24700992
OBJECTIVE	To measure the extent , determinants and results of bypassing local primary care clinics for childbirth among women in rural parts of the United Republic of Tanzania .
METHODS	Women were selected in 2012 to complete a structured interview from a full census of all 30076 households in clinic catchment areas in Pwani region .
METHODS	Eligibility was limited to those who had delivered between 6 weeks and 1 year before the interview , were at least 15 years old and lived within the catchment areas .
METHODS	Demographic and delivery care information and opinions on the quality of obstetric care were collected through interviews .
METHODS	Clinic characteristics were collected from staff via questionnaires .
METHODS	Determinants of bypassing ( i.e. delivery of the youngest child at a health centre or hospital without provider referral ) were analysed using multivariate logistic regression .
METHODS	Bypasser and non-bypasser birth experiences were compared in bivariate analyses .
RESULTS	Of 3019 eligible women interviewed ( 93 % response rate ) , 71.0 % ( 2144 ) delivered in a health facility ; 41.8 % ( 794 ) were bypassers .
RESULTS	Bypassing likelihood increased with primiparity ( odds ratio , OR : 2.5 ; 95 % confidence interval , CI : 1.9-3 .3 ) and perceived poor quality at clinics ( OR : 1.3 ; 95 % CI : 1.0-1 .7 ) and decreased if clinics recently underwent renovations ( OR : 0.39 ; 95 % CI : 0.18-0 .84 ) and/or performed 4 obstetric signal functions ( OR : 0.19 ; 95 % CI : 0.08-0 .41 ) .
RESULTS	Bypassers reported better quality of care on six of seven quality of care measures .
CONCLUSIONS	Many pregnant women , especially first-time mothers , choose to bypass local primary care clinics for childbirth .
CONCLUSIONS	Perceived poor quality of care at clinics was an important reason for bypassing .
CONCLUSIONS	Primary care is failing to meet the obstetric needs of many women in this rural , low-income setting .

