Factors Influencing Women’s Choice of Place of Delivery in Asaba LGA, Delta State
CHAPTER ONE
Research Objectives
The purpose of the study was achieved through the following objectives:
- To determine how demographic factors influence the choice of place of delivery among women in Asaba LGA, Delta
- To establish how socio cultural factors influence the choice of place of delivery among women in Asaba LGA, Delta
- To examine the influence of economic factors on the choice of place of delivery among women in Asaba LGA, Delta
- To establish how Antenatal Clinic attendance influences the choice of place of delivery among women in Asaba LGA, Delta State
CHAPTER TWO
LITERATURE REVIEW
Introduction
This chapter focused on literature related to the factors influencing women’s choice of place of delivery. Demographic factors, social and economic factors in determining women’s choice of place of delivery will be analyzed. One theory has been presented to support the study. A conceptual framework that diagrammatically links variables (that is, independent, dependent and intervening) illustrated and in depth explanation of the variables is provided. Knowledge gap in the literature reviewed has also been identified.
Decision Making Process
People make decisions about many things. They make political decisions; personal decisions, including medical choices, romantic decisions, and career decisions; and financial decisions, which may also include some of the other kinds of decisions and judgments. Quite often, the decision making process is fairly specific to the decision being made. Some choices are simple and seem straight forward, while others are complex and require a multistep approach to making the decisions (Dietrich, 2010).
Therefore, choice of place of delivery by women who are expectant could be influenced by so many factors which may include their age, number of children they have, marital status, level of education, traditional beliefs, occupation, means of transport, antenatal care visits, knowledge and attitudes towards quality of care in health facilities among others. These factors may influence their behavior regarding where to give birth, that is, health facility, home or at traditional birth attendant.
Factors That Influence Decision Making
According to (Dietrich, 2010), demographic variables such as income, education, and marital status, gender, age, and stage of life are important and they influence purchase decisions. Men and women need and buy different products.
In a study by (Asada & Kephart, 2007) in Canada found that the level of education of their respondents influenced their healthcare usage practices. People with higher education were more likely to opt for healthcare services as compared to their less educated counterparts. Hendryx (2002) reported that in the United States of America, people with more years of education are more likely to be sensitive towards their health and are better aware about access to healthcare options. In a study done in Greece, (Lahana, Pappa & Niakas, 2011) found that the level of education not only influence the healthcare usage but also the type of healthcare service provider used by an individual.
The income of an individual plays a crucial part in determining the health care services utilized by an individual. Along with the income and the standard of living of an individual the sensitivity of that individual towards healthy living also rises. The income influences affordability to spend on health care that in turn influences the type of health care service chosen by an individual. It has been found that with a rise in household income of an individual the likelihood of utilizing healthcare services (Regidor, 2008; Asada & Kephart, 2007) and visits to the private practitioners (Lahana, Pappa & Niakas, 2011) are more likely to happen. (Forbes & Janzen, 2004) report that the tendency to use cheaper healthcare services is found more in individuals belonging to the lower income category as they cannot afford the higher priced services available in hospitals.
Household income has also been found as a factor that influences healthcare services utilization. (Vissandjee, Barlow & Fraser ,1997) found out that in rural Gujarat, India, women belonging to higher income households were more likely to utilize healthcare services. (Thind, 2004) reports that in rural Bihar, India, children belonging to households with higher standards of living are more likely to utilize healthcare services. (Amin et al. 2010) reported that women belonging to wealthiest quintile of income in Bangladesh were more likely to use trained healthcare professionals for maternal and child health care.
Marital status has a bearing on the lifestyle of an individual. Especially, for females there might be a change in health care utilization patterns in terms of maternal and child care usage. (Lahana, Pappa & Niakas, 2011) in their study found that marital status was a possible determinant of health care service utilization. They reported that married females are more likely to utilize healthcare services as compared to the single females. These findings are consistent across developed as well as developing nations.
CHAPTER THREE
RESEARCH METHODOLOGY
Introduction
This chapter shall discuss the various methods and procedure that was be used to conduct the research. It is organized as follows: research design, target population, sample size and sampling procedures, data collection methods and procedures, data analysis techniques, ethical issues and operational definition of variables.
Research Design
Orodho (2005) postulates that a research design refers to all the procedures selected by a researcher for studying a particular set of questions or hypothesis. In this study, descriptive survey design was adopted to investigate factors influencing women’s choice of place of delivery in Asaba LGA, Delta State. Both Quantitative and qualitative data was for the study. A descriptive study determines the frequency with which something occurs and investigates the relationship between two or more variables (Cooper and Schindler, 2003). The design was suitable for this study because it is economical, simple, and clear. It also helped in understanding the entire population from the selected part of it.
CHAPTER FOUR
DATA ANALYSIS, PRESENTATIONS, AND INTERPRETATIONS
Introduction
This chapter focuses on presenting the data that was collected during the study. The independent variables for this study were demographic factors, socio cultural factors and economic factors. The dependent variable was place of delivery. The analyzed data was presented in tables and in prose as per the objectives of the study. The data analysis was done using SPSS V.17 and association between independent variables and choice of place of delivery were established. Women of childbearing age were interviewed and two focus group discussions were conducted.
CHAPTER FIVE
SUMMARY OF THE FINDINGS, DISCUSSIONS, CONCLUSIONS AND RECOMMENDATIONS
Introduction
This chapter covers a summary of the study findings, conclusions and recommendations in line with the objectives of the study. The study was aimed at investigating factors influencing women’s choice of place of delivery in Asaba LGA, Delta State. These factors included demographic factors, socio cultural and economic factors.
Summary of Findings
There was a high response rate of 98% (n=373) women participated. This was a high response rate which provided a guarantee that the findings were a representation of the population. The variables that were used for this study were age, number of children, marital status, decision maker, ANC attendance, education of the mother, income and affordability of health facilities.
Most mothers aged between 25 and 34 years (81.5%) delivered in a hospital or health facility compared to mothers aged 15-24 years (74%) or 35-49 years (54.2%) delivering in hospital or health facilities. Marital status was however, not associated significantly with choice of place of delivery. Hospital deliveries were more common in women with fewer children and smaller family sizes compared to those with more children and larger family sizes. 38.7% of women with more than 5 children and 34.8% of those with family sizes of 7 persons or more delivered in hospitals. Between 64.7 and 90.4% of women with 4 or fewer children delivered in hospitals and 66.3% to 93.5% of women with families of 6 or fewer persons delivered in hospitals.
Conclusions
While in some developed countries, it is possible for women to decide to give birth safely at home (Davis, 2000) in developing countries; conditions are not safe enough to encourage women especially those living in rural and remote areas to deliver at home.
This study concludes that hospital delivery is increasing with time in Asaba LGA, Delta State. This is a clear indication that today women are more aware of the need for safe and secure place of delivery where skilled birth attendants are available and incase of emergencies, medical intervention is offered in good time. This could be attributed to free maternity services as this came out clear from the focus group discussions.
From this study, age of mothers, number of children a woman has and the number of household members is strongly associated with the choice of place of delivery. The elderly mothers were more likely to deliver at home compared to the young women.
Recommendations
The following recommendations may help women in Asaba LGA and Nigeria at large to make a better choice when the time to give birth reaches.
Demographic factors
Advocacy to all women of child bearing age on importance of hospital deliveries, this can be done by the Ministry of Health, Ngo’s and community based organizations. Mothers should be made aware that each pregnancy has its own challenges having delivered before does not put them out of risk.
Social factors
Involvement of husbands as key decision makers in the choice of place of delivery during antenatal clinic visits could be one of the best strategies in reduction of home deliveries.
Economic factors
The government should focus more on women empowerment through creating entrepreneurship opportunities for them as a measure to make them financially stable and this could of a positive impact on the choices they make during delivery.
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