Abstract
This study investigated Factors affecting utilization of maternal health care services among women of Child Bearing in primary health care in Ngor-okpala Local Government Area, Imo State. Descriptive research design was used for the study. The population for the study consisted of all pregnant women who are receiving maternal health cares in maternity centres and hospitals in Ngor-okpala Local Government Area, Imo State. The Simple random sampling technique was used to select the sample.
This study concluded that knowledge and attitude of pregnant women towards the utilization of an maternal health care services are encouraging and determine to a large extent their interest in using the services. It was recommended that government should endeavour to provide both human and material resources needed for effective utilization of maternal health care services and the services should be made completely free so that women from low socio-economic statuses would be able to assess it.
Keywords: Utilization, Maternal health care, Pregnancy, Women
CHAPTER ONE
INTRODUCTION
1.1 Background to the study
Greater number of women in developing countries experience life threatening and other serious health problems related to pregnancy or childbirth. Complications of pregnancy and childbirth cause more deaths and disability than any other reproductive health problems in African states, including Nigeria (Nwogu, E.C. 2009). Skilled maternal health care and birth attendance has been advocated globally as the most crucial intervention to reduce maternal mortality. Poor usage of skilled attendance and maternal primary health care services results in high levels of maternal mortality in the de- veloping countries (Amosu, A. M. 2011).
Women of reproductive age according to World Health Organization are women between 15-49, and these constitute more than one fifth of the world’s population and are repeatedly exposed to the risk of pregnancy and child bearing. Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period (WHO, 2009). Complications of pregnancy and childbirth are a leading cause of maternal morbidities and mortalities in developing countries. With a maternal mortality ratio of 545 deaths per 100,000 live births (Mekonnen,Y.2012); Nigeria has the second highest maternal mortality rate in the world and accounts for about 10% of all maternal deaths annually, worldwide. Also, for every woman that dies during childbirth, 30 more suffer long term damage to their reproductive organs[5]. Thus, maternal death and disability repre- sent a huge public health problem in Nigeria. Howev- er, studies indicate that the majority of these deaths and disabilities can be prevented through early and timely access to and utilization of quality maternal healthcare services (Babalola,2009).
Yearly, more than half a million reproductive women die and many millions more suffer disabilities from pregnancy and pregnancy related causes in develop- ing countries. Reproductive age of women according to World Health Organization (WHO,2012) is between 15 and 49 years of age, and these constitute more than one fifth of the world’s population and are repeatedly exposed to the risk of pregnancy and child bearing. Maternal health refers to the health of the mother during preg- nancy, childbirth and the postpartum period. Goal 5 of Millennium Development Goals (MDGs) targets is to reduce by three quarters, between 1990 and 2015, the maternal mortality ratio in all countries. Maternal mortality is the most important indicator of maternal health and well-being in any country. As a result, it has been central to government health sector policies aimed at improving the overall health of the Nigerian population especially that of the women (Celik, 2002).
Nigerian Health Review (2006), reports that one of the major causes of maternal deaths is inadequate moth- erhood services such as antennal care. Approximate- ly two-thirds of all Nigerian women and three-quarters of rural Nigerian women deliver outside of health fa- cilities and without medically-skilled attendants pres- ent. Data from the Nigerian Demographic and Health Surveys 2003 indicate that among pregnant Nigerian women, only about 64% receive maternal health care from a qualified health care provider. There are wide re- gional variations, with only about 28% of women in the Northwest Zone and 54% in the Northeast Zone receiving maternal health care from trained health providers (Adewumi,J.F. 2009). The rest either do not receive maternal health care at all or receive care from untrained traditional birth attendants, herbalists, or religious diviners.
Maternal health care is one of the four pillar initiatives of the Safe Motherhood. It provides reassurance, education support for the women on screening programs and detects the problems that make the pregnancy high risk (Harrison, A.S. 2008). There are many socioeconomic and cultural factors which act as barriers to use of maternal health care. Although it cannot be claimed that maternal health care is the only solution for the high maternal and prenatal death, it can help to reach the Millennium Develop- ment Goals for the maternal and child mortality (WHO, 2013). World Health Organization recommended four ante- natal visits for the low risk pregnancy. There is still debate regarding the optimal number of visits for the maternal health care (Simkhada, B 2008). Early commencement of maternal health care by pregnant women as well as regular visits has the potential to affect maternal and foetal out- come positively (Akpan-Nnah, E. M 2011). However maternal health care services are available in developing countries but utilization of these existing services is poor.
The recommended gestational age for antenatal booking is within the first 12 weeks of pregnancy. Many developing countries do not have national guidelines on maternal health care but commencement of maternal health care within the first 14 weeks of gestation is widely accepted as early. Commencement of fo- cused maternal health care before 14 weeks of gestation allows for early commencement of health education and counselling on expected physiological chang- es, the normal course and possible complications of pregnancy and labour (Akpan-Nnah, E. M 2011).
Globally, scientific evidence has shown that low utilisation of antenatal services is influenced by some factors such as low maternal education, teenage pregnancies, multi-parity, unplanned pregnancies and cultural factors (Simkhada, B 2008).
1.2 Statement of the Problem
Women in developing countries have a higher life time risk of dying from pregnancy related causes compared to their counterparts in developed countries (WHO, 2002). This could be attributed to differences in access to and utilization of maternal health services as evidenced by historic experiences in Europe and the United States, and more recent empirical research; both of which have shown that access to skilled pro- fessionals before and during childbirth and emergency obstetric services dramatically reduces maternal mortality (Akpan E. M 2011).
However, utilization of antenatal services remain low in sub-Saharan Africa (Mekonnen, 2012) including Nigeria where only 58% of women have attended at least one an- tenatal clinic (ANC) during pregnancy, 39% of births are attended by a skilled professional and 35% of deliveries take place in a health facility. Many factors have been linked to low antenatal services utilization including socio-economic, cultural, occupational and demographic differences. Nigeria is a diverse country with stark socio-cultural differences across the regions of the northern and southern protector- ates. This could explain some of the differences re- corded in utilization of Maternal Health Care Services across the country. For example, percentage of births attended by a skilled professional ranges from a high of 81.8% in the South East zone to a low of 9.8% in the North West zone (WHO 2003).
The trend of maternal mortality in developing countries has been increasing and various international organizations have reported that an important fac- tor related to maternal and infant mortality has been linked to lack of maternal health care (Villar J, 2011). According to Federal Ministry of Health (2005), some of the dangers of pregnancy and childbirth can be avoided if the pregnant woman attends antenatal regularly. In order to decrease these mortality rates, regular maternal health care has to be instituted or reinforced which can only be achieved through identifying factors causing poor utilization of maternal health care services.
It is of note that various researches (Babalola,2009) have been conducted on the factors affecting the utilization of maternal health cares in Nigeria. This study is important due to the fact that none of the researches reviewed in this study centred on Ngor-okpala Local Government Area, Imo State and this indicated that there is a research vacuum which this study is intending to fill in order to know the factors that influence the utilization of maternal health care services in the area.
1.3 Objectives of the study
The general objective of this study is to examine the factors that affect the utilization of maternal health care among pregnant women in Ngor-okpala Local Government Area, Imo State. Specifically, the objectives of this study include to:
1. investigate the knowledge and attitude of pregnant women towards antenatal services in Ngor-okpala Local Government Area, Imo State.
2. examine the effect of socio demographic factors on the antenatal services of pregnant women in Ngor-okpala Local Government Area, Imo State.
3. Investigate the women’s satisfaction with the utilization of antenatal services in Ngor-okpala Local Government Area, Imo State.
1.4 Hypotheses Of The Study
The following research hypotheses were tested at 0.05 level of significant:
H01: There is no significant association between knowledge and attitude of pregnant women towards the utilization of maternal health cares in Ngor-okpala Local Government Area, Imo State.
H02: There is no significant association between the pregnant women’s socio demographic factors and their level of satisfaction with the utilization of antenatal services in Ngor-okpala Local Government Area, Imo State.
1.5 Significance of the study
The incidence of maternal mortality still occurs though the free maternal policy has been existing for the past nine years, (WHO, 2013). A number of studies have assessed the effect of free maternal care on access to and utilization of health care facilities, maternal health care and deaths (WHO, 2013). This study seeks to examine the patient factors, community factors and health provider factors that influence the utilization of ANC in Ngor-okpala Local Government Area, Imo State.
It is important to evaluate patient factors, particularly the socio-demographic characteristics to determine their influence on women’s utilization of ANC (Agus, & Horiuchi, 2012). In their systematic review of factors for non-western women’s utilization of prenatal care, Boerleider et al. (2013), found that the category demographic, genetic and pregnancy characteristics and the category accessibility of care only included impeding factors. These analysts argue that the factors found in the review provide specific indications for identifying non-western women who are at risk for not using prenatal care adequately and for developing interventions and appropriate policy aimed at improving prenatal care utilization. Nevertheless, it appears that no such study has been conducted to assess how patient factors, especially socio-demographic factors could influence access to ANC among women attending ANC in Ngor-okpala Local Government Area, Imo State. Thus, this study will seek to fill this gap in the literature accordingly.
1.6 Scope of the Study
The study was conducted in Ngor-okpala Local Government Area, Imo State of Nigeria and was delimited to women of child-bearing age (15 to 49 years) attending antenatal clinics in the health facilities in Ngor-okpala Local Government Area, Imo State, the midwives and obstetricians working in health facilities in Ngor-okpala Local Government Area, Imo State. This was because pregnant women are the recipients of MHS and many of them can be reached in the antenatal clinics, and midwives and obstetricians render MHS. Public and private health facilities offering MHS was used for the study to give a true picture of the extent of MHS provision and utilization in the state. The MHS covers maternal health care services, delivery care services and post natal care services. The study further highlighted the influence of socio-demographic factors which included age, parity, location and maternal education. It also highlighted the MHS enhancement strategies for Ngor-okpala Local Government Area, Imo State.
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