Pregnancy
The 2022 TDHS-MIS estimated the maternal mortality ratio at 104 deaths per 100,000 live births for the seven years before the survey, with a confidence interval of 59 to 149 (a lifetime risk of about 1 in 200); the survey's report notes that what earlier surveys called the maternal mortality ratio is now termed the pregnancy-related mortality ratio, so the figures are not directly comparable. Of women with a birth in the two years before the survey, 90% received antenatal care from a skilled provider, 65% made four or more visits and 34% had a first visit in the first trimester; 81% of births took place in a health facility and 85% were assisted by a skilled provider.
Within Zanzibar, 92% of births in Unguja took place in a health facility against 74% in Pemba, and skilled providers assisted 94% of births in Unguja against 78% in Pemba; on the Mainland the share ranged from 56% in Manyara to over 99% in Dar es Salaam and Iringa. Caesarean sections made up 11% of births (30% in private and 12% in public facilities), 51% of mothers had a postnatal check within two days while 44% had none within 41 days, and half of all women aged 15 to 49 reported at least one problem in getting health care when sick, most often getting money for treatment (36%) and distance to a facility (29%). Ninety-four per cent of women aged 15 to 49 have no health insurance.
Adolescent pregnancy is high: 22% of girls aged 15 to 19 have been pregnant (16% have given birth), from 2% in Mjini Magharibi (Zanzibar) to 45% in Songwe, and 53% among girls with no education against 9% among those with secondary schooling or more. Among women aged 25 to 49 the median age was 17.0 at first sex, 19.8 at first marriage and 19.9 at first birth.
The law has treated school pregnancy as an offence of the man rather than the girl since 2016: under s. 62 of the Education Act (inserted as s. 60A by Act No. 4 of 2016), marrying or impregnating a primary or secondary school girl carries 30 years' imprisonment, helping a school pupil to marry carries a fine of at least TSh 5 million or five years, and heads of school must report such cases to the Commissioner each quarter. On 24 November 2021 the Ministry of Education, Science and Technology issued a circular stating that pregnancy and motherhood are not grounds for expulsion from government schools; Human Rights Watch recorded in March 2022 that the Government had also pledged to ban involuntary pregnancy testing and that the World Bank estimated 6,500 pregnant students stopped attending school each year. On 27 May 2025 the Minister of Education said 10,300 girls who became pregnant at school had returned to study after giving birth (The Citizen, 28 May 2025).
On the Mainland the HIV and AIDS (Prevention and Control) Act requires every pregnant woman, and the man responsible for the pregnancy or her spouse, to be counselled and offered voluntary HIV testing (s. 15(5)), and obliges health facilities to monitor, treat and apply measures to reduce mother-to-child transmission (s. 30); the TDHS found that 88% of pregnant women tested for HIV during antenatal care or labour received their results.
Key points
| Maternal mortality ratio | 104 per 100,000 live births, 95% interval 59 to 149 (seven years before the 2022 TDHS-MIS) |
|---|---|
| Antenatal care | Skilled provider 90%; four or more visits 65%; first visit in first trimester 34% |
| Births in a health facility | 81% (Unguja 92%, Pemba 74%) |
| Births assisted by a skilled provider | 85% (Unguja 94%, Pemba 78%) |
| Postnatal check within two days | Mothers 51%; newborns 54% |
| Girls aged 15 to 19 ever pregnant | 22% (Songwe 45%, Mjini Magharibi 2%) |
| Women aged 15 to 49 without health insurance | 94% |
| Marrying or impregnating a schoolgirl | 30 years' imprisonment (Education Act s. 62(1) to (3)) |
| Pregnant girl at a government school | Pregnancy and motherhood not grounds for expulsion (Ministry circular of 24 November 2021) |
In practice
- A girl who left school because of pregnancy can ask to resume under the 2021 circular; the Minister reported in May 2025 that 10,300 girls had gone back, either to their previous schools or elsewhere.
- Impregnating a primary or secondary school girl is an offence that can be reported at a police station's Gender and Children's Desk, and sexual intercourse with a girl under 18 is rape under s. 130(2)(e) of the Penal Code, with the one exception of the wife aged 15 or more.
- Request antenatal care at a recognised health facility, where the HIV Act on the Mainland requires counselling and an offer of voluntary HIV testing for the pregnant woman and her partner (s. 15(5)).
Cost and coverage
Cost is a barrier in the TDHS data: 36% of women aged 15 to 49 cited getting money for treatment as a problem in obtaining care when sick, and 94% of them have no health insurance.
Recent changes
On 27 May 2025 the Minister for Education, Science and Technology, Prof. Adolf Mkenda, told reporters in Dodoma that 10,300 girls who became pregnant while in school had returned to study, and that research showed the return-to-school policy had not raised pregnancy rates.
Where to go
- Public health facilities and dispensaries for antenatal, delivery and postnatal care (81% of births took place in a facility, 75% in a public-sector one).
- District education office or head teacher, for return to school under the circular of 24 November 2021.
- Police Gender and Children's Desk, for impregnation or sexual abuse of a schoolgirl.
Frequently asked questions
Can a pregnant schoolgirl stay in school in Tanzania?
Since the Ministry of Education circular of 24 November 2021, pregnancy and motherhood are not grounds for expulsion from government schools; Human Rights Watch noted in March 2022 that the Government had also pledged to forbid involuntary pregnancy testing.
Is it a crime to make a schoolgirl pregnant?
Yes: s. 62(3) of the Education Act punishes impregnating a primary or secondary school girl with 30 years' imprisonment, and s. 130(2)(e) of the Penal Code separately treats intercourse with a girl under 18 as rape, apart from a wife aged 15 or more who is not separated.
How many women die in pregnancy in Tanzania?
The 2022 TDHS-MIS estimates 104 maternal deaths per 100,000 live births for the seven years before the survey, with a confidence interval of 59 to 149.
Sources
- 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey -- Summary Report (NBS and OCGS with The DHS Program) — antenatal and delivery care, postnatal care, caesarean sections, teenage pregnancy, median ages, maternal mortality ratio
- 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey -- Final Report (NBS and OCGS with The DHS Program) — Zanzibar institutional deliveries and skilled assistance (Unguja and Pemba), health insurance coverage, definition of maternal mortality
- Education Act, Cap. 353, Revised Edition 2023 (Attorney General's Office, official revised text) — s. 62 (formerly s. 60A)
- Penal Code, Cap. 16, Revised Edition 2023 (Attorney General's Office, official revised text) — s. 130(2)(e)
- HIV and AIDS (Prevention and Control) Act, Cap. 431, Revised Edition 2023 (Attorney General's Office, official revised text) — ss. 15(5) and 30
- Human Rights Watch, "Tanzania: Expedite protections for girls' education" (22 March 2022) — circular of 24 November 2021, pregnancy testing pledge, World Bank estimate
- The Citizen, "Tanzanian government allays fears over schoolgirl pregnancy policy concerns" (28 May 2025) — 10,300 girls returned to school; Minister's statement of 27 May 2025
The general article: Pregnancy · Compare with another country
HIV and AIDS
The HIV and AIDS (Prevention and Control) Act (Act No. 2 of 2008, in force on 1 January 2009 and amended by Act No. 14 of 2019) applies to Mainland Tanzania only (s. 2). Testing is voluntary and nobody may be compelled to take a test, except under a court order, for organ donors and for sexual offenders (s. 15(3) and (4)); a child, defined for HIV testing as a person under 15 (s. 3), or a person unable to comprehend a result needs the written consent of a parent or guardian (s. 15(2)), and a health practitioner who compels a test or tests someone without their knowledge commits an offence (s. 15(7)). Results are released only to the person tested, save for a parent, guardian or trusted person of someone under 18, the spouse or guardian of a person unable to comprehend, 'a spouse or a sexual partner', and a court (s. 16).
The Act puts a duty on the person who knows of an HIV-positive result: to inform a spouse or sexual partner immediately and to take reasonable measures to prevent transmission (s. 26(1)); abusing a spouse or partner, verbally, physically or by conduct, in connection with that disclosure is an offence punishable by a fine of TSh 500,000 to 1 million or three to six months, or both (s. 26(3)). Intentional transmission of HIV carries five to ten years and possible compensation (s. 52); breach of medical confidentiality or unlawful disclosure of status carries a fine of TSh 500,000 to 1 million or six to twelve months, or both (s. 51); and stigmatising or discriminating against someone on the ground of actual, perceived or suspected status is an offence punishable by a fine of at least TSh 2 million or up to one year, or both (ss. 36 and 37).
Complaints about a breach of the Act may be lodged in writing with the secretary of the village, ward, district or urban AIDS committee, the police station, the owner or manager of the health facility, or the employer (s. 56). Self-testing is allowed but must be voluntary and confirmed at a health facility or authorised testing service, and nobody under 18 may self-test or be supplied with a kit (s. 17); every health care facility and voluntary counselling and testing centre recognised by the National AIDS Control Programme is a testing centre (s. 13), and pre- and post-test counselling is required (s. 14).
The THIS 2022-2023 summary sheet (December 2023, described as preliminary) put HIV prevalence among adults aged 15 and over at 4.4%, about 1,548,000 adults: 5.6% of women against 3.0% of men, 4.5% on the Mainland against 0.4% in Zanzibar, from 1.7% in Kigoma to 12.7% in Njombe among Mainland regions and from 0.2% in Kaskazini Pemba to 0.8% in Kusini Unguja among Zanzibar regions. Annual incidence was 0.18%, about 60,000 new infections a year. Viral load suppression stood at 78.0% among all adults living with HIV, 80.9% for women and 72.2% for men, and the sheet says Tanzania had met the second of the three UNAIDS 95-95-95 targets ahead of 2025.
The TDHS-MIS 2022 adds testing data: 80% of women and 64% of men aged 15 to 49 had ever been tested and received their results, 37% of women and 31% of men in the previous 12 months, and 18% of women against 31% of men had heard of HIV self-test kits.
Key points
| Application of the Act | Mainland Tanzania only (s. 2) |
|---|---|
| Compulsory testing | Prohibited, with exceptions for court orders, organ donors and sexual offenders (s. 15(3) and (4)) |
| Duty to inform a spouse or partner | Immediately after a positive result (s. 26(1)) |
| Intentional transmission | 5 to 10 years, plus compensation if ordered (s. 52) |
| Breach of confidentiality | Fine TSh 500,000 to 1 million or 6 to 12 months, or both (s. 51) |
| Stigma and discrimination | Fine of at least TSh 2 million or up to 1 year, or both (s. 37) |
| Adult prevalence (THIS 2022-2023) | 4.4%: women 5.6%, men 3.0%; Mainland 4.5%, Zanzibar 0.4% |
| Aware of status / on treatment / suppressed | 82.7% / 97.9% of those aware / 94.3% of those on treatment |
| New infections among adults | About 60,000 a year (incidence 0.18%) |
In practice
- Test at any health facility or voluntary counselling and testing centre recognised by the National AIDS Control Programme, or, from 18, self-test and confirm the result at a facility (ss. 13 and 17); counselling must be offered before and after the test (s. 14).
- Tell your spouse or sexual partner a positive result promptly and take reasonable measures to prevent transmission (s. 26(1)); verbal or physical abuse in response to the disclosure is itself an offence (s. 26(3)).
- If a clinic, employer or other person discloses your status or discriminates against you, lodge a written complaint with the village, ward or district AIDS committee, the police, the health facility or the employer (s. 56).
Recent changes
THIS 2022-2023, fieldwork from November 2022 to March 2023, was released on the sheet dated December 2023; it counted 33,663 adults interviewed and tested, with an overall response rate of 79.2%.
Where to go
- Health facilities and voluntary counselling and testing centres recognised by the National AIDS Control Programme.
- Village, ward, district or urban AIDS committees, police station, health facility management or employer, for complaints under s. 56.
- Tanzania Commission for AIDS (TACAIDS) on the Mainland and the Zanzibar AIDS Commission (ZAC), which led the 2022-2023 survey with the Ministries of Health.
Worth knowing
The Act applies only to Mainland Tanzania (s. 2), so its testing, confidentiality and anti-discrimination rules, and the penalties above, are not statements about Zanzibar law; the same survey puts Zanzibar prevalence at 0.4%, below 1% in every Zanzibar region.
Frequently asked questions
Can an employer require an HIV test in Tanzania?
On the Mainland s. 15(3) of the HIV Act says nobody may be compelled to undergo testing, and s. 36 prohibits discrimination on the ground of actual, perceived or suspected status, with a fine of at least TSh 2 million or up to a year under s. 37.
Must I tell my husband, wife or partner that I am HIV-positive?
Yes: s. 26(1) requires a person who knows of a positive result to inform a spouse or sexual partner immediately and take reasonable precautions; s. 16(2)(c) also allows test results to be released to a spouse or sexual partner.
Is passing on HIV a crime?
Intentional transmission is an offence punishable by five to ten years under s. 52 of the HIV Act on the Mainland, and the court may order compensation.
Sources
- HIV and AIDS (Prevention and Control) Act, Cap. 431, Revised Edition 2023 (Attorney General's Office, official revised text) — ss. 2, 3, 13 to 17, 26, 36, 37, 51, 52 and 56 as printed in the 2023 edition
- Tanzania HIV Impact Survey 2022-2023 (THIS 2022-2023), Summary Sheet, December 2023 (TACAIDS, ZAC, Ministries of Health, NBS, OCGS, ICAP) — prevalence, incidence, viral load suppression, 95-95-95 cascade, regional figures
- 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey -- Summary Report (NBS and OCGS with The DHS Program) — HIV testing and self-test kits among women and men aged 15 to 49