Low utilization of skilled birth attendants in Ngorongoro Conservation Area, Tanzania: A complex reality requiring action

In the Ngorongoro Conservation Area, Tanzania, only 7% of deliveries are attended by skilled birth attendants (SBAs), contributing to a high maternal mortality ratio of 642 deaths per 100,000 live births. This study identifies complex barriers to SBA utilization, including negative community perceptions of hospital care, financial insecurity, road limitations, and insufficient hospital resources. Using Thaddeus and Maine’s Three Delays model, researchers analyzed delays in decision-making at home, reaching the hospital, and receiving care through participatory action research involving Maasai stakeholders, traditional birth attendants (TBAs), and healthcare workers from 2009 to 2011. Key solutions proposed include increasing food security, integrating TBA/SBA care for culturally appropriate support, expanding hospital staffing, and improving emergency obstetric care availability. The study highlights the need for collaborative, multi-actor efforts to align local needs with clinical best practices in maternal healthcare.

Roggeveen, Y., Birks, L., Kats, J. v., Manyama, M., Hatfield, J., Bunders, J., Scheele, F., & Roosmalen, J. v. (2013). Low utilization of skilled birth attendants in Ngorongoro Conservation Area, Tanzania: A complex reality requiring action. Health, 05(07), 71–83. https://doi.org/10.4236/health.2013.57a4011