Chart of the week #34: Giving birth without safe water and sanitation

Let’s start with some headline statistics:

  • 43% of births in Tanzania take place at home
  • Of these, only 1.5% take place in settings with access to safe water and sanitation
  • Only 44% of health facilities that conduct deliveries have provision of safe water and sanitation facilities

And putting that all together:

  • Only 30% of births in Tanzania take place in an environment that includes access to safe water and sanitation.

These findings come from an analysis of data from the 2010 Demographic and Health Survey (DHS) and the 2006 Service Provision Assessment, by researchers from the London School of Hygiene and Tropical Medicine, the World Health Organisation and Bugando Hospital.

Access to safe water and sanitation facilities seems like such a fundamental part of giving birth, wherever it happens. That only 30% of mothers in Tanzania have such access is pretty shocking.

But the researchers went further, to look at how access to a safe water and sanitation environment when giving birth varied across the country, and between richer and poorer Tanzanians. It turns out that the headline figures cover up some major differences.

I have two charts to share. First, how does access to safe water and sanitation when giving birth vary across the country?

Source: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0106738

Source: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0106738

In two zones (Eastern and Zanzibar), more than half of mothers give birth in environments with safe water and sanitation. In three (Central, Western, Lake), it is less than 1 in 5 mothers. That’s a very wide variation.

The report authors explain the factors behind the difference:

“The high levels of WATSAN-unsafe births in these zones stemmed mainly from the low proportion of facilities meeting the WATSAN-safe definitions compared to other zones. For example, fewer than half of the hospital delivery rooms in these three zones met the WATSAN-safe criteria.”

Second, how does access to health facilities for giving birth vary between richer and poorer people?

Source: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0106738

Source: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0106738

Among the poorest people in Tanzania, 61% reported giving birth at home. Among the richest, the figure was just 7%. What’s more, only the richest homes provided anything like a safe water and sanitation environment for giving birth.

I have two main conclusions here:

1. These regional and socio-economic difference are massive. A strong case can be made for the Ministry of Health to put a lot of focus on (i) working to improve health facilities in the Central, Western and Lake Zones, and (ii) working out why the poor are much less willing or able to attend health facilities for giving birth, and addressing the reasons identified.

2. Look at how much extra value is added to data analysis when you have data that can be disaggregated. The main headline figure – 30% of births in Tanzania take place in safe water and sanitation environments – hides so much. Looking at the disaggregations by zone and wealth gives a far richer picture, and one that provides far more useful insights for policy makers and others within the country. Imagine if we could do the same at district level.

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