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

Socioeconomic inequalities in hospital births among higher risk pregnant women in urban Tanzania: analysis of the 2022 Tanzania Demographic and Health Survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Socioeconomic inequalities in hospital births among higher risk pregnant women in urban Tanzania: analysis of the 2022 Tanzania Demographic and Health Survey Lena Elise Wessing, Fadhlun Alwy Al-Beity, Lenka Beňová, Claudia Hanson, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8077566/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 2 You are reading this latest preprint version Abstract 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. childbirth socioeconomic status health inequalities urban birth location Tanzania obstetrics poverty high parity parity sub-Saharan Africa cities facility-based childbirth tertiary facilities Full Text Supplementary Files Supplementarymaterials.pdf Cite Share Download PDF Status: Under Review Version 1 posted Editor assigned by journal 10 Nov, 2025 First submitted to journal 10 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8077566","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":542798647,"identity":"9db355c8-fea9-4a84-83fe-24aedb96f36d","order_by":0,"name":"Lena Elise Wessing","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIiWNgGAWjYBACPhiDjYGB8QGI4mMH8h7g0cKGxGA2ABnBxgzkJRCjBcSWYGCQI0ILe+/BzzwVdfZ80u3Xqnn+mMkDtbA9wKuF51yyNM+Zw4ltMmfKbs5sSzNsY2ZgN8CrRSLHQDq37UACkJF242PDMUagFjYJvFrk3xj/zv1XZw/SUpDw5789YS0SPGbSuQ3MjG0S6ccYPrCxJRLWwpNjZv3nGNAvEjnMkjPb2JLbQNrxaeFnP2N8c0ZNnb38jPSHn3n+sNn2szcfk/iARwsS4DGAMhgbiNPAwMD+gFiVo2AUjIJRMMIAADrPP/+645e9AAAAAElFTkSuQmCC","orcid":"https://orcid.org/0009-0008-2194-4584","institution":"Karolinska Institutet","correspondingAuthor":true,"prefix":"","firstName":"Lena","middleName":"Elise","lastName":"Wessing","suffix":""},{"id":542798648,"identity":"bfe6cd0e-6fb1-47f7-a4bf-46486fb9ea32","order_by":1,"name":"Fadhlun Alwy Al-Beity","email":"","orcid":"","institution":"Muhimbili University College of Health Sciences: Muhimbili University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Fadhlun","middleName":"Alwy","lastName":"Al-Beity","suffix":""},{"id":542798649,"identity":"495e3709-27da-446f-af18-55d6459f41f6","order_by":2,"name":"Lenka Beňová","email":"","orcid":"","institution":"Instituut voor Tropische Geneeskunde","correspondingAuthor":false,"prefix":"","firstName":"Lenka","middleName":"","lastName":"Beňová","suffix":""},{"id":542798650,"identity":"60274c04-1df8-493a-b473-bd9cab3f4718","order_by":3,"name":"Claudia Hanson","email":"","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":false,"prefix":"","firstName":"Claudia","middleName":"","lastName":"Hanson","suffix":""},{"id":542798651,"identity":"ac5e84d6-0c49-4d29-84ed-f518d47a6df9","order_by":4,"name":"Manuela Straneo","email":"","orcid":"https://orcid.org/0000-0002-2464-1633","institution":"Karolinska Institutet","correspondingAuthor":false,"prefix":"","firstName":"Manuela","middleName":"","lastName":"Straneo","suffix":""}],"badges":[],"createdAt":"2025-11-10 13:24:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8077566/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8077566/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":96318926,"identity":"a5241da5-7de7-49d9-b74e-ed6281d534f2","added_by":"auto","created_at":"2025-11-19 18:24:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":44192,"visible":true,"origin":"","legend":"","description":"","filename":"Fig1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8077566/v1/688dcdd1650c602770a929c1.pdf"},{"id":96318930,"identity":"19375deb-5928-4f4f-8c68-cced11dab2ad","added_by":"auto","created_at":"2025-11-19 18:24:31","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1625249,"visible":true,"origin":"","legend":"","description":"","filename":"Fig2.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8077566/v1/2f6195b3c71ef2d93efb7bec.pdf"},{"id":96367434,"identity":"308c59e6-90db-421b-b853-5486c7f58cd1","added_by":"auto","created_at":"2025-11-20 10:12:46","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":74867,"visible":true,"origin":"","legend":"","description":"","filename":"Fig3.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8077566/v1/e1229e831ff55ef398796162.pdf"},{"id":96318927,"identity":"eff7eb56-1d1b-423c-9980-5a7cc5cc5913","added_by":"auto","created_at":"2025-11-19 18:24:31","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":9322,"visible":true,"origin":"","legend":"","description":"","filename":"jurhJURHD2500649.xml","url":"https://assets-eu.researchsquare.com/files/rs-8077566/v1/6fd5b14ddf6e61fdc1a94756.xml"},{"id":96318928,"identity":"020c951f-0430-488c-817c-89b6d5c12839","added_by":"auto","created_at":"2025-11-19 18:24:31","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1109,"visible":true,"origin":"","legend":"","description":"","filename":"JURHD25006498021.go.xml","url":"https://assets-eu.researchsquare.com/files/rs-8077566/v1/29be07cdf3ad15bece4daf3b.xml"},{"id":96318932,"identity":"d9d8c921-13f3-4c42-82ef-6cfe0f1aac76","added_by":"auto","created_at":"2025-11-19 18:24:31","extension":"xml","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":855,"visible":true,"origin":"","legend":"","description":"","filename":"JURHD2500649Import.xml","url":"https://assets-eu.researchsquare.com/files/rs-8077566/v1/2e0f8d7f8d66559950043b98.xml"},{"id":96369337,"identity":"cba3bcb2-9501-44e8-a706-5320f2a16800","added_by":"auto","created_at":"2025-11-20 10:20:34","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":675452,"visible":true,"origin":"","legend":"","description":"","filename":"ManuscriptSocioeconomicinequalitiesinhospitalbirths.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8077566/v1_covered_575a1abe-87c0-4081-9611-e0085945fc59.pdf"},{"id":96318931,"identity":"b1aa2e7a-2981-4220-ba93-99d7f1ee25ba","added_by":"auto","created_at":"2025-11-19 18:24:31","extension":"pdf","order_by":7,"title":"","display":"","copyAsset":false,"role":"supplement","size":293552,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterials.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8077566/v1/d06d61281b6c8ebb30ec4d72.pdf"}],"financialInterests":"","formattedTitle":"Socioeconomic inequalities in hospital births among higher risk pregnant women in urban Tanzania: analysis of the 2022 Tanzania Demographic and Health Survey","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-urban-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jurh","sideBox":"Learn more about [Journal of Urban Health](https://www.springer.com/journal/11524)","snPcode":"11524","submissionUrl":"https://www.editorialmanager.com/jurh","title":"Journal of Urban Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"childbirth, socioeconomic status, health inequalities, urban, birth location, Tanzania, obstetrics, poverty, high parity, parity, sub-Saharan Africa, cities, facility-based childbirth, tertiary facilities","lastPublishedDoi":"10.21203/rs.3.rs-8077566/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8077566/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIn 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.\u003c/p\u003e\n\u003cp\u003eWe 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.\u003c/p\u003e\n\u003cp\u003eAmong 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).\u003c/p\u003e\n\u003cp\u003eSocioeconomic 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.\u003c/p\u003e","manuscriptTitle":"Socioeconomic inequalities in hospital births among higher risk pregnant women in urban Tanzania: analysis of the 2022 Tanzania Demographic and Health Survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-19 18:24:26","doi":"10.21203/rs.3.rs-8077566/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorAssigned","content":"","date":"2025-11-10T15:41:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Urban Health","date":"2025-11-10T08:23:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-urban-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jurh","sideBox":"Learn more about [Journal of Urban Health](https://www.springer.com/journal/11524)","snPcode":"11524","submissionUrl":"https://www.editorialmanager.com/jurh","title":"Journal of Urban Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"5bce87ca-e088-4b90-a477-8799e54876d4","owner":[],"postedDate":"November 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-19T18:24:26+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-19 18:24:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8077566","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8077566","identity":"rs-8077566","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}