Socioeconomic inequalities in hospital births among higher risk pregnant women in urban Tanzania: analysis of the 2022 Tanzania Demographic and Health Survey

In sub-Saharan Africa, poverty is closely associated with maternal mortality. Averting maternal mortality requires timely, appropriate care at childbirth. Health system levels differ in capacity to provide management of childbirth complications, and hospital births are generally advised for higher-risk women, such as those with first pregnancies or high-parity. There is limited evidence on use of hospitals for childbirth among women in urban settings in Tanzania, but in rural settings, socioeconomic inequalities aggravate obstetric risk and may underlie inequities in mortality. We assessed hospital use for childbirth in urban mainland Tanzania and its association with household wealth and parity. We analyzed data from the 2022 Tanzania Demographic and Health Survey, focusing on urban women with facility births. To study inequalities within the health system, we excluded home births. Birth location was categorized as hospital or primary care facility. Using multivariable logistic regressions, with interaction between binary wealth (poorer and richer 50%) and parity, and post-regression margins analysis, we calculated hospital birth probabilities. Among 1,312 urban women, 54.9% of facility births occurred in hospitals. The richest women had 1.93 times higher odds of hospital births than the poorest (95% CI, 1.14 – 3.27). Probabilities of hospital births by binary wealth differed most at nulliparity (58.5% among poorer and 74.3% among richer women). Socioeconomic inequalities in hospital use persist in urban Tanzania, with the gap between poorer and richer most pronounced at first birth. Policy measures to improve hospital use among poor, higher risk women in urban areas should be identified.