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Women's preferences for place of delivery in rural Tanzania: a population-based discrete choice experiment.

Kruk, M. E., Paczkowski, M., Mbaruku, G., de Pinho, H. and Galea, S. (2009) Women's preferences for place of delivery in rural Tanzania: a population-based discrete choice experiment. American journal of public health, 99 (9). pp. 1666-1672. ISSN 1541-0048

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We fielded a population-based discrete choice experiment (DCE) in rural western Tanzania, where only one third of women deliver children in a health facility, to evaluate health-system factors that influence women's delivery decisions.


Women were shown choice cards that described 2 hypothetical health centers by means of 6 attributes (distance, cost, type of provider, attitude of provider, drugs and equipment, free transport). The women were then asked to indicate which of the 2 facilities they would prefer to use for a future delivery. We used a hierarchical Bayes procedure to estimate individual and mean utility parameters.


A total of 1203 women completed the DCE. The model showed good predictive validity for actual facility choice. The most important facility attributes were a respectful provider attitude and availability of drugs and medical equipment. Policy simulations suggested that if these attributes were improved at existing facilities, the proportion of women preferring facility delivery would rise from 43% to 88%.


In regions in which attended delivery rates are low despite availability of primary care facilities, policy experiments should test the effect of targeted quality improvements on facility use.

Item Type: Article
Keywords: place of delivery, children, health facility, women's delivery
Subjects: Health Systems > Community Health
Maternal & Neonatal Health > Obstetric care
Divisions: Ifakara Health Institute > Biomedical
Depositing User: Mr Joseph Madata
Date Deposited: 08 Sep 2012 21:27
Last Modified: 08 Sep 2012 21:27

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