giving birth can be dangerous and even fatal. But, global public health agendas, like the Safe Motherhood Initiative and 2015 Millennium Development Goals, have been inspiring change.
In 2008, the Haydom Lutheran Hospital, in the Mbulu district of the Manyara region of Tanzania, began offering free ambulance and maternity services in an effort to reduce maternal mortality rates.
Biocultural anthropologist Dr. Crystal Patil, who is an assistant professor of Anthropology and African American Studies at UIC, has been studying the effects of the policy changes at the Haydom hospital. She presented her research to students in Northwestern University’s Program of African Studies, as part of the program’s “Public Health in Africa Series.”
“Some social and economic barriers were removed by this policy,” Patil said. “But, the changes in the policy may have had an impact on the quality of care.”
The Haydom policy change has been effective with 4,558 hospital births reported in 2008, up from 3,343 the previous year. In addition, 94 percent of those who live less than two kilometers from Haydom gave birth in the hospital.
However, there are many factors still keeping women at home when they give birth, and several challenges preventing the new system from
Patil and her team conducted interviews and surveys, and held village meetings. They spoke with mothers, hospital workers and traditional birth attendants.
Women said gossip, perceived discrimination, social support, transportation and sudden labor are some of the many factors that influence where they choose to give birth. Often the reason was simply, “Huwezi kupanga,” which means, “You just can’t plan.”
But, even if planning is possible, once a woman reaches the hospital, she may not receive a nurse’s care because Haydom is severely understaffed.
“So if the woman comes in and she looks OK, they have her labor by herself and deliver by herself,” Patil said. The nurses feel they can’t perform their jobs properly because it’s physically impossible.
Because of this, nurses can’t accompany ambulance drivers, who already face poor road conditions and difficulty locating homes.
“The ambulance drivers aren’t trained to provide healthcare services,” Patil said. “They’re mechanics, so they’re not comfortable going to pick up a laboring woman.”
Though the policy changes have given women more support, there is still a long way to go. Patil said women want to be treated well even if the care they are receiving is free. But, with so few options, it is hard to make a case.
“People don’t have choices,” Patil said. “You have to go to the closest one, so choosing a hospital based on quality of care is impossible.”
Jessica Pouchet, a first-year graduate student in anthropology, came to Patil’s talk because she will be doing her fieldwork in Tanzania, studying the connections between language and environment.
“One element that resonated with me was how the distance from the hospital affects women’s decisions on where to give birth,” she said.
Even as distance becomes less of an issue, such policy changes need to be matched with changes in staffing, said Patil, who heads to Malawi on Friday to work on a group antenatal care project. Until then, women’s hospital birth experiences may be compromised if such quality of care issues are not addressed.