Official websites use. Share sensitive information only on official, secure websites. Correspondence can be sent to Margaret E. Kruk, G. Mbaruku, and S. Galea jointly designed the study and coordinated the fieldwork. Kruk and S. Galea supervised data entry and analysis. Paczkowski led the data analysis. All authors made critical revisions of the article. We fielded a population-based discrete choice experiment DCE in rural western Tanzania, where only one third of women deliver children in a health facility, to evaluate health-system factors that influence women's delivery decisions.
Women were shown choice cards that described 2 hypothetical health centers by means of 6 attributes distance, cost, type of provider, attitude of provider, drugs and equipment, free transport. The women were then asked to indicate which of the 2 facilities they would prefer to use for a future delivery.
We used a hierarchical Bayes procedure to estimate individual and mean utility parameters. A total of women completed the DCE. The model showed good predictive validity for actual facility choice. The most important facility attributes were a respectful provider attitude and availability of drugs and medical equipment. In regions in which attended delivery rates are low despite availability of primary care facilities, policy experiments should test the effect of targeted quality improvements on facility use.
Despite several decades of global health initiatives focused on maternal health, maternal mortality has proven to be an intractable problem.
The Millennium Development Goal indicator of maternal health, the maternal mortality ratio, has remained essentially unchanged over the past 15 years, with an estimated mean annual decline of 0.
