UTILIZATION OF ANTENATAL AND MATERNITY SERVICES BY MOTHERS SEEKING CHILD WELFARE SERVICES IN NIGERIA

ABSTRACT

This study aims to analyze the determinants of utilization of antenatal and maternal health care services among mothers seeking child welfare services with focus on the continuum of care for pregnant women during pregnancy and delivery, that is, the use of antenatal care services and skilled assistance during delivery. This study used data from 2008-09 N-DHS for women with a last birth in the five years preceding the survey. Descriptive methods of analysis and multivariate ordinal regression method of analysis were used to determine the significance of independent variables on the utilization of antenatal care and delivery services. Independent variables for this study include: age, marital status, level of education, type of place of residence and household wealth index. Descriptive and multivariate analysis show that the independent variables affect utilization of maternal health services; women who are married, young and rich are likely to utilize maternal health care services compared to women who are not married, older and are poor. Therefore, more effort is needed to be put to educate the general public on the importance of maternal health care services. Moreover, efforts should be channeled to encourage seeking a continuum of maternal health services by pregnant women. Finally, research should focus into understanding the various factors that influence utilization of maternal health care services. The data analysis shows that the most important factors associated with utilisation of maternal health care services are age and marital status.

CHAPTER 1: INTRODUCTION

1.1 Background

Maternal and child health has emerged as the most important issue that determined global and national wellbeing.  This is because every individual, family and community is at some point intimately involved in pregnancy and the success of childbirth (WHO, 2006).  Despite the honour bestowed on womanhood and the appreciation of the birth of a new born baby, pregnancy and childbirth is still considered a perilous journey. The situation of maternal and child health in Nigeria is among the worst in Africa and has not improved substantially and in some areas of the country, has worsened over the past decade (Ladipo, 2009).  The maternal mortality ratio ranges between 800-15000 per 100,000 live births (Nigeria Demographic and Health Survey, 2003), with marked variation between geo-political zones – 165 in South West compared with 1,549 in the North-East and between urban and rural areas (Ladipo,2009).  Total fertility rate is 5.7 births per woman and it is estimated that approximately 59,000 of maternal deaths take place annually in Nigeria as a result of pregnancy, delivery and post-delivery complications (WHO, UNICEF, UNFPA, 2007).

Research (Ladipo, 2009) indicated close link between the health of the new born with the health of their mothers.  About 30-40% of neonatal and infant deaths result from poor maternal health and inadequate care during pregnancy, delivery and the critical immediate postpartum period (Ladipo, 2009).  In Nigeria 340,000 infants die every year during delivery and shortly afterwards especially if the mother dies in childbirth (WHO, UNICEF, UNFPA, 2007). The under-five mortality ratio is 200 per 1000 live births (WHO, 2006).  These deaths are not unconnected with the poor maternal health services in the country and could be avoided through provision of quality and effective maternal and child health services.

Nigeria is one of the African countries with a rapidly growing population.  As a nation with a growing economy, one of the major health challenges facing the country today is the capacity to sustain the increasing infant and maternal health.  The most common recorded cause of perinatal deaths are similar to those of other less developed countries, and the common denominators are early childbearing poor maternal health and above all, the lack of appropriate and quality services (Okereke, Kanu, Nwachukwu, Anyanwu, Ehiri & Merick, 2005).  Although life-saving practices for most infants have been known for decades, currently one third of the mothers still have no access to health care services during pregnancy and almost half do not have access to health care services during childbirth (Okereke, et al., 2005). In the light of rapid population growth and increased risks of adverse environmental health exposures, maternal and child health prospects could be a serious national public health problem due to factors such as ignorance, apathy, poverty, lack of commitment, illiteracy and corruption (Opara & Ellah, 2007).

1.2 PROBLEM STATEMENT

The 2008-09 N-DHS found that less than half (47 percent) of all pregnant women in Nigeria make the recommended four or more ANC visits. 60 percent of urban women make four or more ANC visits compared with less than half (44 percent) of rural women. The data further show that most women do not receive antenatal care early in the pregnancy; only 15 percent of pregnant women obtain antenatal care in the first trimester of pregnancy; the median number of months at first visit is 5.7 (KNBS and ICF Macro, 2010).

Despite high antenatal care attendance in Nigeria, the rate of delivery in a health facility is low. Only 43 percent of live births in the five years preceding the 2008-09 N-DHS took place in a health facility (KNBS and ICF Macro, 2010).

The 2009 National Reproductive Health Strategy for Nigeria aims to reduce maternal mortality ratio to 147 deaths per 100,000 live births and to increase percentage of women using skilled care in delivery to 90 percent by 2015. When compared to the 2008 N-DHS maternal mortality rate of 488 deaths per 100,000 live births, this target is yet to be achieved.

Nigeria is characterized by low utilization of maternal health care services despite the various interventions. The community component of the KSPA 2010 report shows that women from rural part of the country are least likely to deliver in a health facility. It is known that the majority of the maternal and perinatal deaths can be prevented if women received timely and appropriate care.

In Nigeria, the use of skilled health professionals (the use of a doctor, nurse or midwife) during delivery aggregates to 25.8 percent (N-DHS 2008). The 2007 Reproductive Health Policy recommends having a health worker with midwifery skills during delivery without which there is high risk of maternal death. Comparison of the 2003 and 2008 N-DHS shows that home deliveries increased from 70.6 to 73.3 percent, indicating low utilization of maternal health care services. Having highest proportions of those who gave birth on their own without assistance in both the 2003 and 2008 N-DHS report, this proportion increased from 10.6 percent to 14.6 percent. This means that high proportions of births occur at home without the assistance of a skilled birth attendant.

The National Coordinating Agency for Population and Development (NCAPD) identified the relationship between maternal mortality, age, parity, marital status, birth interval, antenatal attendance and occupation as a research gap (NCAPD, 2006). To provide an in depth outlook that will accelerate progress towards improving maternal services, it is important to understand the level of utilization of maternal health care services among women of reproductive age with intention to examine a continuum of care from pregnancy to delivery rather than study the use of one aspect at a time of maternal health.

1.3 Research Question

What factors influence utilization of maternal health care services in Nigeria?

1.4 Research objective

The aim of this study is to establish determinant factors in the utilization of antenatal and maternal health care services among women of reproductive age in Nigeria

1.4.1             Specific Objective

• To establish factors that determine the use of all maternal health care services

1.5 Justification of the study

Maternal mortality rates in Nigeria remain high and this study aims at contributing to better understanding about utilization of maternal health care services by expectant women in Nigeria. Seeking antenatal services on time by pregnant women helps detect complications and informs mothers on ways to care for themselves and the babies while skilled assistance during delivery decreases both neonatal and maternal morbidity and mortality.

Analysis of patterns of maternal health care utilization behaviour by province is necessary in formulating relevant policies to address provincial differentials in maternal mortality. Therefore, this paper is not only beneficial to women but also policy makers.

A better understanding of the utilization of all maternal health care services will aide in attaining national maternal mortality goals as articulated in various strategies and vision 2030 hence contributing to the achievement of MDGs 4 and 5.

1.6 Scope and limitation

This study will use data from the 2008-09 N-DHS which interviewed 8444 women of age 15 to 49, 1039 from Nigeria with a birth in the past five years. The data is retrospective since information is collected in regard to births five years preceding the survey. Therefore, the accuracy of information relies on the ability of the respondent to recall.

Secondary data is limited to characteristics handled in available data. Information on beliefs and practices that would have been included is not available.

In addition, this study focuses on services during pregnancy and at time of delivery. That is ANC services (the number of visits and timing of visits) and the use of skilled delivery. This excludes other maternal health care services such as the use of postnatal care services and family planning. Further, the study does not include information regarding place of delivery which is crucial to maternal and child health.

Data used in this study is of quantitative nature thus it does not offer explanations to findings in this study. For example, quality of care, cost of transport and distance to a health facility are some of the possible underlying factors in determining the utilizing maternal health care services.

Finally, this study focuses on Lagos state only; therefore, its findings and conclusions cannot be generalized to other states in the country.

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