An Assessment on the Effect of Home Delivery Among Pregnant Women
Chapter One
AIM AND OBJECTIVES
The aim of the study is to determine the effect of home delivery among pregnant women in Sabon Gari Kaduna South Local Government Area through the following objectives:
- To identify the reason and adverse outcomes of home deliveries in women.
- To identify the possible measures that will reduce home delivery among pregnant women in Sabon Gari.
- To understand the effect of home delivery.
- To identify the causes of home delivery among pregnant women.
- To make recommendation according to findings.
CHAPTER TWO
LITERATURE REVIEW
Preamble
Health and well being of women everywhere is very important for it is a key to the health and well being of their families and societies. This is true due to their roles in the health of members of their families. They also need good basic care during pregnancy, at birth and after delivery by having access to safe facilities that can provide the service which are available to health units (Mpembeni et al., 2000; Family Care International, 2006).
In the wake of the importance of the health and well being of women, various initiatives have been established in the world to save mothers’ and infants’ lives. For example, worldwide, the Safe Motherhood Initiatives started in 1987 to improve maternity services and to protect the health of mother and infants (Glob and Regan, 2002). In Kenya the initiatives were established in May 2007 by abolishing maternity fees in public hospitals in order to increase accessibility to referral obstetric care (Kimani, 2008). In Nigeria the initiatives started in 1998 (MDCHMT, 2003; Maswia et al., 2006). Sabon Gari launched Safe Motherhood Initiatives in all its 41 health facilities by equipping them with delivery beds, delivery kits, gloves as well as maternal and child health trained staff, expecting to serve women during labour and childbirth (SDC, 2007).
World Health Organisation and other agencies call for global action of ensuring that all pregnant women have access to a skilled attendant at delivery and referral for high-risk pregnancies and obstetric emergencies. A number of developing countries have made policies and have established strategies and extensive health infrastructures to offer reproductive and child health services free of charge in improving reproductive and child health care services (Mpembeni et al., 2008; Rahma, 1999). For example, Mpembeni et al. (2000) found that the government of Nigeria has been establishing extensive infrastructure of health services. It is estimated that 72% of Nigerians live within 5kms of health facility and 93% live within 10kms. In 1994, 87% of all health facilities provided reproductive and child health services free of charge. Rahma (1999) found that in Bangladesh, a vast of infrastructure has been established to provide maternal health care under national health and family planning programs, which are provided free of charge.
With all these efforts, however, literatures such as Rosser et al. (2000); MDCHMT, (2006) and Kimani, (2008) reported that women’s health status continues to be compromised by inadequate maternal health care especially in rural areas. This has implications for both infant and maternal welfare, as it leads to their mortality. It is reported that unskilled personnel attend most of deliveries at home, traditionally without hygiene, and unsafely; as a result, they create risk to the mothers and infants; pregnant women had no prompt access to referral obstetric care and safe delivery which are available in health facilities; as a result, many women deliver at home (Sreeamareddy, 2006; Koenig, 2007). In Nigeria, home deliveries are referred to childbirths outside health facility (Ministry of Health, 2000).
Various studies have found that many childbirths take place at home, majority of them are in developing countries. For example, in Nepal, Sreeramareddy, (2006) reported that a very large proportion (more than 90%) of deliveries took place at home. Most of the deliveries were natural and traditionally attended. They were privately performed, but unhygienic since there was no use of delivery kits, the attendants did not wash their hands before attending the mothers, and they applied mustard oil to the umbilical cord. Also Koenig (2007) found that in Bangladesh 90% of deliveries took place outside health facilities and ware assisted by medically unskilled birth attendants, with only 10% of them delivering in health facilities.
In Sub Saharan Africa, the percentage of home deliveries attended by non-medical personnel is also high. For instance, Per et al. (2007) reported that 60% of mothers in Sub Saharan Africa deliver without assistance health workers. Telemu (2002) and MDCHMT (2006) found that in Uganda, while antenatal services coverage is 90%; it is deplorable that 74% to 90% of deliveries still occur outside the health facilities.
In Nigeria, (URT 2005; MPEE 2006) reported that though 95% of pregnant women attended antenatal care in health facilities; 47% of the deliveries took place at home. There is a decline in the proportion of births delivered in health facilities over time; from 53% in 1991 to 1992, to 47% in 1996, and 44% in 1999; while in 2004 were 47% of the women that attended antenatal care in health facilities. SDC annual health reports of 2005; 2006 and 2007 show that there was a persistence of home deliveries in Sabon Gari; in 2005, 44%, 40% in 2006, 42% in 2007 that were attended by unskilled health personnel outside health facilities, although more than 95% of pregnant women attended antenatal care in health facilities.
CHAPTER THREE
RESEARCH METHODOLOGY
Study Area and Population
This study was conducted in Sabon Gari, Kaaduna state. According to Housing Census (2002), the area has a population of 171 202 with a growth rate of 2.8%. Administratively, the area is divided into three divisions, 14 wards and 71 registered villages. The area has one hospital, two health centres and 48 dispensaries of which the government owns 35 (health facilities), voluntary agencies 13, the army two and the private sector one (SDCP, 2008).
Research Design
The study used cross-sectional research design in which data were collected at one point in time. According to Casley and Kumar (1998), this design is favourable in a situation where a researcher is constrained by time and resource for data collection. The design is good in determining relationship among and between variables. Therefore based on the advantages exemplified in this research design, the researcher concentrated on the design which facilitates simple statistical description and interpretation of data and provides a possibility of determining relationship between variables needed in the discussion.
Sample Size and Sampling Procedure
The study involved 200 women of whom 111 had delivered at home and 89 at health facilities. The respondents were obtained from five wards The selection of the 89 women who delivered at health facilities was random, conducted in exit interviews, whereby the researcher had to wait for women that were coming from the clinic and ask anyone of them to be interviewed. When an interview with one of them was being conducted, the rest of them were exiting.
CHAPTER FOUR
RESULTS AND DISCUSSION
Overview
This study sought to examine factors that influence home deliveries in Sabon Gari. In first place, the study sought to establish the influence of demographic, socio- cultural, geographic, economic factors, and the environment of health facilities on home deliveries. Secondly, it intended to determine the impact of home deliveries on maternal and infant mortality.
CHAPTER FIVE
SUMMARY, CONCLUSIONS, AND RECOMMDNDATIONAS
Summary
With regard to factors that influence home deliveries, the application of herbs for facilitating labour seemed to be leading, such that out of 111 mothers who delivered at home 93% applied the herbs. Additionally, findings show that low income of people, bad condition of roads, long distance to health facilities, and shortage of skilled staff, supplies and equipments, lack of women’s decision making power, lack of timing and transport to health facilities influenced home deliveries in the study area.
As for the impact of home deliveries, 8% of the respondents reported that their relatives died of maternal problems, of which, from home deliveries were 11% while from health facilities were 3%. Concerning infant mortality, 5% of mothers who delivered at home said that they lost their children within 28 days after birth whereas 3% of mothers who delivered at health facilities reported to have lost their children within 28 days. Home deliveries therefore led to more infant and maternal mortality compared to health facility deliveries.
Conclusion
Based on the findings, it can be concluded that except for respondents’ level of education, all other variables i.e., demographic, economic, geographic, socio-cultural factors and environment of health facilities influenced home deliveries. Level of education did not influence home deliveries in the study area presumably because majority of the respondents were standard seven leavers. Comparing between a standard seven leaver with someone without any type of formal education does not make much difference. Additionally, home deliveries had impact on maternal and infant mortality as they caused more deaths to mothers and infants compared to health facility deliveries.
Recommendations
Since Rural Development Policy 2007-2013 focuses on improving quality of life in rural areas and encouraging diversification of rural economy (Maeda and Bagachwa, 2007); the following might help to reverse the trend of home deliveries not only in the study area but also in other rural areas.
Firstly, since 98% of mothers who delivered at home reported to use herbs for facilitating labour, more awareness against those norms is needed so that all women deliver at health facilities in minimizing the dangers associated with home deliveries. Secondly, based on findings 87 % of mothers who delivered at home said that health facilities in the study area encounter shortage of skilled birth attendants, and 79% reported that facilities experience inadequate delivery equipment and supplies which made women to deliver at home. So there is a need for health facilities to be equipped with human resources and delivery materials in rural areas so as to reduce risks related to home deliveries. Thirdly, given that field data pointed out that 87% of mothers who delivered at home said that they delivered at home because of low income they earn, there is a call for community empowerment on entrepreneurship and resource mobilisation in order to raise people’s income so that they eventually afford delivery costs at health facilities. Fourthly, because of long distance to health facilities 88% of respondents reported to deliver at home, and 91% said to have given birth at home due to lack of transport, this calls for improvement of infrastructures (roads, water ways) and transportation systems in rural areas in order to enable women access delivery services in health facilities. Fifthly, there is a need of implementing existing Health Policy of 2000 which, among other things stresses the need of bringing adequate health care services near people in rural areas (instituting dispensaries in every 5 kilometres, a health centre in every 10 kilometres, a area hospital in each area, and improving referral system from community level to national level).
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