Maternal health in Tanzania
29 October 2015
It is not going so well with the fifth Millennium Goal in Tanzania: improving maternal health. In some places, mothers still have an average of seven children. Fifty percent of the women give birth at home without a midwife, which results in one of the highest maternal mortality rates. On 3 November 2015 Judith Westeneng received her doctorate from Radboud University of Nijmegen in the Netherlands. She investigated the relationship between empowering Tanzanian women and their reproductive health.
Picture: Judith Westeneng
Inequalities in the power of women, their husbands and possibly other people as well can influence health behaviour either directly or indirectly. By using unique panel data, a number of relationships between power and pregnancies in Tanzania’s lake region have now been revealed by Judith Westeneng.
This study investigates whether there is a reciprocal effect between maternal health and empowering women. Having a greater say in family planning and the use of health care facilities increases the chance of good health. And vice versa, being in good health as well as giving birth to healthy children, increases the chance of women having a greater say. This study by Westeneng shows that women who contribute to the household income not only make use of pregnancy check-ups more often, they also have fewer home births. They probably take autonomous decisions about the use of health care during pregnancies, which benefits their health. However, it turns out that the relationship between empowering women and maternal health depends on the stage of the reproductive cycle.
The reproductive cycle
Picture: Judith Westeneng
The first stage of the reproductive cycle is family planning. The birth of children affects the labour participation of women, and thus her opportunities for generating an income. Contrary to what you might expect, the number of children particularly of younger women (who are in their twenties) has a positive effect on the number of hours she works. However, the number of children does have a negative effect on attending school: children who have younger brothers and sisters are, on average, not enjoying as many years of education. This is the case even though education is crucial for empowering the next generation. A number of relationships are not supported by this study. For example, the number of children does not seem to affect the physical integrity of women. And economic empowerment does not seem to have a significant impact on the use of contraceptives.
In the second stage, during pregnancies, we see that economic empowerment has a direct positive effect on the number of pregnancy check-ups: women who have been empowered economically generally opt more frequently for prenatal care. Economic empowerment also contributes positively to birth health care: women who have been economically empowered give birth in a hospital or clinic more often rather than at home.
The final stage is birth and child mortality rate. The status of a woman is strongly related to fulfilling her reproductive role, and having children increases her status in the household. But what if a woman cannot meet these expectations? What if she ‘fails’ as a mother, either because she does not have children (who live) or because she has children who die? Does this affect her status negatively? Miscarriages and stillbirths have an unfavourable effect on the attitude of the spouse in terms of violence but do not have an effect on the control that women have over their sexual relationships. Child mortality does have a negative impact on the control that women experience over their sexual relationships and also on the rate of participation in education of the other children, and thus on the future prospects of these children.
Picture: Shutterstock / Anton Ivanov
Investing in family planning (particularly reducing the number of children) seems to have a positive impact, albeit small, on the investments in education for children and can potentially contribute to reducing poverty of the next generation. This research study reveals the circle of causes and effects. This also implies that the women who have been the least empowered and the most marginalised are more likely to have a large number of children and run the highest risk of health problems. In addition, they run the highest risk of being stigmatised. Their status in the household certainly does not benefit from this. Westeneng further shows that not all empowerment dimensions have a positive effect on maternal health, and vice versa, not all outcomes of reproductive health have the same effect on empowerment.