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Background Maternal mortality rates are still unacceptably high in many countries, indicating violation of women´s human right to life and health. Access to adequate information about maternal health rights and available services are essential aspects of realizing women´s right to accessible health care. This study aimed at assessing awareness of the right to access maternal health services among women who had recently given birth, and the association between such awareness and the utilization of maternal health services in two districts in Tanzania. Methods This study was cross sectional in design. Interviews were conducted with women who gave birth within one year prior to the survey in two different district councils (DC) namely Hai DC and Morogoro DC, selected purposively based on the earlier reported rates of maternal mortality. We used a two-stage cluster sampling to select the study sample. Analysis employed Chi-square test and Logistic regression. Results A total of 547 respondents were interviewed. Only a third (34.4%) reported to be aware of their right to access maternal health services. Main sources of information on maternal health rights were the media and health care providers. Occupation and education level showed a statistically significant association with awareness of access rights. Hai DC had higher proportion of women aware of their access rights compared to Morogoro DC. Women who were aware of their right of access were almost 5 times more likely to use skilled birth attendants compared to those who were not (AOR 4.61 95% CI: 2.14–8.57). Conclusion and recommendations Awareness of the right to access maternal health services was low in the studied population. To increase awareness and hence uptake of Pregnancy care and skilled birth attendants at delivery we recommend the government and partners to prioritize provision of information, communication and education on women´s human rights, including the right to access maternal health services, especially to women in rural areas.
This was a cross sectional study in design conducted between August and September, 2012. Cross sectional studies have been commonly used in medical and social sciences research to describe features of the population at a particular time [18]. Several studies have used this design to assess awareness of health interventions and concepts in the population including human rights [18][19] [20]. Interviews of a random sample of women (age 18–50) who gave birth within one year prior to the survey were done using a questionnaire with both open and close ended questions. The questionnaire was developed in English language and then translated into Kiswahili which is the language spoken by all women in the study sites. Back translation to English was done by an independent person to ensure good quality of the translation so as to keep the same meaning. The questionnaire was pre-tested among 45 women of reproductive age in a similar setting to test for clarity, validity and reliability of the questions after which the tool was revised and finalized for use. Six trained research assistants who were university graduates in social sciences were trained and they administered the questionnaires to the women respondents in both districts. The interview lasted for about 40 minutes and no remuneration was done to the respondents as time compensation. Women´s awareness of their rights to access maternal health services was measured by first asking women general questions relating to human rights: whether they had ever heard of the term “human rights” and whether they had ever heard that it is their right to access maternal health services. Women who responded with a yes in one or both of these questions were then asked a follow-up and open-ended questions on what they knew or had heard about their right to access maternal health services. The information generated from the open-ended questions was analyzed using content analysis. All those who mentioned the right to access good quality maternal services, free maternal services or non-discriminatory services were considered to be aware of their right to access maternal services. The study was conducted in Tanzania in the two districts: Morogoro DC in the Morogoro region and Hai DC in the Kilimanjaro region. The two councils were purposefully selected due to their differences in the reported rates of maternal mortality. According to the Adult Mortality and Morbidity Project (AMMP), Morogoro DC had a higher maternal mortality rate, estimated at 107/100,000 live births whereas Hai DC had an estimated maternal mortality of 43/100, 000 live births [21]. Morogoro DC has a population of 286,248 scattered over an area of 19056 kilometres2 whereas Hai DC has a population of 210,533 living in an area of about 226 kilometres2 [22]. Both districts are predominantly rural with subsistence farming being the main economic activity. There were a total of 63 health facilities providing maternal health services in Morogoro DC of which 3 were hospitals, and 6 health centers and the rest are dispensaries, whereas in Hai DC the corresponding number of health facilities was 32 of which 1 was a hospital, 4 health centers and 27 dispensaries. A two stage cluster random sampling was employed to select the study sample. We first selected a random sample of 30% of health facilities providing maternal health services in each district. This complies with the WHO/UNICEF recommendation that a random sample of 25% or above of facilities can represent the health situation of a district [23]. imple random sampling using the lottery method was used to select the health facilities. For each of the selected health facilities, one village in its catchment area was selected randomly. In the selected village, a house to house survey was conducted and all women who had given birth within the previous one year were included in the survey upon giving written informed consent. During data collection, investigators checked the questionnaires daily on site for completion and consistency. Errors were corrected before leaving the location. Filled in questionnaires were packed in envelopes and transported to MUHAS for data processing. Double data entry was done using EPI Info version 3.5.2 data entry program. Data cleaning was done using the data compare utility of EPI INFO software and all disagreements were checked and corrected. We had a number of independent variables which included age, occupation, level of education, ability to read and write, marital status, parity (number of live births) and distance from the village to the nearest health facility providing maternal health services. The quantitative data was analysed using SPSS for Windows version 23 and STATA version 12. Frequency distributions and two-way tables were used to summarize both the outcome and independent variables. The χ2 test was used to assess association between awareness of the right to access health services and social demographic factors and the association between utilization of SBAs during delivery with socio demographic characteristics and awareness of access rights. P-values equal to or less than 0.05 were considered statistically significant. Multiple logistic regression was used to assess individual effect of independent variables on predicting awareness and usage of SBAs while adjusting for potential confounding variables. In all analyses, adjustment for clustering effect was done using survey (svy) commands in STATA. We present crude odds ratios (COR) from binary logistic regression and adjusted odds ratios (AOR) from multiple logistic regression analysis. The information collected from open-ended questions were analyzed using content analysis to distinguish those who were aware and those who were not aware of their maternal health rights. This was done by one of the authors who is a Social Scientist.
