The 2010 maternal mortality rate per 100,000 births for Tanzania was 790. This is compared with 449 in 2008 and 610.2 in 1990. The UN Child Mortality Report 2011 reports a decrease in under-five mortality from 155 per 1,000 live births in 1990 to 76 per 1,000 live births in 2010, and in neonatal mortality from 40 per 1,000 live births to 26 per 1,000 live births. The aim of the report The State of the World's Midwifery is to highlight ways in which the Millennium Development Goals can be achieved, particularly Goal 4 – Reduce child
mortality and Goal 5 – improve maternal health. In Tanzania there are only two midwives per 1,000 live births; and the lifetime risk of death during delivery for women is one in 23.
The Human Rights Measurement Initiative finds that Tanzania is fulfilling 76.7% of what it should be fulfilling for the right to health based on its level of income. When looking at the right to health with respect to children, Tanzania achieves 92.5% of what is expected based on its current income. In regards to the right to health amongst the adult population, the country achieves only 85.8% of what is expected based on the nation's level of income. Tanzania falls into the "very bad" category when evaluating the right to reproductive health because the nation is fulfilling only 51.7% of what the nation is expected to achieve based on the resources (income) it has available.
Maternal and child health status Both maternal and child health are interdependent and substantially contributing to high burden of mortality worldwide. Every year, 289,000 women die due to complications in pregnancy and childbirth, and 6.6 million children below 5 years of age die of complications in the newborn period and of common childhood diseases. Sub-Saharan Africa (SSA), which includes Tanzania, contribute higher proportion of maternal and child mortality. Due to considerable proportion of mortality being attributed by maternal and child health, the United Nations together with other international agencies incorporated the two into Millennium Development Goals (MDGs) 4 and 5. In this regard, Tanzania through the Ministry of Health and Social Welfare (MoHSW) adopted different strategies and efforts to promote safe motherhood and improve child survival. Similarly, in an effort to improve maternal and child health, Tanzania's government has declared maternal and child health services to be exempt from user fees in government facilities.
Maternal health indicators
Maternal mortality ratio
Complications during pregnancy and childbirth are a leading cause of death and disability among women of reproductive age in developing countries. Statistically, maternal mortality contributes to only 2.3 per cent of the total mortality. The maternal mortality ratio (MMR) represents the risk associated with each pregnancy. MMR is estimated by using both number of maternal deaths and live births. Many low-income countries have no or very little data and modelling is used to obtain a national estimate. According to estimates in 2013, total maternal deaths and MMR in Tanzania were 7,900 and 410 per 100,000 live births respectively. In relation to MDG 5, Tanzania is supposed to reach the MMR of 230 per 100,000 live births by 2015. Reduction of maternal deaths is one of the main goals of the Tanzanian poverty reduction strategyNational Strategy for Growth and Reduction of Poverty II, Tanzania Ministry of Finance and Economic Affairs, July 2010, page 73, accessed 26 October 2014 and the health sector reform program, but progress has been slow. The slow progress in reducing maternal mortality on mainland Tanzania is compounded by the impact of the HIV/AIDS epidemic.
Antenatal care coverage
Good care during pregnancy is important for the health of the mother and the development of the unborn baby. Many health problems in pregnant women can be prevented, detected, and treated during antenatal care visits with trained health workers. The World Health Organization recommends a minimum of four antenatal care (ANC) visits. The Tanzania Demographic and Health Survey 2010 showed that 98 percent made at least one ANC visit and 43 percent made four or more visits.Tanzania Demographic and Health Survey 2010, National Bureau of Statistics, Tanzania Ministry of Health and Social Welfare, April 2011, page 129, accessed 26 October 2014
Skilled birth deliveries This indicator is directly linked to a process of giving birth by pregnant woman, and most of maternal mortality are likely to happen at this stage. Most maternal deaths result from haemorrhage, complications of unsafe abortion, pregnancy-induced hypertension, sepsis and obstructed labour. However, these proportions of causes for maternal deaths are likely to differ from one country to another. According to official estimates, more than 20 women die of pregnancy and childbirth-related complications every day in Tanzania. Ensuring that mothers have access to a skilled attendant during labour can dramatically reduce the risk of death for the mother and newborn child. In the 2010 Tanzania DHS, about 51% of deliveries were assisted by skilled personnel. While it was 41% in 1999 Tanzania DHS. Potentially the current figure national-wide will be more than 51 per cent. Shortage of health providers, among others, are limiting factors to be delivered by skilled provider. The ratio of doctors to patients in Tanzania is 1:25,000 and the ratio of nurses to patients is 1:23,000. While the ratio in the United States is 1:300. President Jakaya Kikwete in May 2014 appealed to health workers in Tanzania to ensure that lives of women and children are not at risk during delivery. In Tanzania, two thirds of women give birth in their own homes, because there are very few health facilities within reach that can provide life-saving emergency services.
Postnatal care coverage Every year in Africa, at least 125,000 women and 870,000 newborns die in the first week after birth, yet this is when coverage and programmes are at their lowest along the continuum of care. Since up to 50 per cent of maternal deaths occurs after delivery, a midwife or a trained and supervised Traditional Birth Attendant (TBA) should visit all mothers as soon as possible within the first 24–48 hours after birth. The 2010 figure in utilizing postnatal care in Tanzania was only 31 per cent according to TDHS. Coverage of postnatal check-up within 4 hours after birth varies from 9 percent in the Lake zone to 34 percent in the Southern zone in Tanzania. Postnatal care (PNC) programmes are among the weakest of all reproductive and child health programmes in Tanzania and Sub-Saharan African in general. Given the absence of PNC guidelines in Tanzania, the Reproductive and Child Health Section (RCHS) of the Ministry of Health and Social Welfare [Tanzania] reported in 2009 that is in the process of developing it to be used country-wide.
Modern family planning use The policy environment for family planning in Tanzania is mixed, but promising. At the 2012 London Summit on Family Planning, President Kikwete highlighted Tanzania's continued efforts to improve family planning. He mentioned the National Strategy for Growth and Reduction of Poverty (MKUKUTA II) which has a strong family planning component, and the National Family Planning Costed Implementation Plan (2010) which endeavors to reach a contraceptive prevalence target of 60% of all women by 2015 and will require $88.2 million between 2010 and 2015. Like many countries in sub-Saharan Africa, Tanzania's once successful family planning program has slowed markedly, with rates of contraceptive prevalence well below levels needed to reach current demand and country goals. In Tanzania, 34.4 percent of married women in 2010 reported use of any method of contraception, while modern methods reached a prevalence of 27.4 per cent. Factors limiting contraceptive prevalence in Tanzania include widespread misconceptions and concerns about side-effects, low acceptance of long–acting methods, erratic supplies and a limited range of choices, gaps in provider knowledge and skills (along with provider bias), competing priorities pursuing scarce resources, limited male involvement, poor communication between spouses, and the perceived value of large families also contribute to low use of family planning methods.
Child health indicators
Infant and under-five mortality rate
Children in sub-Saharan Africa are about over 16 times more likely to die before the age of five than children in developed regions. Tanzania has reduced the infant mortality rate (IMR) of 101 to 38 per 1000 live births from 1990 to 2012 respectively. Also, it has reduced substantially the under-five mortality rate (U5MR) of 166 to 54 per 1000 live births from 1990 to 2012 respectively.
Malaria is the leading cause of death for Tanzanian children and is a major cause of maternal mortality. Tanzania is making considerable progress in the reduction of child mortality. In that respect, Tanzania is likely to achieve MDG 4 of reducing child mortality. The most significant contribution to the reduction of under-five mortality is improved control measures of malaria, Acute Respiratory Infections, diarrhea; improved personal hygiene, environmental sanitation; and preventive, promotive as well as curative health services. Tanzania's average annual rate of reduction of child mortality over the last 15 years was 4.6%, while, the Millennium Development Goal rate set by UN is an annual average rate of reduction of 4.3 percent.
Vaccination coverage There have been improvements in the planning process, community ownership and involvement, improving coverage, effective mobilization of funds for the Expanded Program of Immunisation, improvements in the safety of vaccine delivery and introduction of new and underutilized vaccines. According to 2010 Demographic and Health Survey in Tanzania, 66% at 12 months of age were fully immunised during the survey. The 2010 DHS in Tanzania which is the latest, presents the BCG coverage of 95.5%, DPT vaccine coverage of 88%; Polio (Pol3) coverage of 84.9% and Measles coverage of 84.5%. The proportion of children vaccinated against measles increased from 80% in 2005 to 85% in 2010. But the vaccination coverage in Tanzania presented to be more than 90% for each of the above vaccines according to World Health Organization in 2012. Year BCG DTP3 Pol3 Measles DHS 2010 95.5% 88.0% 84.9% 84.5% WHO 2012 99.0% 92.0% 90.0% 97.0%
The government of Tanzania via the Minister of Health and Social Welfare, has urged in 2012 partners and stakeholders in the country to join the National Immunization Coordination Committee to ensure that all children in Tanzanian are covered.
An Electronic Immunisation Register has been established, which permits online access to the medical records of mothers and infants, enabling vaccination teams in remote areas to operate more effectively, especially with nomadic people. It also helps to coordinate stock levels and order new supplies.
Exclusive breastfeeding