1.1 Introduction
Child delivery services are a critical component of maternal healthcare, directly impacting the health outcomes of both mothers and newborns. These services encompass the medical care and support provided during childbirth, including prenatal, intrapartum, and postpartum care. Access to quality child delivery services is essential for ensuring safe and healthy deliveries, reducing maternal and neonatal mortality rates, and promoting overall maternal health.
In many parts of the world, disparities in access to and quality of child delivery services persist, often due to socio-economic factors, geographic barriers, and healthcare infrastructure limitations. These disparities can lead to adverse outcomes such as increased rates of complications during childbirth, higher maternal and infant mortality rates, and long-term health issues for both mothers and children.
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
The global burden of maternal mortality remains a pressing issue. According to the World Health Organization (WHO), approximately 295,000 women died during and following pregnancy and childbirth in 2017, with the vast majority of these deaths occurring in low-resource settings. These deaths are largely preventable with proper medical care and timely interventions (WHO, 2019).
In ancient civilizations, childbirth was primarily a domestic event, attended by female relatives and midwives. These midwives were often experienced women who passed down their knowledge through generations. The Ebers Papyrus (circa 1550 BCE), an ancient Egyptian medical text, includes references to obstetric practices, indicating the early recognition of specialized care during childbirth (Nunn, 2002). During the medieval period in Europe, childbirth continued to be managed by midwives, with varying levels of expertise. The Church played a significant role in regulating midwifery practices, and many midwives incorporated herbal remedies and traditional practices into their care (Green, 1989). However, the lack of medical knowledge and hygiene often led to high maternal and infant mortality rates.
A crucial factor in improving maternal health outcomes is the accessibility and quality of child delivery services. These services include prenatal care, skilled attendance at birth, and postnatal care. Skilled birth attendance is particularly vital, as it can significantly reduce the risk of complications such as hemorrhage, infections, and hypertensive disorders, which are among the leading causes of maternal mortality (WHO, 2018). However, access to quality child delivery services is often hindered by various barriers. Socio-economic factors such as poverty, education, and cultural practices can influence women's utilization of maternal healthcare services. Geographic barriers, including the distance to healthcare facilities and inadequate transportation, further exacerbate these challenges. Additionally, healthcare systems in many regions may suffer from shortages of trained healthcare professionals, inadequate infrastructure, and insufficient medical supplies (Campbell & Graham, 2006).
Efforts to improve child delivery services are multi-faceted and involve strengthening healthcare systems, training healthcare providers, and addressing socio-economic and geographic barriers. Initiatives such as the WHO’s "Every Woman, Every Child" campaign and the United Nations' Sustainable Development Goals (SDGs), specifically Goal 3.1, aim to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030 (UN, 2015). Therefore, in Nigeria where the research was carried out, the activities that was conducted is to know the factors influencing utilization of child delivery services among women.
1.3 Statement of Problems
Investigation revealed that many women, particularly in low- and middle-income countries, face significant barriers to accessing quality child delivery services. Geographic isolation, lack of transportation, and financial constraints prevent numerous women from reaching healthcare facilities. In rural areas, healthcare infrastructure is often inadequate, and the shortage of skilled health professionals exacerbates these challenges. This inequitable access results in higher maternal and neonatal mortality rates in underserved regions (Campbell & Graham, 2006).
Additionally, fear of mistreatment or lack of respect in healthcare settings can deter women from seeking facility-based deliveries. Reports of disrespectful and abusive treatment by healthcare workers, including verbal abuse, and discrimination, have been documented in various contexts. Such experiences undermine trust in the healthcare system and discourage women from utilizing essential services (Bohren et al., 2015).
Furthermore, even when services are accessible, the quality of care provided can be inconsistent. Poor infrastructure, lack of essential medical supplies, and inadequate training of healthcare providers contribute to substandard care. The absence of proper infection control measures and emergency obstetric care can lead to preventable complications and deaths during childbirth (Koblinsky et al., 2016).
1.4 Aim and Objectives of Study
The aim of the study is to evaluate the Factors Influencing Utilization of Child Delivery Services Among Women in Calabar South Local Government Area. In achieving this aim, the following specific objectives were laid out as follows:
- To investigate the training and competency levels of healthcare providers involved in childbirth in the area under study;
- To examine transportation and logistical barriers that prevent women from reaching healthcare facilities;
- To evaluate the geographic distribution and availability of maternal healthcare facilities in the study area; and
- To propose measures to strengthen healthcare systems and policies to better support maternal and neonatal health.
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:
- Are there transportation and logistical barriers that prevent women from reaching healthcare facilities?
- What is the geographic distribution and availability of maternal healthcare facilities in the study area?
- What are the training and competency levels of healthcare providers involved in childbirth in the area under study?
- What are the measures that strengthen healthcare systems and policies to better support maternal and neonatal health?
1.6 Research Hypothesis
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
- H01: Women living in rural areas have significantly less access to child delivery services compared to women in urban areas.
- H02: Socio-economic status is not a significant predictor of access to child delivery services, with higher socio-economic status associated with greater access.
- H03: Healthcare facilities in low-resource settings provide lower quality child delivery services compared to facilities in high-resource settings.
1.7 Significance of Study
The findings from this study will support the development of financial support mechanisms, such as insurance schemes, that can alleviate the economic burden on families and promote timely and adequate maternal care. Also, identifying socio-economic, cultural, and logistical challenges helps policymakers and healthcare providers design strategies that are responsive to the needs of diverse populations, thereby reducing disparities in maternal and neonatal health.
Furthermore, the study also sheds light on psychosocial factors, such as women's experiences and perceptions of care during childbirth. Understanding these factors is essential for creating a healthcare environment that is respectful, supportive, and free from abuse or discrimination. Such an environment not only improves immediate health outcomes but also builds trust in the healthcare system, encouraging more women to seek professional care for future pregnancies.
1.8 Scope of Study
The scope of this research study is focused on the factors influencing utilization of child delivery services among women in Calabar South Local Government Area.
1.9 Limitations of the Study
During the course of this study, many things militated against its completion, some of which are:
- 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).
1.10 Definition of Terms
Perception:
It is the process of recognizing and interpreting sensory stimuli. Learn the definition of perception, how it is related to the five senses, how it differs from reality, and more.
Acceptance:
In human psychology is a person's assent to the reality of a situation, recognizing a process or condition (often a negative or uncomfortable situation) without attempting to change it or protest it.
Knowledge:
Familiarity, awareness or understanding of women of child-bearing age in the three selected primary health care centers in Mushin Local Government, about Caesarean section.
Maternal Health:
Maternal health refers to the health of women during pregnancy, childbirth, and the postpartum period. It encompasses a wide range of healthcare services aimed at ensuring safe pregnancy and delivery and includes prenatal, intrapartum, and postnatal care (WHO, 2016).
Child Delivery Services:
Child delivery services are medical and support services provided to women during labor and childbirth. These services include skilled attendance at birth, management of labor and delivery, and immediate postpartum care for both the mother and the newborn (UNICEF, 2015).
Skilled Birth Attendant:
A skilled birth attendant (SBA) is a healthcare professional, such as a midwife, doctor, or nurse, who has been trained to manage normal pregnancies and childbirth and can identify, manage, or refer complications in women and newborns (WHO, 2018).
Maternal Mortality:
Maternal mortality refers to the death of a woman while pregnant or within 42 days of the termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes (WHO, 2019).
