1.1 BACKGROUND INFORMATION
Globally, an estimated 585,000 maternal deaths occur annually, with over 99% of these deaths occurring in developing countries. It is barely five years to the target for the attainment of Millennium Development Goal (MDG) 5, which seeks to reduce the maternal mortality ratio (MMR) by three fourths, compared to the 1990 level.
Qualified antenatal care, skilled birth attendance, access to emergency obstetric care and neonatal resuscitation skills are vital components to substantially reduce maternal, perinatal and neonatal mortality in developing countries. The level of skilled birth attendance varies markedly among and within regions and countries, being well below 50% in many countries in South-East Asia and Sub-Saharan Africa. Although official nation-wide figures may show high coverage rates, this picture can be misleading. Typically, rates of skilled attendance are lower in rural than in urban areas This situation applies to Tanzania where in 2004/2005 the average rate of skilled attendance was as high as 81% in urban areas and as low as 39% in rural, remote districts (DHS 2004/2005). Even within rural regions, marked differences may exist which can be related to cultural norms, socioeconomic circumstances, accessibility of health institutions and service provision. In the case of nomadic populations, it is even more difficult to provide health services, including obstetric care with skilled birth attendance.
In Tanzania the majority of women are making the recommended number of antenatal care visit more than eight in ten women are making their first visit later than recommended. 95% of pregnant women make at least one antenatal care visit, while only 62% make four or more visit. Moreover 47% of women attending antenatal visits recall having been informed related dangerous complication Andrea et al.( 2010)
In Tanzania, like other Sub Saharan Africa countries, maternal mortality remains to be a problem of public health importance. The 2004 Tanzania Demographic and Health Survey (TDHS) published a maternal mortality ratio (MMR) of 578/100000 live births  but maternal mortality rate before the survey estimated as 454 maternal death per 100000 live birth. The 95% confidence interval for the 2004 to 2005 rate of 578 is 466 to 690. the 95% confidence interval indicate that true maternal mortality ratio from the 2010 TDHS maternal mortality ratio of 556 is lower than the 2004 TDHS estimated of 578, suggesting that the maternal mortality in Tanzania may have stated to decline.
The study has revealed that most of Nigeria women tended to obtain care rate in pregnancy, and for about one third the care was inadequate. In this study, almost half 47% of the women started attending the antenatal clinic only in the third trimester. In a sample of South Africa antenatal clinic attendees, it was found that 75% had already attended either in the first 7% or second trimester 68%. Kambaran, chirenje and Rusakaniko found among rural Zimbabwe antenatal clinic attendees that only 21.6% started antenatal clinic in the first trimester and 62% made five or less antenatal visits but the attendance to delivery health care services still low which led to high result of maternal death.
The medium number of months that pregnant women at their first visit in mpanda district is 5 and other women do seek Antenatal care until their six month which led to minimum attendance to delivery services. Late and low attendance may be explained by different factors to be explored by the study. Therefore, reasons for low utilization of antenatal and derivers health care services want further investigation.
1.2 Statement of the problems and significance of the study
1.2.1 Statement of the problem
The problem of low deliveries in health facilities exist in Mpanda district at Kashaulili ward which was less than 50% thus seems to be a serious problem....