Qualified antenatal care, skilled birth attendance, access to emergency obstetric care and neonatal resuscitation skills are vital components to substantially reduce maternal, perinatal and neonatal mortality in developing countries. The level of skilled birth attendance varies markedly among and within regions and countries, being well below 50% in many countries in South-East Asia and Sub-Saharan Africa. Although official nation-wide figures may show high coverage rates, this picture can be misleading.
Typically, rates of skilled attendance are lower in rural than in urban areas This situation applies to Tanzania where in 2004/2005 the average rate of skilled attendance was as high as 81% in urban areas and as low as 39% in rural, remote districts (DHS 2004/2005). Even within rural regions, marked differences may exist which can be related to cultural norms, socioeconomic circumstances, accessibility of health institutions and service provision. In the case of nomadic populations, it is even more difficult to provide health services, including obstetric care with skilled birth attendance.
In Tanzania the majority of women are making the recommended number of antenatal care visit more than eight in ten women are making their first visit later than recommended. 95% of pregnant women make at least one antenatal care visit, while only 62% make four or more visit. Moreover 47% of women attending antenatal visits recall having been informed related dangerous complication Andrea et al.( 2010)
In Tanzania, like other Sub Saharan Africa countries, maternal mortality remains to be a problem of public health importance. The 2004 Tanzania Demographic and Health Survey (TDHS) published a maternal mortality ratio (MMR) of 578/100000 live births  but maternal mortality rate before the survey estimated as 454 maternal death per 100000 live birth. The 95% confidence interval for the 2004 to 2005 rate of 578 is 466 to 690. the 95% confidence interval indicate that true maternal mortality ratio from the 2010 TDHS maternal mortality ratio of 556 is lower than the 2004 TDHS estimated of 578, suggesting that the maternal mortality in Tanzania may have stated to decline.
The study has revealed that most of Nigeria women tended to obtain care rate in pregnancy, and for about one third the care was inadequate. In this study, almost half 47% of the women started attending the antenatal clinic only in the third trimester. In a sample of South Africa antenatal clinic attendees, it was found that 75% had already attended either in the first 7% or second trimester 68%. Kambaran, chirenje and Rusakaniko found among rural Zimbabwe antenatal clinic attendees that only 21.6% started antenatal clinic in the first trimester and 62% made five or less antenatal visits but the attendance to delivery health care services still low which led to high result of maternal death.
The medium number of months that pregnant women at their first visit in mpanda district is 5 and other women do seek Antenatal care until their six month which led to minimum attendance to delivery services. Late and low attendance may be explained by different factors to be explored by the study. Therefore, reasons for low utilization of antenatal and derivers health care services want further investigation.
1.2 Statement of the problems and significance of the study
1.2.1 Statement of the problem
The problem of low deliveries in health facilities exist in Mpanda district at Kashaulili ward which was less than 50% thus seems to be a serious problem. According to District annual health report (2010). Mpanda district has 40% of women delivered in Health units, while the Antenatal coverage 70%. Tanzania national health policy formed in 1990 reviewed by the ministry of health aimed at improving the health and wellbeing of all Tanzanians with a focus on those at most risk and to encourage the health system to be more responsive to the need of people (URT, 2003).
The deliveries outside Health units and low antenatal care has subjects a woman into complications such as tears, retained placenta, ruptured uterus, postpartum hemorrhage, puepheral sepsis, increased mother to child transmission and missing intermittent preventive treatment . It often happens to some women who agree to enter Health unit only when birth complications have advanced and tends to increase the incidence of maternal mortality (Ahmed 1998 and Mathew et al 1995).
Despite the information from different studies indicated above, Limited information was little available in a study area on factors hindering pregnancy women failed to attend antenatal and delivery health care services, therefore my study was carried out in the study area to reveal this information and to examine which factors hinder the remaining percent of pregnancy women failed to attend those services, current status of utilization of services and measures taken by those services provider to tackle the problem.
1.2.2 Significant of the study
The study result from the research will be used to plan appropriate interventions towards improving safe motherhood services in the district of Mpanda especially in Kashaulili ward. Result of this study will also help development a practitioner dealing with safe motherhood i.e. Government and NGOs in Mpanda district towards proper formulation of strategies and effective Health education messages to help on solving the problem of low deliveries in Health and encourage antenatal care attendance.
1.3.1 General objective
To assess the utilization of antenatal and delivery health care services among women in Mpanda district
1.3.2 Specific objectives
Current status of utilization of antenatal and delivery health care services information
To asses factors hindering utilization of antenatal and delivery health care service
To examine measures undertaken by the health service providers to overcome the problem antenatal utilization and delivery health care services
1.4 Research Questions
1. What is Current status of utilization of antenatal and delivery health care services¬¬?
Age of respondent
Sex of respondent
2. What are the factors hindering utilization of antenatal and delivery health care service.
Social cultural factors
Transport cost to access health services
Number of health facilities
Distance to health facilities
Maternal care services utilization
3. What are measures undertaken by the health service provider to overcome the situation in the study.
Awareness creation programme
Number of seminars and training
Communication material used
1.5 Scope of the study
The study was conducted in Mpanda district cover the selected ward which was kashaulili ward this was among wards where there was little utilization of antenatal and delivery health care services. Where by data was collected from hospitals, dispensaries, and health centre and community members of child bearing especially women
1.6 Conceptual frame work
The study assumes that, a very good understanding of factors influencing pregnancy women to attend maternal care before and during delivery of their babies result into combination of impacts. That means failure to understand factors influencing antenatal care and skilled birth attendance will obviously call for redesigning of the reasons. however the redesigning of the factors will eventually take into consideration revisiting other existing factors that the researcher in one way or another did not involve them in the study so as to come up with strong factors that led pregnancy women failed to attend maternal care before birth and during delivery of their babies.
-Availability of health facility
-Distance to health facility
-Transport cost to health services
-Social cultural factors
-delivery at home
-Age of respondent
-Sex of respondent
Improved safe mother hood
Conceptual frame work indicating relationship between utilization of antenatal and delivery health care services CHAPETER TWO
2.0 LITERATURE REVIEW
2.1 Antenatal care and skilled birth attendance
This help to detect problem in pregnancy or labor before they become serious. At the antenatal care the midwifes or doctors wants to know how the pregnant women feel about any problem she have noticed, it is the period where they check blood pressure, test urine, check swelling of the legs hands and face in order to detect the related diseases called eclampsi and problem that pregnancies women can face during deliveries of their babies and encourage them to attend to health center soon Coffin 2001.
2.2 Global concern on antenatal care and skilled birth attendance Several studies have been done to determine the magnitude of health facility deliveries. Underneath are a few of the documented studies. Barbhuiya et al (2001) in their study on prevalence of home deliveries and ante-natal care done in Gazipur Thana Bangladesh results showed that 83% of the respondents received ante-natal check-up throughout their last pregnancy and out of 505 respondents 91.3% of the respondents was found to have delivered at home while only 8.7% at health institutions.
On the other hand Kaguna et al (2000) in their study on factors influencing choice of delivery sites in Rakai district Uganda noted that 44% of the sample delivered at home, 17% at traditional birth attendants place, 32% at public health units and 7% at private clinics. In Tanzania the Demographic Health Survey (1996) described health facility delivery being 47% and home delivery being 50%.
2.3 Another study done by Patricia (1994) in Zimbabwe reported that whereas ANC attendance rates were high however the deliveries in the majority of cases did not take place at the hospital or planned place which was only 44.3% health unit deliveries. Similarly Geoffrey and Sembatya in their study done in Mangachi district in Malawi in 1996 reported that although many mothers attend ante-natal clinics at various units in Malawi, less than one quarter of they actually deliver in the health centre, which was 23% of all deliveries in the study.
Mothers knowledge is an important factor in enabling them in attending ANC. Findings from a study by Ladfors et al 2001 in a population based study Swedish Womens opinions about ante-natal delivery and post partum care reported that 81% of porous women answered that, checking blood and urine samples, fetal rate and measurement of feudal height were the most important procedures in ante-natal care. Mother has also been reported to be having substantial knowledge on risk factors a study in Ekpoma.
2.4 Nigeria reported that the community was knowledgeable about hemorrhage in pregnancy and delivery, however because of the inability to recognize early warning signs they continued with traditional treatment even when clear evidence of danger existed (Chiwuzie et al 1995). Mothers have a tendency to believe that, the more they deliver the less the complications and hence the less need to deliver in health facility. The TDHS (1996) discovered that in overall 45% of births were delivered in a health unit, while about half of the births were delivered at home. The proportion of births delivered in a health unit decreases with the mothers parity. Mathew et al (1995) in survey to establish knowledge of Teas in Nigeria on handling deliveries they noted that, many of the birth attendants were illiterate and only a few had been trained by a health professional. Majority did not recognize potentially serious complications occurring in the mother as a cause of concern
2.5 A similar study in Mongachi Malawi by Godfrey and Margaret (1996) reported that many deliveries which took place at home were either primegravide or grand multiparous. Although the reasons given for not being attended or being attended by non-trained personnel during delivery appeared genuine, the risks taken by the grand multiparas remained disturbingly high. These women who take the trouble to attend antenatal clinics, among them, they were assumed to have been motivated to use the health facilities. The influence of distance cannot be underscored. WHO (1986), Studies done in Cuba, Egypt, Indonesia, Jamaica and Turkey on maternal mortality demonstrated that maternal complication rates are increased in areas where women are likely to arrive in the hospital, in a serious condition. .
2.6 Attendance to Antenatal clinic in South Africa
In South Africa attendance rate to antenatal care is still a problem as people they attend later. a study conducted in south Africa found that, despite the widespread availability of free antenatal care services, most women in rural south Africa attend their first antenatal clinic late in pregnancy and fail to return for any follow up care, potentially leading to avoidable perinatal and maternal complications Myer et al.2003. However it was found that in a sample of South Africa antenatal clinic attendees, it was found that 75% had already attended either in the first 7% or second trimester 68% Myer 2003.
2.7 Factors determining attendance in other African countries Although a function government maternity center in the Yoruba community in Nigeria offered a full range of antenatal and delivery services, most of the women did not register for antenatal care until their six month of pregnancy or later, and 65% delivered at home Brieger 1994. another study revealed that the use of maternal health services tend to be shaped mostly by level of education, place of residence, region of residence, occupation and religion Addais,1998.
2.8 Quality of antenatal care and skilled birth attendance in Tanzania The most estimated coming from Tanzania show that 94percent of pregnancy women makes at least one antenatal care visits. Also records show that women in Tanzania tend to obtain care late in pregnancy while are seems to be inadequate. Women are supposed to be educated on antenatal care and skilled birth attendance early and get counseled regarding pregnancy related complication during their visits. Pemba2010. However, it was found that most of the women did not know when in the course of pregnancy they should start attending antenatal clinics Mlay, 1994
2.9 Information gap
Despite the information from different studies indicated above, Limited information is little available in a study area on factors hindering pregnancy women failed to attend antenatal and delivery health care services, therefore this study is going to carry out in the study area to reveal this information and to examine which factors hinder the remaining percent of pregnancy women failed to attend those services, current status of utilization of services and measures taken by those services provider to tackle the problem.
2.10 Information gap
According to different studies undertaken by the researchers most of them based on the issue like factors affecting utilization of antenatal care, social support as the factor determining attendance to antenatal care, delay of antenatal clinic and related complication. But there is no study under taken concerning utilization of antenatal and skilled birth attendance in Mpanda district especially in kashaulili ward that is from that point, I want to study the factors led the remain percentage of pregnancy women failed to attend maternal care before birth and during delivery their babies.