Results of this study demonstrate a significant prevalence of non-facility births of 19.2%, among women who took part in IPV interviews. The study also found that 35.5% of Tanzanian women had experienced intimate partner violence. In Tanzania, a history of intimate partner violence, low maternal education, low household economic status, fewer than four ANC visits, multiparity, and a history of pregnancy termination were all important predictors of non-facility childbirth.

With an alarming 19.2% prevalence of non-facility births among women who took part in IPV interviews in Tanzania, the study’s findings highlight a serious lack of access to maternal healthcare for victims of IPV. This noteworthy rate highlights the multiple vulnerabilities that these women encounter, such as logistical, emotional, and physical obstacles that prevent them from seeking essential healthcare during pregnancy and childbirth (7). Similarly, a previous study conducted in sub-Saharan Africa revealed that 36.1% of all births were attended by unskilled birth attendants (8). Among women who did not receive care from a skilled birth attendant (SBA), 17.6% were assisted by traditional birth attendants (TBAs), 12.3% relied on a friend or relative, and 4.9% gave birth without any assistance (8).

Even after adjusting for potential confounders, the results show that IPV is a significant predictor of non-facility births attended by unskilled birth attendants. Interestingly, compared to women who had never experienced IPV, those who had experienced IPV were 1.38 times more likely to give birth outside of a medical facility. Due to fear, limited mobility, and a lack of support from their partners, women who experience intimate partner violence frequently have limited access to maternal healthcare services, according to studies conducted in sub-Saharan Africa (9–11). Women’s autonomy can be increased and facility-based deliveries can be encouraged by addressing IPV through integrated maternal health programs that include IPV screening and support services. These findings collectively emphasize the urgent need for targeted interventions to address the intersection of IPV and maternal health, ensuring that no woman is forced to give birth outside a safe and supportive healthcare environment due to violence or fear.

The study also found a strong and significant association between non-facility birth and maternal education level. Women with only a primary education had nearly twice the chance of giving birth outside of a medical facility, while those without any formal education were nearly three times more likely to do so. Previous studies have demonstrated that women with only a primary education or no formal education have lower health literacy, less knowledge of the benefits of maternal health, and less self-efficacy when navigating healthcare systems(12). Similar findings have been reported in Tanzania and other low-resource settings where maternal health use is closely linked to women’s educational attainment (13–15). Informed decision-making and more facility births can result from increasing maternal health literacy and women’s educational opportunities.

The study also found that a strong predictor of non-facility birth was the household wealth index. As poverty increased, the likelihood of giving birth outside of a medical facility increased as well.

The likelihood of a non-facility birth was seven times higher for women from the poorest households than for those from the wealthiest. This is in line with previous studies that show poverty is associated with cost-related barriers like lack of household financial decision-making authority, indirect care costs, and transportation challenges(16,17). To assist low-income women in overcoming financial barriers, social protection programs such as maternal health vouchers, conditional cash transfers, and community transportation initiatives should be extended(18).

The study also found that women who had fewer than four ANC visits were almost twice as likely to give birth outside of a hospital as women who had four or more visits. Given the strong link between lower ANC attendance and non-facility births, the WHO recommends that at least four ANC visits are necessary for early detection and treatment of complications. (19). Data from past studies carried out in sub-Saharan Africa supports this conclusion, demonstrating that ANC visits provide an opportunity to educate and encourage facility-based deliveries (20–22). Attendance may be increased and the number of institutional births may rise if ANC services are made available, and comprehensive, and encourage facility delivery through community-based education and mobile ANC services.

The study also discovered that women who had multiple children were more likely to choose non-facility birth. Compared to primigravida women, those who had two or four children were twice as likely to give birth outside of a hospital. Non-facility childbirth was three times more common among those with five or more children. Similar findings have been reported in previous studies conducted in sub-Saharan Africa Individualized birth preparedness planning and additional family planning counseling should be provided to women who have given birth more than once to address concerns and encourage facility-based deliveries.

This study has several shortcomings despite its insightful findings. First, it is more difficult to prove a link between intimate partner violence and non-facility births due to the cross-sectional design. Future research should use longitudinal designs to better understand causal relationships over time to mitigate this. Second, self-reported information on IPV and place of birth could be underreported due to social desirability bias and recall issues. Researchers recommend the use of mixed-method techniques, such as triangulation with medical facility records and qualitative interviews, to validate results. Third, the study’s focus on Tanzania restricts the findings’ applicability to other contexts with distinct sociocultural and medical backgrounds. Comparative studies and research expansion across various geographic areas can improve the results’ applicability and guide more comprehensive maternal health interventions.