Acknowledging this critical lack of services, the Tanzanian government launched the National Road Map Strategic Plan to Accelerate Reduction of Maternal, Newborn and Child Deaths in Tanzania (also known as the ‘One Plan’) in April 2008, in conjunction with the national advocacy campaign, Deliver Now for Women and Children in Tanzania.

The goal was to coordinate the various maternal health initiatives in the country, and to mobilize communities to improve maternal and child outcomes. The ‘One Plan’ has set the goal of a two-thirds reduction in the MMR to 193 deaths per 100,000 live births by 2015. Key operational targets for maternal health services under the plan include increasing coverage of skill attendance at childbirth to 80%, expanding coverage of comprehensive EmOC to all hospitals, and expanding coverage of basic EmOC to 70% of health centers and dispensaries (MOHSW, 2008).

Meeting these targets will require immediate and sustained investments in the primary healthcare system in Tanzania. Functioning health facilities are needed; staffed by trained health workers and equipped with essential medical supplies, with rapid referral systems for obstetric complications.Services must also be delivered in a respectful and non-discriminatory manner so women and their families have confidence in facility-based care.To inform maternal health policy and advocacy, CARE International in Tanzania and Women’s Dignity, together with local research partners, conducted a qualitative analysis of women’s access to facility-based delivery in three rural districts of Tanzania. The study was designed to give voice to women’s choices and decisions about where they give birth, and to capture health providers’ views of their capacity to provide quality delivery care. The research aimed to understand why 94% of Tanzanian women use antenatal services, but only 47% deliver at a facility, and in particular to identify the key barriers they face in accessing facility-based childbirth.