Association between decision-making during pregnancy and woman-centred care among Tanzanian pregnant women: A cross-sectional survey

Dorkasi L Mwakawanga; Sanmei Chen; Beatrice Mwilike; Ally Abdul Lyimo; Naoki Hirose; Yoko Shimpuku

doi:10.1016/j.wombi.2024.101615

Association between decision-making during pregnancy and woman-centred care among Tanzanian pregnant women: A cross-sectional survey

Women Birth. 2024 Apr 13;37(4):101615. doi: 10.1016/j.wombi.2024.101615. Online ahead of print.

Authors

Dorkasi L Mwakawanga¹, Sanmei Chen², Beatrice Mwilike³, Ally Abdul Lyimo³, Naoki Hirose², Yoko Shimpuku⁴

Affiliations

¹ Global Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami Ward, Hiroshima 734-8553, Japan; Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, P. O Box 65001, Dar es Salaam, Tanzania.
² Global Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami Ward, Hiroshima 734-8553, Japan.
³ Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, P. O Box 65001, Dar es Salaam, Tanzania.
⁴ Global Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami Ward, Hiroshima 734-8553, Japan. Electronic address: yokoshim@hiroshima-u.ac.jp.

PMID: 38615514
DOI: 10.1016/j.wombi.2024.101615

Abstract

Background: Many women in Tanzania lack autonomy in decision-making for their pregnancy and childbirth. Woman-centred care (WCC) seeks to provide each woman with the appropriate information that promotes participation and highlights their informed decision-making. Thus, decision-making has been proposed as an essential determinant of WCC. This study aimed to assess the association between decision-making and WCC among Tanzanian pregnant women.

Methods: We conducted a cross-sectional study among 710 pregnant women in Tanzania. The 23-item Woman-Centred Care English version questionnaire was used to assess how women perceived the care provided by midwives. Participants were categorized into two decision-making groups: decision-making for the birthing place by pregnant women themselves and by others. The pre-defined cut-off point of the top 20 percentile was used to indicate a high level of WCC. Binary logistic regression models were used to determine the association between decision-making and WCC.

Results: The median score (interquartile range) of WCC was 97 (92-103) points when decisions were made by pregnant women, compared to 92 (88-96) points when decisions were made by others (p<0.001). There was a significant association between decision-maker and WCC in both unadjusted (p<0.001) and multivariable-adjusted (p=0.006) analyses. The unadjusted odds were approximately 5 times higher in the pregnant women decision-making group (OR: 4.80, 95% CI: 2.74-8.43) and 3 times higher (OR:2.90, 95% CI: 1.36-6.07) after the adjustment for covariates. We observed no significant interaction between decision-making and parity on the level of WCC (p for interaction=0.52).

Conclusion: Pregnant women who made decisions for the birthing place had a higher likelihood of having a high level of WCC compared with their counterparts. Our findings suggest that women should be empowered to be involved in decision-making to increase their satisfaction with the care provided by healthcare providers and foster a positive childbirth experience.

Keywords: Autonomy; Childbirth; Decision-making; Tanzania; Woman-centred care.