Realizing women´s right to maternal health: A study of awareness of rights and utilization of maternal health services among reproductive age women in two rural districts in Tanzania

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.

研究背景
许多国家的孕产妇死亡率仍处于令人无法接受的高位，实质侵犯了妇女的生命健康人权。获取关于孕产妇健康权利及可及服务的充分信息，是实现妇女获得可及医疗服务权利的关键环节。本研究旨在评估坦桑尼亚两个地区委员会（District Council, DC）近期分娩妇女对获得孕产妇健康服务权利的认知现状，以及此类认知与孕产妇健康服务利用之间的关联。
研究方法
本研究采用横断面研究设计。研究选取基于既往报告的孕产妇死亡率通过目的抽样确定的两个地区委员会：海地区委员会（Hai DC）与莫罗戈罗地区委员会（Morogoro DC），对调查开展前1年内分娩的妇女进行访谈。本研究采用两阶段整群抽样法选取研究样本，数据分析采用卡方检验与逻辑回归分析。
研究结果
最终共纳入547名受访对象。仅三分之一（34.4%）的受访者表示知晓自身获得孕产妇健康服务的权利。孕产妇健康权利相关信息的主要来源为媒体与医疗服务提供者。职业与受教育程度与该权利认知水平存在统计学意义上的显著关联。海地区委员会知晓自身获得服务权利的妇女占比高于莫罗戈罗地区委员会。知晓自身获得服务权利的妇女，其使用熟练接生人员接生的概率约为未知晓者的5倍（校正优势比[Adjusted Odds Ratio, AOR] 4.61，95%置信区间[Confidence Interval, CI]：2.14~8.57）。
结论与建议
本次研究纳入人群中，孕产妇健康服务获得权利的认知水平普遍偏低。为提升认知水平，进而提高孕期保健与分娩时熟练接生人员的使用率，本研究建议政府及合作方优先开展妇女人权相关的信息传播与教育工作，其中包括孕产妇健康服务获得权利的宣传教育，尤其应针对农村地区妇女推进相关工作。