The World Health Organization estimates that Tanzania’s maternal mortality ratio is 578 deaths per 100,000 live births. Death related to pregnancy and childbirth represents 18 percent of all deaths to women ages 15-49.
Just looking at deaths related to pregnancy and childbirth, however, doesn't give a sense for the full scope of this problem, writes Isis Gaddis, an economist with the World Bank, in a post for the blog Africa Can End Poverty. "The broader problems caused by poor reproductive health are far greater than what is suggested by these mortality statistics. For every maternal death, many more women suffer from pregnancy- or childbirth-related impairments, often with long-term negative impacts on their health and labor force participation."
A major factor behind high maternal mortality rates is "insufficient utilization of reproductive health services," according to Gaddis. The World Health Organization recommends that pregnant women visit a health care provider four times during their pregnancy for checkups. In Tanzania, however, less than 40 percent of women report at least four checkups with a health care provider while they were pregnant.
Another issue is that many births, at least 49 percent, are not attended by a skilled health care provider, according to the World Health Organization. About 15 percent of births are attended only by a traditional birth attendant while 29 percent were attended only by relatives or friends. More than 60,000 births, just over 3 percent, are delivered without any assistance.
In assessing the reasons for low access to prenatal care, Gaddis said "under-utilization of reproductive health services is related to poor accessibility and the cost associated with seeking care." The government of Tanzania spends $57 per person on health care, according to figures from the Organization for Economic Cooperation and Development.
This means that many health expenses must be paid out of pocket. The per capita GDP in Tanzania in 2011 was $1,600, which means families live on about $4.50 per day. Women in Tanzania report paying on average $5 to deliver their babies, plus an additional fee every time they visit the doctor for prenatal checkups, according to research published in Health Policy and Planning, an academic medical journal.
But Gaddis suggests another reason why women in Tanzania may not be getting the recommended amount of prenatal care. "In 2010, only around half of the women (53 percent) who received antenatal care were informed about potential pregnancy complications. Unlike health care needs of children, which are often addressed through large-scale immunization campaigns and other ‘vertical’ programs, reproductive health care needs are addressed through the general health care system, which suffers from the well-known problems of weak staff incentives, poor accountability and inadequate service delivery."