Barriers to birth preparedness and complication readiness in Tanzania: a narrative review through the lens of the Three Delays Model

Introduction Birth Preparedness and Complication Readiness (BPCR) is a key safe motherhood intervention aimed at reducing maternal and neonatal mortality through timely decision-making, delivery planning, and rapid response to obstetric emergencies. This narrative review synthesizes evidence on BPCR implementation in Tanzania, examines underlying barriers, and proposes strategies to strengthen BPCR.Methods A structured narrative review was conducted using PubMed, Scopus, and Google Scholar, supplemented by grey literature from national and international sources. Searches used MeSH and free-text terms related to BPCR, maternal health, and the Three Delays Model. Studies (2016–2026) addressing BPCR in Tanzania were included. From 162 records, 14 publications were thematically synthesized.Results BPCR implementation in Tanzania shows marked regional and contextual disparities, with generally low preparedness, particularly in rural areas. Barriers were grouped into four domains: socio-cultural and gender-related factors, economic constraints, health system limitations, and knowledge and awareness gaps. These barriers interact across the Three Delays Framework, leading to delayed decision-making, delayed access to care, and suboptimal facility-based management. Key determinants of BPCR uptake included antenatal care attendance, male partner involvement, education level, and health system readiness, which collectively shape preparedness outcomes across settings.Conclusion BPCR in Tanzania is constrained by interconnected individual, socio-cultural, economic, and health system barriers. Strengthening implementation requires integrated, equity-focused interventions that improve antenatal care quality, promote male and community engagement, enhance financial protection mechanisms, and strengthen health system capacity. These strategies are essential for reducing preventable maternal deaths and achieving Sustainable Development Goal 3.1