The Influence of Intimate Partner Violence on Non-Facility Births Attended by Unskilled Providers in Tanzania: Evidence from the 2022 Demographic and Health Survey

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Abstract Background Non-facility births assisted by unskilled attendants remain a significant public health concern in Tanzania. Despite government efforts to expand access to maternal health services, such as increasing the number of healthcare facilities, scaling up skilled birth attendants, and eliminating financial barriers, many women continue to give birth under the care of unskilled attendants. This study aimed to assess the influence of intimate partner violence (IPV) as a predictor of non-facility births attended by unskilled individuals in Tanzania. Method The study used the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2022 TDHS-MIS) dataset, with a weighted sample of 2,284 women of reproductive age who gave birth two years preceding the survey and were included in intimate partners violence survey. Descriptive analysis determined the magnitude of both experiences in different forms of intimate partner violence and non-facility. Both univariate and multiple regression analyses were used to identify significant determinants of non-facility birth. Result A total of 438 women (19.2%) had non-facility births assisted by unskilled attendants. After adjusting for confounding factors, key predictors of non-facility births included ever experiencing any form of IPV (aOR=1.383, p=0.007). Other significant factors were educational attainment, with women having no formal education (aOR=2.718, p<0.001) and primary education (aOR=1.785, p=0.011) being more likely to give birth outside a facility; wealth index [poorest (aOR=7.468, p<0.001), poorer (aOR=4.434, p<0.001), middle (aOR=3.27, p=0.001) and richer (aOR=2.734, p=0.005)]; Antenatal Care (ANC) attendance less than four visits (aOR=1.574, p<0.001); number of children ever born [Two to four (aOR=2.408, p<0.001), more than four (aOR=3.119, p<0.001)] and ever terminated pregnancy (aOR=1.525, p=0.026). Conclusion Women who experienced IPV had significantly higher odds of non-facility births. Other crucial predictors included low educational attainment, poverty, having multiple children, attending fewer than four ANC visits, and a history of pregnancy termination. Since IPV is a modifiable risk factor, early detection during ANC visits and the implementation of targeted interventions could greatly enhance access to facility-based births with skilled professionals, thereby improving maternal and child health outcomes.

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