Background <p>Mistreatment of pregnant women during childbirth in health facilities(HFs) is a public concern in Tanzania. The practice poses a number of negative health effects to women and the new-born including long terms disabilities and deaths. However, there is limited empirical evidence on the current prevalence and socio-demographic disparities associated with mistreatment of pregnant women during childbirth services in HFs in Tanzania.</p> Methods <p>This study used secondary data of 5,810 pregnant women aged 15–49 years who gave birth in health facilities drawn from the 2022 Tanzania Demographic and Health Survey. All data were weighted to account for complex sampling design and non-response rate. Outcome variable was mistreatment status of pregnant women during childbirth, dichotomized as yes and no. Independent variables grouped into individual, social and structural determinants in line with Anderson model of health services usage. Descriptive analysis to show distribution of respondents among characteristics in terms frequency and percent, chi-square to determine association and multivariable regression analysis to determine the magnitude of association were performed. A threshold of p-value less than 0.05 was set to determine a significant factor.</p> Results <p>In Tanzania, the prevalence of women mistreatment during childbirth in the HFs is 24.3%. Results from multivariable showed that individual determinants; the women’s younger age 15–29 had higher like hood of being mistreated during childbirth compared to older women (30–49 years). Regarding social determinants, women who were uninsured were more likely to report mistreatment. Structural determinants, women receiving childbirth care at dispensary level, residing in Northern and Coast zones, and those who reported difficult in obtaining permission to access healthcare were more likely to report mistreatment during childbirth services compared to their counter parts.</p> Conclusion <p>The prevalence of pregnant women’s mistreatment during child birth in the HFs in Tanzania is common at 24.3%. Being not covered by health insurance, residing in Northern and coast zones, having a big problem to get permission to access healthcare and accessing childbirth services at dispensary, were significantly associated with mistreatment during childbirth in HFs in Tanzania. Efforts to begin the implementation of universal health insurance and providing special eye to dispensaries are needed in ending mistreatment of pregnant women during child birth in the country.</p>