Maternal alcohol consumption during pregnancy and associated factors among pregnant women in Tanzania: evidence from the 2022 Tanzania Demographic and Health Survey

Abstract

Background

Maternal alcohol consumption remains a significant public health concern. The consumption is associated with an increased risk of miscarriage, stillbirth, and Fetal Alcohol Spectrum Disorders, which can impair fetal growth and lead to low birth weight. This study aims to investigate the prevalence of alcohol use among pregnant women and identify associated factors utilising data from the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS).

Methods

This analytical cross-sectional survey design utilised secondary data from the 2022 TDHS-MIS. The survey employed a multistage cluster sampling method to generate representative national and sub-national health and health-related indicators between February and July 2022. A total of 1,182 pregnant women were included in the analysis. Data analysis involved descriptive statistics and binary logistic regression using STATA version 18.5 to assess factors associated with maternal alcohol consumption. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were computed to estimate the strength of the association between independent variables and alcohol use.

Results

The mean age of the participants was 27.3 years (standard deviation: 6.9). The overall prevalence of alcohol consumption during pregnancy among pregnant women in Tanzania was 3.9% (95% CI: 2.8–5.4). Factors associated with alcohol consumption were women aged 25–34 (aOR = 5.17, 95%CI: 1.62–16.51) and more than 35 years of age (aOR = 20.89, 95%CI: 6.55–66.62), women who were never married (aOR = 7.89, 95%CI: 2.20-28.25), On the other hand, women living in the western zone (aOR = 0.20, 95%CI: 0.04–0.88).

Conclusion

The study reveals a notable prevalence of alcohol consumption during pregnancy in Tanzania. Key demographic factors influencing alcohol use include maternal age, marital status, and prominent regional disparities, notably lower rates in Zanzibar compared to the western zone. These findings highlight the necessity for targeted public health initiatives to educate pregnant women. This was a cross-sectional survey, which limited the causal relationship among the observed factors.

Background

Alcohol is a toxic and psychoactive substance that has been designated as a Group 1 carcinogen by the International Agency for Research on Cancer for many years [1, 2]. Maternal alcohol consumption is a serious health concern for both mothers and their unborn children, leading to a range of harmful effects [3]. Studies have shown that maternal alcohol consumption increases the chances of miscarriage and stillbirth [4]. Additionally, heavy drinking can hinder fetal growth, resulting in low birth weight [5, 6] and can lead to sudden infant death syndrome [7]. Importantly, there is no known safe level of alcohol consumption for pregnant women [1]; any amount can potentially cause lasting impacts on a child’s development, such as cognitive and behavioural issues associated with Fetal Alcohol Spectrum Disorders (FASD) [8]. These alcohol-related neurodevelopmental disorders can affect a child’s educational and social experiences throughout their life [9]. This excessive maternal alcohol use has been associated with medicinal poisoning, childhood depression and anxiety [7]. The best way to protect the health of both the mother and the child is through complete abstinence from alcohol during pregnancy [10]. Despite this, alcohol use during pregnancy is still reported, highlighting the need for ongoing research and awareness of this significant issue.

Globally, there is a reported prevalence of approximately 10% of maternal alcohol consumption, with significant regional variations [11]. In developed countries, consumption is notably higher, reporting rates of 25–46% among pregnant women, highlighting an increase in trend [12]. This disparity is shown by differing cultural norms and alcohol consumption patterns [8, 11], suggesting that underlying social attitudes toward drinking may influence pregnant women’s behaviours regarding alcohol [8, 13]. The UK ranks among the highest globally in terms of the rates of alcohol consumption during pregnancy, with figures ranging from 41.3 to 75% [10]. Additionally, nearly 14% of pregnant individuals in the United States reported current drinking, with about 5% engaging in binge drinking [14]. These figures illustrate the scale of the challenge faced globally regarding alcohol consumption during pregnancy and emphasise the need for effective public health interventions to address this issue.

In Sub-Saharan Africa, the situation is similarly concerning, with studies indicating varying prevalence rates of alcohol consumption among pregnant women, ranging from approximately 2.5–59.28% across different countries [15,16,17]. Specific studies have reported that in countries like Ghana, the prevalence of alcohol consumption during pregnancy can reach as high as 48%. In contrast, in regions of Nigeria, figures have been reported as high as 59.3% [16, 18]. In contrast, other nations such as Burkina Faso have demonstrated lower rates, with a study revealing a self-reported alcohol use of 18.5% among pregnant women [18, 19]. One study reported the prevalence of excessive maternal alcohol consumption in various countries as 3.8% in South Africa, 24.5% in the Democratic Republic of the Congo, 9% in Uganda, and 7.7% in Ethiopia [20]. The significant variations in prevalence can largely be attributed to cultural influences, social norms surrounding alcohol use, and differences in research methodologies [16, 18]. This inconsistency underscores the urgent need for public health interventions to address alcohol consumption during pregnancy within the region, considering its implications for maternal and child health.

In Tanzania, the prevalence of alcohol use among pregnant women has been reported at alarming rates, with a recent study indicating that up to 42.2% consume alcohol at least once a week [21, 22]. Previous small-scale studies have provided crucial data, demonstrating that factors such as maternal age, education level, religion, and access to antenatal care significantly influence alcohol consumption patterns among pregnant women in Tanzania [22]. However, there is a notable gap in comprehensive public health strategies derived from specific factors associated with maternal alcohol consumption, highlighting an urgent need to explore these factors and establish targeted interventions.​ Given the considerable primary and secondary risks linked to maternal alcohol consumption, it is essential to gain a deeper understanding of the problem at a national level. This study addresses this gap by utilising the latest 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2022 TDHS-MIS) data analysis to provide a detailed overview of the prevalence of alcohol use during pregnancy and the associated factors. This study focuses on cultural and demographic influences because these factors shape health behaviours and attitudes toward alcohol consumption. Understanding these influences is critical for designing effective interventions that resonate with the unique cultural contexts of Tanzanian women. The findings of this study will contribute to the existing body of literature and inform policymakers and healthcare providers of the urgent need for culturally appropriate interventions aimed at reducing alcohol consumption during pregnancy, ultimately improving maternal and child health outcomes in the region.

Methods

Data source and design

This study was an analytical cross-sectional survey that utilised secondary data from the 2022 TDHS-MIS, which conducts nationally representative population-based household surveys typically every five years. The data were extracted in the file code TZGR82FL [23].​ The Tanzania National Bureau of Statistics conducted the survey with the Ministries of Tanzania Mainland and Zanzibar.

Population and sampling

Data for this study was obtained from the latest DHS conducted between 24 February and 21 July 2022 across all regions in Tanzania. The target population for the 2022 TDHS-MIS included women of reproductive age (15–49 years) across the 31 administrative regions in Tanzania. At the country level, a sampling frame is usually obtained. To minimise sampling errors, the country was stratified by geographic region and urban/rural areas within each region, followed by a two-stage sampling to select a household to be surveyed. The first sampling was to choose a primary sampling unit (PSU) and then select a household. PSUs are survey clusters usually based on census enumeration areas (EAs). A probability proportion to size was employed in each stratum to select the PSU. For each selected PSU, a complete household listing was done. This was followed by choosing a fixed number of households to be surveyed using equal probability systematic sampling. All women who had spent the night before the survey in the selected households were eligible for the survey. A total of 15,254 women of reproductive age were interviewed. This study analysed data from the women who reported being pregnant during the survey of 1,182 women of reproductive age (weighted).

Study variable

Dependent variable

The outcome variable for this study was alcohol consumption responses to the question, “During the past 30 days, how many days did you have a drink that contains alcohol?” Current alcohol consumption was defined as those pregnant women who drank daily or had drunk in the past 30 days that contained alcohol based coded as ‘1’ and otherwise ‘0’.

Independent variables

The independent variables were included based on the available data and literature [17, 18, 24]: age in years, education level (no formal education, primary, secondary or higher), husband’s education level (no formal education, primary, secondary or higher), place of residence (urban or rural), marital status (never married, married, cohabiting or separated/divorced), exposure to media (listening to the radio or reading the newspaper or watching television less than once a week or at least once a week and otherwise), wealth index (poorest, poorer, middle, richer or richest), wanted the current pregnancy (yes or no), working status (yes or no), parity (≤ 2 or ≥ 3), ever tested for HIV (yes or no), terminated a pregnancy (yes or no), visited by fieldworker in the past 12 months (yes or no), screened for cervical cancer (yes or no) and geographical zones (western, northern, central, southern, eastern or Zanzibar).

Statistical analysis

Data was coded and analysed using STATA version 18.5 (STATA Corp, College Station, TX). Descriptive statistics were presented using means, standard deviation (SD) for continuous variables, and frequency and proportion for categorical variables. The prevalence of alcohol consumption during pregnancy was calculated as the number of women who reported drinking daily or having consumed an alcoholic beverage in the past 30 days, divided by the total number of women in the study. The Pearson chi-square test was used to compare the differences in the proportion of alcohol use during pregnancy across participants’ characteristics. All explanatory variables in the model were assessed for multicollinearity during bivariate analysis before fitting the multivariable regression model.

To account for the complexity of the survey design, we applied individual sampling weights, primary sampling units (clusters), and strata to adjust for the cluster sampling design. A weighted binary logistic regression model was fitted to determine the factors associated with alcohol consumption during pregnancy. Univariate analyses were performed by fitting each independent variable against the dependent variable. Independent variables with p-values of < 0.05 in the univariate analyses and those considered in the literature as a potential confounder were included in developing a multivariable regression model through a backward selection at p < 0.2. We used logistic regression because the outcome was binary. Given the low prevalence of maternal alcohol consumption (< 10%), we also considered potential issues with rare-event bias. We examined the distribution of the outcome and found it relatively balanced.

Additionally, we assessed multicollinearity among the exposure variables and confirmed that multicollinearity was not a concern. Based on these assessments, logistic regression was determined to be the appropriate model. The odds ratio (OR) and associated 95% confidence intervals (CI) were presented to estimate the magnitude and strength of the association. A statistically significant was considered for a p-value < 0.05.

Results

Characteristics of study participants

Table 1 presents our findings with 39.1% being adolescent girls and young women, and more than half (60.4%) were married. Regarding education, 57.5% had completed primary education; among those with a partner, more than half (58.4%) of their partner had completed primary education. We also found that more than half were working (61.2%), and more than two-thirds were exposed to media (67.5%). Just 16.0% had ever terminated pregnancy, and only 4.4% had been visited by fieldworkers in the past 12 months.

The distribution of alcohol consumption was significantly different with age group, marital status, working status, parity, termination of pregnancy and geographical zones (p < 0.05), as highlighted in Table 1.

Table 1 Demographic characteristics and distribution of alcohol consumption during pregnancy in Tanzania (N = 1,182)

Prevalence of alcohol consumption during pregnancy

The overall prevalence of alcohol consumption during pregnancy among pregnant women in Tanzania was 3.9% (95% CI: 2.8–5.4).

Factors associated with alcohol consumption during pregnancy

In crude analysis

, women aged 25–34 and ≥ 35 were more likely to consume alcohol during pregnancy (cOR = 4.34, 95%CI: 1.31–14.32) and (cOR = 13.85, 95%CI: 3.85–49.86) respectively, compared to those aged 15–24. Women who were separated or widowed had increased odds of consuming alcohol during pregnancy compared to married women (cOR = 5.23, 95%CI: 1.61–16.12). We also found that women who were working (cOR = 2.96, 95%CI: 1.16–7.56) were more likely to consume alcohol compared to their counterparts. (Table 2).

In adjusted analysis

, after controlling for age, marital status, working status, wealth index, parity and geographical zones. Women aged 25–34 (aOR = 5.17, 95%CI: 1.62–16.51) and more than 35 years of age (aOR = 20.89, 95%CI: 6.55–66.62) were more likely to consume alcohol compared to those aged 15 to 24. Compared to married women, women who were never married had increased odds of consuming alcohol (aOR = 7.89, 95%CI: 2.20-28.25). On the other hand, women in Zanzibar were less likely to consume alcohol during pregnancy compared to women in the western zone (aOR = 0.20, 95%CI: 0.04–0.88). (Table 2)

Table 2 Factors associated with alcohol consumption during pregnancy

Discussion

This study aimed to determine the prevalence of alcohol use during pregnancy and the associated factors using the most recent 2022 TDHS-MIS data analysis. Our analysis revealed that the prevalence of alcohol consumption during pregnancy is a public health concern, evidenced by a reported overall prevalence of 3.9% (95% CI: 2.8–5.4) among pregnant women. Alcohol consumption during pregnancy was associated with age, single and marital status, and geographical location.

The prevalence of alcohol consumption among pregnant women illustrates a broader trend seen throughout Sub-Saharan Africa, where rates can differ significantly based on cultural practices and societal norms related to alcohol use.​ Research shows that while certain regions report a lower prevalence, urban areas exhibit much higher alcohol consumption [16]. For instance, a 2021 study in Tanzania found that up to 42.2% of pregnant women consume alcohol at least once a week [21]. In Northern Tanzania, a 2015 study reported a maternal alcohol consumption prevalence of 21.5% [24], which has shown a decreasing trend over the years; a subsequent study in Central Tanzania in 2018 reported a prevalence of 15.1% [22]. This declining trend contrasts with previous studies in Tanzania and other Sub-Saharan African contexts, where higher rates were observed [18]. The variation in prevalence can be attributed to differences in study design and coverage. Additionally, the lack of targeted public health initiatives and educational programs addressing the risks of alcohol consumption during pregnancy poses significant challenges in mitigating this issue [25]. ​Therefore, further research and community-wide educational interventions are urgently needed to raise awareness and reduce the associated health risks for mothers and children in Tanzania and other regions.

In Tanzania, increasing age among pregnant women exhibits a significantly higher likelihood of consuming alcohol compared to younger adolescent girls, indicating a substantial age-related risk factor for maternal alcohol consumption [24]. This trend reflects broader patterns observed across Sub-Saharan Africa, where older women are often more socially accepted and encouraged to participate in alcohol consumption, sometimes due to cultural norms and lifestyle choices [21, 25]. In another part of the world, a qualitative study highlights how older women may use alcohol as a means of coping with life stresses and societal pressures, thereby embedding drinking into their daily routines [26]. Additionally, cultural norms may attribute a degree of social freedom to older women, as they are perceived as more autonomous in their lifestyle choices, which can lead to higher alcohol consumption rates [18]. The implications of this finding are significant, as alcohol use during pregnancy is associated with serious health risks for both the mother and the fetus, including adverse birth outcomes and developmental disorders. Addressing alcohol consumption among this age group in Tanzania and other similar contexts is essential, necessitating tailored public health interventions that consider cultural perceptions and existing social norms surrounding alcohol use.

This study found that women who were never married were more likely to consume alcohol compared to their married counterparts, which shows a heightened tendency toward alcohol use in this demographic. This finding was also supported by the study conducted in Ethiopia [17]. This phenomenon is reflective of broader sociocultural trends observed across Sub-Saharan Africa, where marital status often correlates with social expectations and norms regarding alcohol consumption [16, 18]. This phenomenon can be explained through the lens of social identity theory, where these individuals may feel less constrained by traditional familial expectations, granting them the freedom to engage in behaviours, including maternal alcohol consumption, that are typically discouraged for pregnant women [7, 27, 28]. Unmarried women may experience different social pressures or greater freedom in their choices, leading to higher rates of alcohol consumption, as they might be less accountable to family or community expectations that often accompany marriage [29]. Furthermore, studies suggest that unmarried women may face social isolation, leading them to seek companionship in settings where alcohol is consumed [30], potentially contributing to patterns of excessive drinking habits in urban areas [31]. Addressing this disparity is crucial for public health initiatives aimed at reducing alcohol-related risks among vulnerable populations, emphasising the need for targeted interventions such as community-based education programs, supportive networks and counselling that consider the unique challenges faced by never-married women in Tanzania and other similar settings.

Significant disparities in alcohol consumption during pregnancy were noted between different regions, notably highlighting low consumption by women in Zanzibar compared to those in the western zone. This difference may be attributed to these regions’ varying cultural practices, societal norms, and economic conditions [32]. Zanzibar, with its predominantly Islamic population, often experiences stricter social norms surrounding alcohol consumption, which may contribute to the lower prevalence of drinking among pregnant women. In contrast, the western zone of Tanzania, which may have more diverse cultural influences and higher accessibility to alcohol, shows higher rates of alcohol use among pregnant women [25, 33]. Such regional disparities in alcohol consumption during pregnancy are emblematic of broader trends observed throughout Sub-Saharan Africa, where cultural, educational, and socioeconomic factors play crucial roles in influencing women’s health behaviours and attitudes towards alcohol during pregnancy. Addressing these disparities is vital for public health interventions aimed at reducing alcohol-related risks and improving maternal and child health outcomes across Tanzania. The study showed a need for policy advocacy aimed at strengthening health systems to tackle maternal alcohol consumption effectively.

The findings of this survey reveal that characteristics such as wealth index and parity greater than three show non-significant associations with maternal alcohol consumption, aligning with mixed findings in existing research [16, 34]. Economic hardship may influence alcohol use, but socio-cultural practices in Tanzania could lead women across various wealth levels to drink, irrespective of financial status [35]. Furthermore, the lack of association between higher parity and alcohol consumption suggests that women with more children may be more aware of the risks or face community discouragement regarding drinking. Previous studies have shown mixed results about parity’s role and wealth index in alcohol consumption [15, 16, 18]. At the same time, some literature indicates higher parity [18] and good socioeconomic status [34] correlate with increased alcohol use. These findings highlight the necessity for further research into the social and cultural factors influencing alcohol consumption behaviours among pregnant women in Tanzania.

Recommendation

The findings underscore the need for targeted public health initiatives that specifically focus on educating and empowering vulnerable populations, particularly unmarried women and older expectant mothers, to mitigate health risks for both mothers and children. Interventions could include culturally tailored educational programs that raise awareness about the dangers of alcohol consumption during pregnancy, provision of counselling services that address the unique challenges faced by these groups, and community-based support networks that encourage abstinence and offer resources for substance abuse treatment. Additionally, implementing accessible screening programs to identify at-risk individuals and facilitate early intervention could significantly enhance maternal and child health outcomes.​ Such initiatives must consider the diverse cultural norms and socio-economic conditions across different regions of Tanzania. Future research should prioritise exploring these specific interventions, alongside improving community awareness and access to essential resources, to effectively reduce alcohol consumption during pregnancy and contribute to better maternal and child health outcomes in Tanzania and throughout Sub-Saharan Africa.

Strength and limitations

This study on maternal alcohol consumption in Tanzania presents several strengths, including utilising the most recent 2022 TDHS-MIS data, which offers a reliable estimate of the overall prevalence and informs public health policies. It effectively identifies demographic factors, such as age and marital status, associated with alcohol consumption. It highlights regional disparities, particularly the lower prevalence in Zanzibar, thus contextualising cultural influences on health behaviours. However, the study is limited by its reliance on self-reported data, which may introduce biases such as recall bias, where participants may not remember or underreport their alcohol consumption. Furthermore, the cross-sectional design hinders the ability to draw causal inferences, as it does not allow for the assessment of relationships between variables. The absence of detailed insights into the underlying reasons for alcohol consumption restricts the capacity to design targeted interventions. Additionally, not accounting for influential confounding variables, such as comprehensive socioeconomic status and psychological factors, may further complicate the interpretation of the study’s outcomes. ​Addressing these gaps is essential for a more nuanced understanding of the factors influencing alcohol use during pregnancy and for developing effective public health strategies.

Conclusion

This study highlights the prevalence of alcohol consumption during pregnancy in Tanzania and identifies key demographic and regional factors influencing this public health issue.​ The findings reveal that age, marital status, and geographical location significantly affect alcohol use among pregnant women, with unmarried and older women being particularly at risk. The notable regional disparities, especially the lower prevalence in Zanzibar compared to the western zone, underscore the complex interplay of cultural norms and socio-economic conditions in shaping health behaviours. While the study leverages the most recent 2022 TDHS-MIS data to provide a comprehensive understanding of these patterns, it also acknowledges essential limitations such as reliance on self-reported data and the inability to draw causal inferences. Addressing the public health implications of these findings is crucial; hence, targeted educational and support interventions tailored to vulnerable populations are essential to mitigate the health risks associated with alcohol consumption during pregnancy and improve maternal and child health outcomes across Tanzania and SSA.