The rural-urban divide in Tanzania: Residential context and socioeconomic inequalities in maternal health care utilization.

Background: Existing studies in Tanzania, based mostly on rural samples, have primarily focused on individual behaviors responsible for the lower utilization of maternal health care. Relatively less attention had been paid to inequalities in structural circumstances that contribute to reduced utilization of maternal health care. More importantly, scholarship concerning the impact of the rural-urban divide on socioeconomic disparities in the utilization of maternal health care is virtually nonexistent in Tanzania.

Methods: Drawing from the Demographic Health Survey (2015-2016) conducted in Tanzania, our study includes a total of 3,595 women aged between 15-49 years old, who had given birth in five years before the month of the interview and living in both rural and urban Tanzania. The maternal health care utilization was assessed by four variables (i.e., antenatal care, skilled delivery assistance, the before and after discharging postnatal care). The independent variables were wealth, education, residence, parity, occupation, age, and the head of the household's sex. We used bivariate statistics and logistic regression to examine the rural-urban differences in the influence of education and wealth on maternal health care utilization.

Results: Significantly lower use of maternal health care in rural than urban areas demonstrated a stark rural-urban divide in Tanzania. We documented socioeconomic inequalities in maternal health care utilization in the form of lower odds of the utilization of such services among women with lower levels of education and household wealth. The educational inequalities in the utilization of skilled delivery assistance (or = 0.37, 95% CI: 0.16, 0.86; p = 0.021) and (before discharge) postnatal care (or = 0.60, 95% CI: 0.38, 0.95; p = 0.030) were significantly wider in rural than urban areas. The differences in the odds of the utilization of skilled delivery assistance between women in poorer wealth quintile and women in richer household wealth quintile were also significantly wider in rural areas than in urban areas. However, the statistically significant rural-urban divides in the impacts of socioeconomic status on antenatal care and (after discharge) postnatal care were not observed.

Conclusion: This study establishes the need for consideration of the rural-urban context in the formulation of policies to reduce disparities in maternal health care utilization in Tanzania.