Maternal Health Care Seeking Behavior and Pregnancy Outcome of Pregnant Women of Amuzukwu Community in Abia State.
CHAPTER ONE
Objective of the study
The purpose of this study is to examine the health care seeking behaviour of pregnant women and their pregnancy outcome in Amuzukwu community in Abia State.
Specific objectives of the study are to:
- Determine the gestational age at which pregnant women book for ANC in Amuzukwu community.
- Determine how often the pregnant women go for ANC in third trimester.
- Ascertain the facility utilized by pregnant women with complication(s) for care.
- Ascertain the pregnancy outcome of the pregnant women in the study area
CHAPTER TWO
REVIEW OF RELATED LITERATURE
Introduction
This chapter presents the review of relevant literature on health care seeking behavior under the following headings; conceptual review: concept of maternal health care, concept of pregnancy and childbirth, concept of maternal health care seeking behaviour; theoretical review: theory of planned behavior; empirical review, and summary of reviewed literature.
Conceptual Review
Concept of Maternal Health Care
Adele (2010) suggests Maternal Health Care to indicate the health of women during pregnancy, childbirth and the postpartum period. It encompasses the health care dimension of family planning, preconception, prenatal, and postnatal care in order to reduce maternal morbidity and mortality. Motherhood is often a positive and fulfilling experience, for many women. It can however be associated with suffering, ill-health and even death.
Preconception care can include education, health promotion, screening and other interventions for women of reproductive age to reduce risk factors that might affect future pregnancies. The goal of prenatal care is to prevent risks in pregnancy if possible, and to direct the woman to appropriate specialist medical services as necessary.
Postnatal care issues include recovery from childbirth, concerns about newborn care, nutrition, breastfeeding, and family planning
Concept of pregnancy and childbirth
Kozier and Erbs (2010) explain Pregnancy as the development of one or more offspring(s), also known as embryo, in a woman’s womb. It is the common name for gestation in humans and is the period between conception and birth. A full term pregnancy lasts nine months and usually does not involve major health problems. Sometimes however complications develop that jeopardize the health of the mother, unborn baby or even both. Getting regular checkups is the best way to make sure that the pregnant woman and her baby stay healthy. This is called prenatal or ANC. During this period, the pregnant woman should see her skilled health care provider if she has one or choose one to take care of her and the unborn baby during the pregnancy. Adele suggests that the best person to take care of a pregnant woman and her baby is an obstetrician (doctor), and/or a licensed midwife/nurse. During the first ANC visit, the skilled health care provider will ask the pregnant mother about her health, other pregnancies and the health of other members of the family, as well as the first day of her last menstrual period to estimate her due date. This is also the time to bring a list of questions, problems, symptoms and concerns about pregnancy for discussion and to clear doubts and fears. Subsequent visits will be used to educate the pregnant mothers on the stages of pregnancy, processes of labour and delivery. Any illness or discomfort identified will be addressed properly.
Childbearing is a key part of women’s life and occurs mainly in the adolescent and adult years. Maternal health is a very important issue as motherhood is also their most productive time when they strive to fulfill their potential as individuals, mothers, and also as citizens of a wider community. At the individual level, women’s poor health causes lack/loss of employment, leading to poor income. This as well as the mother’s age, her level of education and parity contributes to women’s persistent poverty and lack of empowerment which has implications for their health care seeking behaviour during pregnancy. WHO (2014) estimated that 289,000 women died globally following pregnancy and childbirth. Almost all of these deaths occurred in low resource settings, and most could have been prevented if the women adopted positive MHCS behaviour. The use of skilled care during pregnancy and childbirth can save the lives of these women. Rastogi (2012) explains that in communities where women’s needs are accorded low priority by families and themselves, they have less treatment behaviours. Garba, Hllanndu, Ajayi, et al (2011) explains that this less treatment behaviours often lead to poor maternal health care seeking behaviours with high probability for negative pregnancy outcome like stillbirth, severe post-partum haemorrhage or even maternal death.
CHAPTER THREE
RESEARCH METHOD
This chapter presents research design, area of study, population of study, sample, sampling procedure, instrument for data collection, ethical consideration, validity and reliability of instrument, procedure for data collection and method of data analysis.
Research Design
Correlation design was used in this study. This design examines the characteristics, behaviours, attitude and intentions of a group (typically only a subset) to answer a series of questions. Descriptive cross-sectional design was successfully used by Osubor, Fatusi, and Chiwuzie, (2006) and Garba, et al (2011)to assess maternal health care seeking behaviour of Nigerian women. In this study, descriptive cross-sectional design was considered appropriate because of the need to assess the relationship between maternal health care seeking behaviour and pregnancy outcome.
Area of Study
Azumukwu is a community in Umuahia North Local Government Area of Abia State, Nigeria. Its headquarters are in the city of Umuahia. It has an area of 245 km2 and a population of 220,660 at the 2006 census.
Population of the Study
Eze (2014) suggests that the estimated population of pregnant women in the study area was 586.This population estimate of pregnant women was from January to December 2021 in the community Monitoring and Evaluation Unit (M&E)(2014)).
CHAPTER FOUR
RESENTATION OF RESULTS
This chapter presents the data from the study. A total of 207 questionnaires were administered and information elicited from 207 respondents. Responses from the questionnaire were presented according to research objectives using frequency distribution tables, and percentages.
Table 1 shows that the majority of the respondents (46.4%) were aged between 18 and 27 years with a mean age of 29 years. Most of the mothers (31.4%) were poultry farmers, 20.8% were employed by the government, while only a few: 1.9% and 6.8% were fulltime house wives and students respectively. 48.3% of the mothers completed secondary education while10.1% had tertiary education and the same 10.1% had no formal education.
CHAPTER FIVE
DISCUSSION OF FINDINGS, SUMMARY, CONCLUSION AND RECOMMENDATIONS
This chapter presents the discussion of major findings, summary of the study, conclusion and recommendations, limitation of the study and suggestions for further research.
Discussion of major findings:
Demographic characteristics of the respondents
Majority 96 (46.6%) of the respondents was aged between 18 and 27 years with a mean age of 29 years. This indicates that most of the respondents in the study areas are young women. This agrees with MagadiAgwandaObare (2007) which suggested that age of women at pregnancy plays an important role in maternal health care seeking behaviour. According to educational qualification 48.3% of the women completed secondary education and only 10.0% had no formal education. During focus group discussion, the researcher gathered that those that were educated up to secondary level adopted positive maternal health care seeking behaviours themselves (78% weekly ANC attendance in 3rd trimester).This helped those with secondary education to encourage their co-wives that had no formal education or just primary education to equally adopt positive maternal health care seeking behaviours (sought care from skilled care providers) which was noted by their use of ANC services. This agrees with Gage and Calixte (2006) which suggested that the higher a woman’s level of education, the more likely she is to seek maternal health care services. It equally agrees with Jayaraman Chandrasekhar and Gebreselassie (2008) which stated that the higher the overall educational level in a community, the more likely are the women to deliver in a health facility than in a TBA home. Findings also reveal that most of the women could support themselves financially because they have something doing to earn money (poultry farming, petty trading, and public servants etc.). The researcher observed that this encouraged most of them to seek maternal health care services without depending on anybody for financial aid for the little demands made of them by health care providers (mostly for sundry). It agrees with furuta and Salway (2006) who opined that, the context in which women are employed influence their health care seeking behaviour and access to health care services. They argued that, women who are working and earning money have better autonomy and financial ability to pay for services. Thus, they seek care from skilled providers often. This however disagrees with Kamal (2009) who opined that in some regions of the world, non-working women are more likely to use some maternal health care services. It was also observed that 37.8% and 25.1% respondents had a parity of four (4) and three (3) respectively. The researcher observed this numbers of children adequate for the women to cope with and still attend ANC services. This also agrees with Kamal (2009) who indicated that good relationship has been found to exist between parity and utilization of maternal health care seeking behaviour. However, it disagrees with JayaramanChandrasekhar and Gebreselassie (2008) which stated that a woman is more likely to seek maternal health care services for the first pregnancy because of the risk of unknown outcome associated with it than for subsequent pregnancies.
Objective 1: Where Pregnant Women Book for ANC and the trimester.
Majority of the respondents(92.7%) received ANC from skilled health care providers in health facilities while only a few received from TBA (3.4%). Majority of the women booked for ANC during the first trimester while only a few booked during the third trimester. This was commendable as most of the women had the opportunity to be properly cared for if they attended regular ANC. This also shows that majority of the women was aware of the benefits of those services provided by skilled health care providers and as such often go for those services by booking early for ANC in health facilities. This was in agreement with Kamal(2009) who stated that pregnant women who are aware of maternal health care services provided by skilled health care providers and how to access them are more likely to use them during pregnancy and delivery than those who know only about the traditional birth attendants (TBAs).
The researcher equally observed that most of the women (31.4% were poultry farmers and 20.8% were public servants) had income earning capacity and were able to pay the little fee demanded of them by the skilled health care providers during antenatal care. This agrees with Furuta and Salway (2006) which opined that women who are working and earning money (poultry farming, petty trading, and public servants etc.) have better autonomy and financial ability to pay for services. Equally, it agrees with Pinar, Osman, Ahmet, Seyhan, Ahmet, Dilsad et al (2009)which opined that educated and employed women are more likely to seek antenatal care as well as consult qualified professional such as doctors, nurses, or midwives for care and delivery than uneducated and unemployed women. According to place of antenatal care, 2.9% of the respondents received antenatal care from TBA and have done so for their previous babies. This was in agreement with Jayaraman, et al (2008) who explained that women who deliver their first babies at a TBAs home without any problems are most likely not to seek ANC or delivery from a health facility or under a skilled health care provider.
CHAPTER FIVE
DISCUSSION OF FINDINGS, SUMMARY, CONCLUSION AND RECOMMENDATIONS
This chapter presents the discussion of major findings, summary of the study, conclusion and recommendations, limitation of the study and suggestions for further research.
Discussion of major findings:
Demographic characteristics of the respondents
Majority 96 (46.6%) of the respondents was aged between 18 and 27 years with a mean age of 29 years. This indicates that most of the respondents in the study areas are young women. This agrees with MagadiAgwandaObare (2007) which suggested that age of women at pregnancy plays an important role in maternal health care seeking behaviour. According to educational qualification 48.3% of the women completed secondary education and only 10.0% had no formal education. During focus group discussion, the researcher gathered that those that were educated up to secondary level adopted positive maternal health care seeking behaviours themselves (78% weekly ANC attendance in 3rd trimester).This helped those with secondary education to encourage their co-wives that had no formal education or just primary education to equally adopt positive maternal health care seeking behaviours (sought care from skilled care providers) which was noted by their use of ANC services. This agrees with Gage and Calixte (2006) which suggested that the higher a woman’s level of education, the more likely she is to seek maternal health care services.
Summary of the study
This study was a descriptive cross-sectional survey that intended to determine the health care seeking behaviour of pregnant women as well as their pregnancy outcome. The study was delimited to antenatal care seeking behaviour and delivery care as well as reasons for choice of place of delivery. Demographic factors that may influence their maternal health care seeking behaviour and pregnancy outcome were determined. Relevant literatures to the study were reviewed. The theory of planned behaviour as proposed by Ajzan (2009) was applied to the study.
A sample of 207 respondents was drawn from a target population of 586 pregnant women. Instrument for data collection was self-structured questionnaire which was administered by the researcher with the help of her research assistants. This facilitated 100% return rate of the questionnaire distributed. The questionnaires were analysed using descriptive statistics. The data generated were presented in tables. Variables of interest were cross-tabulated with health care seeking behaviours and pregnancy outcome of the respondents. Chi-square was used to test for Significance Association at 0.05 level of significance.
From the findings, majority of the mothers were young (18 – 27 years) with a mean age of 29 years, 48.3% completed secondary education, had income earning capacity, 37.8% had a parity of three (3). These women recorded high level of attendance to antenatal care in health facilities especially general hospital (53.1%) and 80.2% of the respondents had weekly visit for antenatal care in third trimester, 40.6% accessed care for health problem(s) experienced from health facility (general hospital), and 36.0% delivered under skilled health care providers. However a few (4.0%) of the respondents accessed antenatal care and delivery services (1.0%) from TBA home where the 0.5% negative outcome of babies’ birth was recorded.
The respondents that accessed care from health facility said they did so because of the free maternal health care services provided by the state government and the attitude of the care providers. Thus, an association was found between place of antenatal care and baby’s birth outcome (P<0.05) but no association was found between demographic variables (age and educational status) and maternal health care seeking behaviour (P>0.05) as well as between maternal health care seeking behaviour (frequency of ANC in 3rd trimester) and pregnancy outcome (mothers’ delivery outcome).
Implication of the study
Findings of this study show that education coupled with the free maternal health care services provided by the state government has gone a long way in influencing the behavior exhibited by most of the pregnant women which lead to the high percentage of positive pregnancy outcome recorded.
Significant association was found between place of ANC and of babies’ birth outcome (P<0.05) which confirmed that some respondents booked for ANC in two places (a health facility and a TBA). This shows the place of ANC greatly influences baby’s birth outcome.
Conclusion
From the foregoing, this study has been able to examine the current picture of the maternal health care seeking behaviour and pregnancy outcome among pregnant women in Azumukwu community in Abia State. Some of the studies carried out in the past show that education, place of residence and income influence maternal health care seeking behaviourbut this study show that education and income were not so much influential in the health care seeking behaviour of the respondents. This is because the women had free access to maternal health care services through free “Maternal and Child Health Care” provided by the state government. Also, observed was that the educated mothers in the study areas were able to positively influence their co-wives and friends that had no formal education to adopt positive health care seeking behaviour. Thus, a good number of the respondents exhibited positive maternal health care seeking behaviour with positive pregnancy outcome. This study also revealed that, although Abia State government provided free maternal health care services in every locality, 3.4% of the women in the study area still patronized TBAs. It was also gathered during focus group discussion that the TBAs are nearer them, have better attitude, are always available and stays with them after delivery in the same room as against the skilled care providers that will leave them alone in the postnatal ward. The respondents that patronize the TBAs said they do so because they believe the TBAs can only take deliveries. Thus, when they experience health problems in pregnancy, they access care from skilled care providers in health facilities. A low level of negative maternal health care seeking behaviour with booking during the first trimester and weekly visit for the antenatal care during the third trimester was observed among the respondents. This could not be attributed to their level of education as both the educated and those without formal education show the same level of maternal health care seeking behaviour with respect to booking and weekly visit for antenatal care during third trimester.
It was also found that some respondents booked for antenatal care in two places: a health facility and TBA home. Such women opined that they booked in a health facility for any emergency, if not; they hoped to deliver in a TBA home. Majority of the women accessed antenatal care and delivery services from skilled health care providers because they trust their efficiency and attitude as well as their husbands’ decision that they deliver in a health facility.
Recommendation
Mothers should be encouraged to fully utilize the free maternal and child health care services provided by the state government.
Registered midwives should be encouraged to be entrepreneurial in nature right from the training period so as to establish maternity homes close to the women in the community in order to fill the gap currently occupied by TBAs.
In the absence of a midwife owned maternity home in most localities, TBAs should be registered with the general hospitals in their community as part of life saving skill measures. This will make it possible to take them through seminars to improve their skills and reduce the risks involved in their practice.
Limitations to the study
This study was carried out in only two towns in Enugu State and cannot be generalized for the whole state/country.
The population of study was not stratified into urban and rural towns as these would have given understanding of the differences between those living in the urban and those in the rural areas of the state.
The information given by the respondents may lack objectivity and sincerity especially with the mothers’ parity and number of children alive as some mothers argued that children are not counted
Suggestions for further study
The following areas were recommended for further research
- Similar study should be carried out in other States of the Federation.
- Study should be conducted on the influence of health system staff on maternal health care seeking behaviour and pregnancy outcome.
- Study should be carried out to find out why some women do not attend antenatal care despite the free maternal health care services provided by the government of Abia State.
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