Summary measures of inequalities in facility delivery services utilization among reproductive-aged women: Evidence from the 2022 Tanzania Demographic and Health Survey

Background: Globally, coverage of facility deliveries has increased but remains uneven despite the association between facility delivery and lower maternal mortality being well established in previous studies. Inequalities in the utilization of facility delivery services persist, potentially undermining progress toward reducing maternal mortality and morbidity. This study aims to assess the inequalities in facility delivery service utilization among reproductive-aged women in Tanzania, using the 2022 Tanzania Demographic and Health Survey (TDHS). Methods: This study employed an analytical cross-sectional design, utilizing nationally representative secondary data from the 2022 TDHS, and applied the World Health Organization (WHO) Health Equity Assessment Toolkit (HEAT) software. The study incorporated five variables as stratifiers for inequality; the WHO HEAT software utilized these stratifiers to evaluate disparities in several health and social indicators. Four measures were used to assess inequality, namely: Difference (D), Population Attributable Fraction (PAF), Population Attributable Risk (PAR), and Ratio (R). Result: The facility delivery coverage among women of reproductive age was 84.6% overall, with notable inequalities. Coverage was highest among the richest women (97%) and those with secondary or higher education (over 83%), while the poorest women and those with low education had substantially lower rates. Urban women had higher coverage (94%) compared to rural women (78%), and regional disparities ranged from 73% to 98%. Inequality analyses showed economic status as the strongest factor influencing facility delivery, with a 31.1 percentage point difference and a 1.5 times higher likelihood among the richest compared to the poorest. Education, residence, and region also contributed to disparities. Conclusion: This study presents several key summary measures of inequalities in facility delivery in Tanzania, primarily driven by economic status, educational attainment, residential location, and regional disparities. These disparities highlight the need for integrated strategies that aim to overcome financial, informational, and geographical barriers hindering equitable access to facility delivery services.