Women's Perspectives on Barriers to Skilled Birth Attendance and Emergency Obstetric Care in Rural Tanzania: A Right to Health Analysis.

Tanzania is among the countries with high rates of maternal mortality. In 1976, Tanzania ratified the International Covenant on Economic, Social and Cultural Rights, which enshrines the right to health, including maternal health care. This right is further recognized in national law and policy. Despite these commitments, Tanzanian women continue to die from preventable maternal causes. Using a right to health lens, this qualitative study explored the barriers preventing rural underserved women from seeking skilled birth attendance and emergency obstetric care in Ngorongoro, Tanzania, where the use of such services has historically been low. Our study included a document review of maternal health-related laws, policies, and reports issued by governmental and nongovernmental entities, alongside interviews with 32 women of reproductive age. We found that the right to quality maternal health care was constrained by (1) low government budget allocations, (2) a lack of skilled health providers and maternal health care infrastructure and supplies, (3) long distances to health care facilities and a lack of transportation, (4) high cost of transportation and health facility delivery, (5) the tradition of home delivery, and (6) distrust that health care facilities would provide respectful and culturally appropriate care. We then generated key recommendations to overcome such barriers and thereby improve rural maternal health care and reduce maternal mortality.