Dissertation (MSc Midwifery)Background: Assessing the influence of fear during pregnancy, labour and delivery on birth outcome among women is very important. Normally women experience happiness, satisfaction and self-fulfilment but some may feel some changes and may develop fear which maycause maternal and neonatal complications. Objective: The aim of this study was to assess the influence of fear during pregnancy, labour and delivery on birth outcome among post-delivery women in Zanzibar. Methods: This was a matched case-control study involving 204 post-delivery women who were randomly selected from 4 ? selected hospital in Zanzibar. Cases (n=68) were those who had the undesirable birth outcome among others including birth asphyxia, C/Sand fetal distress. While control (n = 136) were those who had desirable birth outcome, that is normal birth outcome for both mother and baby. Comparing groups mean, bivariate and multivariate logistic regression were conducted and t-test, chi-square, and odds ratio were reported. Results: The results show that there was no significant difference between cases and control in all demographic variables. Among all cases (n=68), 17 (25%) had the highest level of fear during pregnancy compared to the control in which among all control (n=136), only 24 (17.65%) had the highest level of fear. During labour, 13 (19.12%) of cases had the highest level of fear while in control 27 (19.85%) had the highest level of fear. And during delivery ), 19 (27.94%) of cases had the highest level of fear while in control only 22 (16.18%) had the highest level of fear. The ttest results showed no significant difference in fear mean score between cases and vi control during pregnancy and labour, but there was a significant mean score difference during deliver (p < 0.001). Fear during delivery was significantly associated with the type of job (p=0.0005) and information refactor (p= <.0001). Also, the result showed that the undesirable birth outcome was significantly associated with fear during delivery (p=0.0047). Women who experienced moderate to a high level of fear during delivery were two times more likely to have undesirable birth outcome than those who experienced a low level of fear (AOR = 1.941, p = 0.08). Conclusion: This study has found that all post-delivery women (100%) experience some level of fear during pregnancy, labour and delivery which influenced by personal factor mainly no able to cope with motherhood, family support, type of information received from other including friends and family, also feared due to experience of birthing process and health services received, This fear end up with undesirable birth outcome (abnormal birth outcome.)..