Effect of women's decision-making power on the use of skilled birth attendants at childbirth in Tanzania

Objective. Maternal mortality remains unacceptably high in developing countries, especially in sub-Saharan Africa, where more than half of live births are unattended by Skilled Birth Attendants (SBA). This study assesses the ways in which women's status and decision-making power are related to the use of SBAs at most recent births among married women in Tanzania. Data and Methods. The 2010 Tanzania Demographic and Health Survey (weighted n = 4,516). Multivariate logistic regression analysis was used, including mediation and moderation analyses. Results. Women's household decision-making power (scored 0-6) has a positive significant association with the use of SBA (OR=1.096), after controlling for sociodemographic characteristics. Additionally, women's age, household wealth, and urban residence show significant, positive associations with the use of SBAs, while parity is negative. Relative to women with primary education, women with no formal education have 34.3 % lower odds of using a SBA (OR=0.657); women with high education have 1.97 times higher odds (OR=1.968). Also, this relationship between women's education and SBA use appears to be mediated by decision-making power, especially among women with no formal education (OR=0.98, Sobel test statistic=-1.95, p=0.05). Conclusions. Further understanding of the mechanisms linking socioeconomic determinants to SBA use is needed for prioritizing program and policy interventions targeting the most vulnerable groups. Maternal health programs may have the potential to accelerate maternal mortality reduction by focusing on women's empowerment, especially among women with little formal education.