Parity and institutional delivery in rural Tanzania: a multilevel analysis and policy implications
Open accessAbstract
OBJECTIVES: We assess the extent to which the use of healthcare facilities for childbirth varies by parity, conditional on socio-economic, psychological and health characteristics. We also assess differences in the determinants of institutionalized delivery for first-time mothers and multiparous, and explore village-level variations in observed relationships. METHODS: Survey data from a three-stage cross-sectional cluster sample of 1205 women from a rural district of Tanzania were analysed using random-intercept multilevel models. RESULTS: Use of health facilities for delivery was low (39%), with odds of institutionalized delivery three times higher among nulliparous women (0 children prior to current delivery) compared with women with one to four children; and 30% lower among women with five or more children compared with those with one to four children. In parity group analyses, women with at least some education and women with more than three antenatal care visits had higher odds of institutionalized delivery among nulliparous. Belief in the importance of institutionalized delivery increased the odds of delivering in a facility among multiparous women; so did health insurance for women with five or more children. We found a significant variation in institutionalized delivery among multiparous women based on their village of residence (one to four and five or more children), but these variations were not observed among nulliparous women. CONCLUSION: Parity is a pivotal determinant of the use of health facilities for delivery, and its significance varies by village of residence; hence, interventions targeting women according to parity may increase the use of facilities for delivery in rural Tanzania. Future research should focus on the village-level characteristics that influence institutionalized delivery in multiparous.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Women with lower education, higher parity, and those living in rural areas are the least likely to access facility delivery services.
“Women with lower education, higher parity, and those living in rural areas are the least likely to access facility delivery services [9, 32, 33].”
From Impact of smartphone-assisted prenatal home visits on women’s use of facility delivery: Results from a cluster-randomized trial in rural Tanzania (2018) · cites this paper as [33]
A woman's perceptions of risk associated with childbirth are likely to be lower and her preference for home birth higher if she has delivered safely at home in the past.
“In contrast, a woman’s perceptions of risk associated with childbirth are likely to be lower and her preference for home birth higher if she has delivered safely at home in the past [33, 44].”
From Impact of smartphone-assisted prenatal home visits on women’s use of facility delivery: Results from a cluster-randomized trial in rural Tanzania (2018) · cites this paper as [33]
These findings lend weight to recent calls to target safe motherhood interventions according to parity in rural Tanzania.
“These findings lend weight to recent calls to target safe motherhood interventions according to parity in rural Tanzania [33], and recognize the critical influence of past delivery location on women’s choices.”
From Impact of smartphone-assisted prenatal home visits on women’s use of facility delivery: Results from a cluster-randomized trial in rural Tanzania (2018) · cites this paper as [33]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
The citation lists haven’t been fetched yet
References 64 · Cited by 41
Research works printed but not linked: 1
- World Health Organization. Progress on The Health-Related Millennium Development Goals (MDGs) 2009. Factsheet No. 290, Table 8: Health Inequalities. Geneva: WHO. [Google Scholar]
- Authors
- Ndao-Brumblay, S. K., Mbaruku, G., & Kruk, M. E.
- Affiliations
- University of Michigan (US)
- Columbia University (US)
- Venue
- Health Policy and Planning
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-11-05
- Volume
- 28
- Issue
- 6
- Pages
- 647-657
- ISSN
- 0268-1080 (ISSN-L)
- 1460-2237
- PMC
- PMC3753883
- OpenAlex
- W2103494766
- Cited by
- 41
- References
- 64
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 2 · 2023: 3 · 2022: 4 · 2021: 4 · 2020: 7 · 2019: 2 · 2018: 1 · 2017: 2 · 2016: 3 · 2015: 5 · 2014: 2 · 2013: 1
- FWCI
- 2.25
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Health Policy and Planning (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- IHI Repository (acceptedVersion)
- Funders
- University of Michigan
- School of Public Health, University of Michigan
- National Institutes of Health
- National Institute on Drug Abuse (DA 017642, DA 022720, R01DA022720, R01DA017642)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Keywords
- parity, institutional delivery, rural Tanzania, nulliparous women, multiparous women, maternal health service utilization, prenatal care, maternal education, health insurance, village-level variation, maternal health policy
- MeSH terms
- Cross-Sectional Studies, Female, Humans, Maternal Health Services, Parity, Policy Making, Pregnancy, Rural Population, Social Class, Tanzania, Delivery, Obstetric
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
