Utilization of Antenatal and Maternity Services by Mothers Seeking Child Welfare Services in Nigeria
Chapter One
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
Specific Objective
To establish factors that determine the use of all maternal health care services
CHAPTER TWO
LITERATURE REVIEW AND CONCEPTUAL FRAMEWORK
Introduction
Previous studies have shown that the uptake of maternal health care in developing countries has significant consequences for both the safe transition of the mother through pregnancy and child birth, and the survival and health of the child during early infancy (Khan, 1987).
In spite of the importance of maternal care, poor access to and low utilization of such services continue to be important determinants of maternal mortality and morbidity throughout the world (Mekonnen, 2003). Despite the benefits of maternal healthcare services, many women in developing countries do not receive pre-natal care at all, and the care that is received is often characterized by an insufficient number of visits timed late into the pregnancy. Furthermore, the delivery care utilized in most developing countries is dominated by homebirths. Hence high risk pregnancies are often not identified, obstetric histories are ignored, opportunities for transmitting FP messages are missed and important information on child nutrition and healthcare is not disseminated to a large proportion of mothers. Previous literature has documented an urban-rural dichotomy in child health and survival and the utilization of maternal healthcare in developing countries (Madise and Diamond 1996, 1997; Stephenson, 1998).
The Safe Motherhood Demonstration Project in Nigeria 2004 identified five major causes of maternal death: hemorrhage, infection, hypertensive disease in pregnancy, unsafe abortion and obstructed labor. Many of these deaths could be averted if women had access to essential obstetric care when they need it. However, despite a reduction in the proportion, a review of maternal deaths records showed that the number of maternal deaths during pregnancy increased at end line. This increase of deaths during pregnancy may indicate more deaths due to abortion complications and probably due to indirect causes such as severe malaria in pregnancy, HIV/AIDS, tuberculosis, cardiac diseases, severe anemia, etc.
The situation regarding neonatal and perinatal health only improved marginally. For instance, 30 percent of women said they had lost at least one child at baseline compared to 28 percent at end line. The age of children who had died was not asked at baseline but among women who had lost a child aged one year or less at end line, 36 percent died within the first month of birth.
Use of Antenatal Care Services
Health professionals recommend that the first antenatal visit should occur within the first trimester of pregnancy and continue on a monthly basis through to the 28th week and fortnightly up to the 36th week or until birth (National Bureau of Statistics- Nigeria, Ministry of Health- Nigeria & ORC Macro, 2004).
Studies demonstrating the high levels of maternal mortality and morbidity in developing countries and research identifying causes of maternal death have emphasized the need for antenatal care and availability of trained personnel to attend to women during labor and delivery. The importance of tetanus toxoid injections given prior to birth is to reduce neonatal mortality. Although antenatal cannot prevent all obstetric emergencies (Vilar, 1997), the information provided by the antenatal service provider on danger signs, diet and planning for delivery, along with testing anemia, malaria and high blood pressure are important for the successful management of pregnancies and subsequent well-being of the child.
CHAPTER THREE:
DATA AND RESEARCH METHODS
Data Source
This study utilizes the data collected during the Nigeria Demographic Health Survey (N-DHS) carried out in 2008 by the Nigeria National Bureau of Statistics in collaboration with other stakeholders. The survey had a sample size of 8444 women aged between 15 and 49 years from all states in Nigeria.
In this particular study, factors determining full utilization of antenatal and maternal health care services are derived using data from the women file subset. The data was derived from women with a birth in the five years preceding the survey. The entire sample size of women interviewed in Lagos state was 1039 respondents.
Methods of Data Analysis
Descriptive Analysis
Descriptive statistics such as frequency distributions of the respondents are used to determine demographic and socio-economic characteristics of the respondents. Cross-tabulation is used to examine the hypothesized association between use of maternal health care services and socio-economic and demographic characteristics. Since cross tabulations only give simple associations between dependent and independent variables, Chi-square test is carried out to test the significance of the assumed associations.
CHAPTER FOUR
FACTORS ASSOCIATED WITH UTILISATION OF MATERNAL HEALTH CARE SERVICES AMONG WOMEN OF REPRODUCTIVE AGE IN NIGERIA
Introduction
This chapter presents the results of the study findings on factors associated with utilization of antenatal maternal health services in Nigeria. Section 4.2 is a description of the background characteristics of the population under study while section 4.3 presents the results of bivariate analysis. Cross tabulations are used to determine the hypothesized relationships while chi-square test helps to determine the significance of the relationships. Section 4.4 shows the results of multivariate analysis while section 4.5 presents the discussion of the findings.
CHAPTER FIVE:
SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
Introduction
This chapter presents a summary of the study findings and conclusions, as well as recommendations for programs and research drawn from the findings. Section 5.2 summarizes the study findings while section 5.3 gives recommendations based on the findings both to program implementers as well as recommendations for research.
Summary
The study set out to analyse the determinants of utilisation of maternal health services in Nigeria and the association of the selected variables namely maternal age, marital status, highest level of education, type of residence and wealth index.
In order to determine the association between the explanatory variables and the dependent variable, cross tabulations analysis was done and Chi square used as test of significance. On the other hand, to find out the effect of predictor variables on utilisation of maternal health services, multivariate ordinal regression was done.
In this study, the depended variable is a composite index consisting of skilled assistance during delivery, timing of antenatal visits and the number of antenatal visits. Multivariate analysis results indicate that the selected independent variables had influence on the utilisation of maternal health services. The factors have a similar influence on the use of skilled assistance, early antenatal care visits and more than four antenatal visits.
Conclusion
This study set out to determine factors that are associated with utilization of maternal healthcare services among women of reproductive age in Nigeria, Nigeria. It examines health seeking behaviour in reference to seeking a continuum of maternal health care services from onset of pregnancy to delivery, that is, timing of antenatal visits, number of antenatal visits and skilled assistance during delivery.
In this study maternal service is measured with ordered scale and analyzed using ordinal regression model to find the factors associated with the use of maternal services. The ordinal coefficients are interpreted using odds ratio. Bivariate analysis has been used to establish association of independent variables on utilization of maternal health care services.
This study shows that the demographic and socio-economic factors play a role in determining utilisation of maternal health services. The findings of this study therefore confirm the conceptual framework discussed above.
Bivariate analysis results show that while age and marital status are consistently strong predictors in the utilization of all the maternal health services considered in this study, other determinants generally vary in magnitude and level of significance by the type of maternal service- timing and number of antenatal visits, and skilled assistance. Bivariate analyses of skilled assistance during delivery show that all the independent factors are extremely significant. Age and marital status are significant in determining utilization of all maternal health care services. Wealth and type of place of residence are more significant in determining the timing of antenatal visit than in determining the total number of antenatal visits. Similarly, the highest level of education is more significant in determining the total number of visits than in timing of antenatal visits.
Multivariate ordinal regression results indicate that type of place of residence, highest level being no education and middle wealth index are not significant in the model. Women with primary and higher education, young, married and rich are more likely to utilize maternal health care services.
Lastly, women who seek antenatal care on time and have at least four antenatal visits are more likely to use skilled delivery services from health facility.
Recommendations
Recommendations for programs
The findings show that utilization of maternal health services for Nigeria is very low. Increased efforts should focus on sensitizing the general public on maternal health services and so programs should promote health seeking behavior among women. The health personnel need to be trained about maternal health services and should take part in educating their target populations on the importance of seeking maternal health care services on time.
This study shows that women without education, poor women and those who are not married are less likely to seek maternal health care services. Maternal health programs should therefore be intensified for poor and illiterate women. Programs should be designed to particularly target younger and older women, poor women and those with low levels of education.
Recommendations for Research
More research is needed in understanding determinants of utilization of maternal health services specifically on why women of middle wealth are less likely to seek early antenatal visits and will not go for the 4+ visits compared to poor women. More studies also need to be done to understand why middle wealth is not a significant factor in utilization of maternal health services. Lastly, research should focus on why the rural women are utilizing maternal health care services more than women who reside in urban areas.
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