1.1 Introduction
Maternal health refers to the health of women during pregnancy, childbirth, and the postpartum period, encompassing physical, mental, and social well-being (World Health Organization [WHO], 2019). Maternal health services include antenatal care, skilled attendance at birth, emergency obstetric care, and postnatal care, all of which are critical to ensuring positive health outcomes for both mother and child. Utilization of these services is defined as the extent to which women access and use available maternal health facilities and interventions to safeguard their health during pregnancy and childbirth (Fagbamigbe & Idemudia, 2015).
The utilization of maternal health services is influenced by a wide range of demographic and socio-economic factors. Demographic characteristics such as age, parity, marital status, and education significantly shape women's health-seeking behaviors. Younger women and those with higher education levels are more likely to seek professional health care during pregnancy, while older, less-educated women often face challenges in accessing services (Okonofua et al., 2018).
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are significance of the study, scope of work, research hypothesis and questions, limitation of the study and definition of terms.
1.2 Background of Study
Maternal health has long been recognized as a fundamental component of public health, and its evolution is closely linked to the development of healthcare systems worldwide. Historically, maternal mortality rates were alarmingly high due to limited medical knowledge, lack of skilled birth attendants, and poor access to healthcare facilities. According to WHO (2019), the formalization of maternal health services began in the early 20th century with the establishment of maternity hospitals and the training of professional midwives to reduce maternal and infant deaths.
In Nigeria, maternal health services have a complex history influenced by colonial and post-colonial healthcare policies. During the colonial period, maternal health care was primarily available in urban centers, and rural areas, where the majority of the population lived, largely depended on traditional birth attendants. Okonofua et al. (2018) stated that these services were limited, and maternal mortality rates remained high due to poor infrastructure and insufficient skilled personnel. Post-independence, the Nigerian government introduced several policies aimed at improving maternal health, including the establishment of primary healthcare systems, immunization programs, and free maternal care initiatives in selected states (Adedini et al., 2018).
Maternal health remains a critical component of public health, particularly in developing countries where maternal morbidity and mortality rates continue to be unacceptably high. According to the World Health Organization (2019), maternal health encompasses the physical, mental, and social well-being of women during pregnancy, childbirth, and the postpartum period. It is widely reported that access to quality maternal health services including antenatal care, skilled birth attendance, emergency obstetric care, and postnatal care is essential to reducing maternal and neonatal mortality (Adedini et al., 2018). Several scholars have affirmed that demographic characteristics, such as age, marital status, parity, and educational level, significantly influence the utilization of maternal health services.
Okonofua et al. (2018) contended that younger women and those with higher education levels are more likely to access antenatal and postnatal care, while older and less-educated women often face barriers to consistent service utilization. In addition, Akinyemi, Oyediran, and Akinyemi (2019) reported that rural residency, coupled with inadequate transportation and poor road networks, limits access to health facilities, which in turn affects maternal health outcomes.
Adedini et al. (2018) asserted that household income, occupational status, and economic autonomy strongly determine whether women can afford and consistently use maternal health services. Women from low-income households are less likely to utilize formal health facilities and may rely on traditional birth attendants or delay care-seeking, increasing the risk of complications during pregnancy and childbirth.
Uzochukwu, Onwujekwe, and Akpala (2015) stated that even when financial resources are available, social and cultural influences such as household decision-making power, gender norms, and community expectations can limit women's ability to access professional maternal care. Despite efforts by government agencies and non-governmental organizations to improve maternal health service coverage, disparities persist. It has been affirmed that gaps in knowledge, awareness, and affordability continue to hinder effective utilization, especially among women in lower socio-economic brackets (Fagbamigbe & Idemudia, 2015).
In Igbo-Etiti Local Government Area of Enugu State, the utilization of maternal health services is influenced by the combined effects of demographic and socio-economic factors. The uneven distribution of health facilities, coupled with cultural and economic barriers, poses challenges to achieving optimal maternal health outcomes in the region. This study is set against the backdrop of the persistent maternal health challenges in Igbo-Etiti LGA, with particular focus on how demographic and socio-economic variables influence the utilization of maternal health services.
1.3 Statement of Problems
Investigation revealed that demographic factors such as age, parity, marital status, and educational level are significant determinants of maternal health service utilization. Women with higher education levels and those in younger age groups are more likely to access antenatal care, skilled birth attendance, and postnatal services, while older, less-educated women often face barriers to these services (Okonofua et al., 2018).
In Igbo-Etiti Local Government Area, the uneven distribution of health facilities, coupled with poor road infrastructure and transportation challenges, is another barrier affecting service utilization. Rural women, who constitute a significant proportion of the population, often travel long distances to reach health facilities, which discourages regular antenatal visits and timely delivery in health centers (Akinyemi et al., 2019).
Furthermore, socio-economic factors, including income, occupation, and household wealth, strongly influence women's ability to afford and access quality maternal health care. Women from low-income households are less likely to utilize formal health facilities and are more prone to rely on traditional birth attendants or delay seeking care (Adedini et al., 2018). It is against this backdrop that this study seeks to investigate the demographic and socio-economic factors influencing the utilization of maternal health services in Igbo-Etiti Local Government Area, Enugu State, Nigeria.
1.4 Aim and Objectives of Study
The aim of the study is to investigate the demographic and socio-economic factors influencing the utilization of maternal health services in Igbo-Etiti LGA, Enugu State, Nigeria. In achieving this aim, the following specific objectives were laid out as follows:
- To determine the influence of demographic factors such as age, marital status, parity, and educational level on the utilization of maternal health services.
- To examine the effect of socio-economic factors, including income, occupation, and household wealth, on access to maternal health services.
- To assess the challenges within the existing healthcare system that affect maternal health service utilization.
- To provide recommendations for improving maternal health service utilization in Igbo-Etiti LGA.
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- How do demographic factors influence the utilization of maternal health services in Igbo-Etiti LGA?
- What is the effect of socio-economic factors on women's access to maternal health services in the study area?
- What challenges within the healthcare system affect maternal health service utilization in Igbo-Etiti LGA?
- What measures can be implemented to improve maternal health service utilization in the region?
1.6 Research Hypotheses
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
Hypothesis One
- H0: There is no significant relationship between demographic and socio-economic factors and the utilization of maternal health services in Igbo-Etiti LGA, Enugu State.
- H1: There is a significant relationship between demographic and socio-economic factors and the utilization of maternal health services in Igbo-Etiti LGA, Enugu State.
Hypothesis Two
- H0: Demographic and socio-economic factors do not significantly influence the utilization of maternal health services in Igbo-Etiti LGA, Enugu State.
- H1: Demographic and socio-economic factors significantly influence the utilization of maternal health services in Igbo-Etiti LGA, Enugu State.
1.7 Significance of Study
It is believed that at the completion of the study, the findings will guide policymakers, healthcare providers, and development partners in designing effective interventions to enhance maternal health outcomes. Also, policymakers will have evidence to support resource allocation and implementation of targeted maternal health programs.
Furthermore, non-governmental organizations will be able to develop community-based interventions addressing socio-economic and cultural challenges. In addition, community leaders and households will become more aware of factors influencing maternal health, promoting community involvement in maternal health initiatives.
Lastly, academics and researchers will benefit from empirical data for future studies in maternal health.
1.8 Scope of Study
This study focuses on the utilization of maternal health services in Igbo-Etiti Local Government Area of Enugu State, Nigeria. The study covers both rural and semi-urban communities, concentrating on public primary healthcare centers and other available maternal health facilities within the LGA.
1.9 Limitations of the Study
During the course of this study, there were some problems encountered which stood as limitations to the research work. Some of the limitations include:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
- Initial Cooperation Delay from Respondents: A particular limitation of this work came as a result of the respondent refusal to offer their cooperation at the initial time they were contacted. This contributed in making the success of this research study difficult.
1.10 Definition of Terms
Maternal Health:
Maternal health refers to the physical, mental, and social well-being of women during pregnancy, childbirth, and postpartum, ensuring safe and healthy outcomes for both mother and child (WHO, 2019).
Maternal Health Services:
These are healthcare services provided to women during pregnancy, childbirth, and after delivery, including antenatal care, skilled birth attendance, emergency obstetric care, and postnatal care (Fagbamigbe & Idemudia, 2015).
Utilization:
Utilization is the extent to which women access and use available maternal health services to meet their healthcare needs (Okonofua et al., 2018).
Demographic Factors:
These are characteristics of individuals such as age, marital status, parity, and educational level that influence behavior, including health-seeking behavior (Adedini et al., 2018).
Socio-Economic Factors:
These include income, occupation, household wealth, and social status, which affect access to and affordability of health services (Uzochukwu, Onwujekwe, & Akpala, 2015).
Barriers:
Barriers refer to obstacles, whether systemic, cultural, or financial, that prevent women from accessing and using maternal health services effectively (Akinyemi, Oyediran, & Akinyemi, 2019).
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