Decomposing rural urban and wealth related inequalities in facility delivery in Tanzania using the 2022 TDHS MIS

Facility delivery is critical for improving maternal and newborn outcomes, yet national coverage can mask geographic and socioeconomic inequalities. This study examined rural-urban and wealth-related gaps in facility delivery among women with a recent birth in Tanzania. This study used data from the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey. The analysis included women aged 15–49 years with a recent birth and available information on place of delivery. Facility delivery was coded as delivery in a public, private, or religious/voluntary health facility. Weighted descriptive analyses estimated facility-delivery prevalence across geographic and socioeconomic groups. Weighted Blinder–Oaxaca-type linear probability decomposition models estimated how much of the rural–urban and richest–poorest gaps was explained by measured characteristics. A wealth-by-residence interaction was formally tested, and 95% confidence intervals were obtained using a cluster bootstrap that accounted for the complex survey design. Sensitivity analyses repeated the decompositions using ANC 8 + visits instead of ANC 4 + visits. The analytic sample included 5836 women with a recent birth. Weighted facility-delivery prevalence was 81.5% overall, 94.4% among urban women, and 76.4% among rural women. Facility delivery increased from 62.5% among women in the poorest wealth quintile to 97.4% among those in the richest quintile. In the decomposition sample, the rural–urban gap was 17.9% points (95% CI 14.5–21.4), of which 88.2% was explained by measured characteristics, with wealth being the largest contributor. The richest–poorest gap was 34.8% points (95% CI 29.3–40.2), of which 83.4% was explained; urban residence, maternal education, and perceived distance to a health facility were the largest contributors. The wealth-by-residence interaction was statistically significant ( p = 0.038), and rural–urban differences were minimal among women in the richest quintile. Sensitivity analyses using ANC 8 + visits produced similar conclusions. Facility delivery was high overall in Tanzania, but substantial rural-urban and wealth-related inequalities remained. Much of these gaps was explained by differences in socioeconomic position, maternal education, antenatal care attendance, and perceived geographic access. Policies that reduce distance-related barriers and improve access among poor and rural women may help narrow persistent inequalities in facility delivery.