Violence Against Women in Tanzania and its Association With Health-Care Utilisation and Out-of-Pocket Payments: An Analysis of the 2015 Tanzania Demographic and Health Survey

BACKGROUND: Violence against women is a major public health concern. In addition to adverse physical, mental, and sexual and reproductive health consequences, violence against women confers a considerable cost to health services and the health sector as well as to individuals and households in the form of out-of-pocket expenditures. This study aimed to assess whether physical or sexual violence against women is associated with higher health-care utilisation rates and out-of-pocket expenditures in Tanzania. METHODS: This study used data from the 2015 Tanzania Demographic and Health Survey. Multivariate regression analysis was used to assess the association between health-care utilisation and partner and non-partner violence among 9,304 women. Outpatient and inpatient health expenditures were analysed using means and t-tests. RESULTS: Women who had ever experienced physical or sexual violence (partner or non-partner) were significantly more likely to utilise health services, and in particular outpatient services, than never abused women. Out-of-pocket expenditures for out-patient care, however, did not differ by abuse status. This was in contrast to inpatient care, wherein, although abused women were not more likely to have higher utilisation rates compared with never abused women, abused women were significantly more likely to incur higher average out-of-pocket expenditures for inpatient visits. This significant difference in expenditure was possibly because of the different inpatient services sought—abused women were more likely to seek care because of illness, while never-abused women were more likely to seek care for pregnancy and delivery. CONCLUSION: This study highlights how violence against women in Tanzania potentially translates to higher health-care utilisation, possibly because of the long-term or chronic effects of persistent abuse. Health-care policies should, therefore, consider issues such as accessibility and affordability for health services. Additionally, governments should address the issue of violence against women more widely, thereby reducing their own costs as well.