Reflections on the dynamics of the coexistence of multiple knowledge cultures in a community-based maternal health project in Tanzania

Abstract

Maternal mortality is a persistent problem worldwide and has received increased international attention as a result of the Millennium Development Goals (MDGs). In Tanzania, and sub-Saharan Africa as a whole, maternal mortality remains high. In Magu District, Tanzania, only 47% of births are attended by a skilled birth attendant, compared to the target of 90% in the MDGs. This study investigates the low uptake of maternal health services in Magu District against the background of different knowledge cultures, arguing that the gulf between local knowledge, biomedical knowledge and organizational knowledge has resulted in a mismatch between demands and needs of women and the supply of services. Stakeholder analysis was undertaken and the needs and experiences of two key stakeholder groups were undertaken: women of reproductive age and healthcare providers. Data collection by interviews, participant observation and focus group discussions took place during May-December 2012. Healthcare providers and women were found to have markedly different perspectives on causes of delay to reaching appropriate care, based on their different knowledge cultures. Healthcare workers cited socio-cultural motivations as main reasons: women?s lack of knowledge on the importance of antenatal care or lack of decision-making power in the household. However, most women seemed to base their decision on the perceived accessibility and quality of care. For women, financial risks outweighed the risks of pregnancy. This case demonstrates that improvements in healthcare cannot be reached by simple technical interventions and policies. Instead, partnerships are needed between different stakeholders from different knowledge cultures based on mutual respect and recognition of the value of each other?s knowledge.