1.1 Introduction
Emergency obstetric care encompasses a range of medical interventions aimed at managing complications arising during pregnancy, childbirth, and the postpartum period. These services include but are not limited to assisted vaginal delivery, cesarean section, management of obstetric hemorrhage, treatment of hypertensive disorders, and provision of neonatal resuscitation (WHO, 2019). Despite the recognized importance of EmOC in reducing maternal mortality and morbidity, the utilization of these services remains suboptimal in many regions, particularly in resource-constrained settings.
Various barriers hinder women's access to emergency obstetric care, including geographical remoteness, financial constraints, lack of transportation, inadequate healthcare infrastructure, cultural beliefs, and social norms (Ganle et al., 2019; Shah et al., 2017). Additionally, disparities in the quality and availability of EmOC services further exacerbate the challenges faced by pregnant women and their families in accessing timely and appropriate care (Kruk et al., 2015).
This chapter will address the background information that motivated this study, the challenges that prompted it, its aim, and its objectives as a preface to subsequent sections of the study. Additional factors include the study's significance, scope, limitations, research questions and hypotheses, and the definition of technical terms.
1.2 Background of Study
Maternal mortality remains a poignant indicator of global health inequality, with a disproportionate burden falling on low- and middle-income countries (LMICs). Despite significant progress over the past few decades, approximately 810 women still die each day from preventable causes related to pregnancy and childbirth (World Health Organization [WHO], 2019).
Access to timely and quality emergency obstetric care (EmOC) services is critical for averting maternal deaths, yet utilization rates in many regions, particularly in LMICs, remain suboptimal. Emergency obstetric care encompasses a spectrum of interventions aimed at managing complications arising during pregnancy, childbirth, and the postpartum period. These interventions include assisted vaginal delivery, cesarean section, management of obstetric hemorrhage, treatment of hypertensive disorders, and neonatal resuscitation (WHO, 2019). Despite the recognized importance of EmOC in reducing maternal mortality and morbidity, several barriers impede its accessibility and utilization.
Health systems in many low and middle-income countries are characterized by unavailable or nonfunctional emergency medical transport systems. This often means poor access to quality Emergency Obstetric and Newborn Care (EmONC), which is an important determinant of maternal mortality.
Transport challenges exacerbate the second obstetric delay, ie, delay in getting pregnant women who need EmONC services to the health facility, and may lead to deaths from complications arising from causes of maternal deaths, such as hemorrhage, prolonged obstructed labor, sepsis, and eclampsia. An interplay of economic, sociocultural, geographic, and health system factors contributes to the delays and limits women’s access to prompt EmONC services in times of need.
Understanding the utilization patterns and the factors influencing the utilization of emergency obstetric care services is crucial for developing effective interventions aimed at improving maternal health outcomes. By addressing barriers to access and enhancing the quality and availability of EmOC services, significant strides can be made towards reducing maternal mortality and achieving global targets such as those outlined in the Sustainable Development Goals (SDGs).
This study seeks to examine the utilization impact of emergency obstetric care services, focusing on identifying barriers to access, assessing utilization patterns, and exploring the effectiveness of interventions aimed at improving utilization. By elucidating the factors that influence the utilization of EmOC services, this research aims to inform evidence-based policies and interventions aimed at strengthening maternal healthcare systems and ultimately reducing maternal mortality rates.
1.3 Statement of Problems
Investigation revealed that the disparities in access to emergency obstetric care services among different socio-economic groups and geographical regions. Also, there are factors contributing to delayed access to emergency obstetric care services, such as distance to health facilities, transportation issues, and cultural beliefs, drawing on research like. These problem statements provide a starting point for researching the utilization impact of emergency obstetric care services, addressing various dimensions such as access, quality, barriers, and systemic challenges.
1.4 Aim and Objectives of Study
The aim of the study is to determine the utilization impact of emergency obstetric care services. In achieving this aim, the following specific objectives were laid out as follows:
- To assess and compare the pattern of utilization of basic emergency obstetric care and comprehensive emergency obstetric care services in the study area;
- To assess the impact of accessing emergency obstetric care services on maternal health outcomes;
- To identify the barriers hindering the utilization of emergency obstetric care services; and
- To explore community perspectives on emergency obstetric care services, including awareness, perceptions, and attitudes towards seeking care, and assess their impact on utilization.
1.5 Research Question
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:
- Is there significant impact of accessing emergency obstetric care services on maternal health outcomes?
- Are there barriers hindering the utilization of emergency obstetric care services?
- What is the pattern of utilization of basic emergency obstetric care and comprehensive emergency obstetric care services in the study area?
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
- H0: There is no significant difference in maternal mortality rates between pregnant women who utilize emergency obstetric care services and those who do not.
- H1: Pregnant women who utilize emergency obstetric care services have lower maternal mortality rates compared to those who do not.
Hypothesis Two
- H0: There is no significant association between the utilization of emergency obstetric care services and neonatal mortality rates.
- H1: Neonates born to mothers who utilize emergency obstetric care services have lower neonatal mortality rates compared to neonates born to mothers who do not utilize these services.
Hypothesis Three
- H0: There is no significant difference in the prevalence of obstetric complications between pregnant women who receive timely emergency obstetric care and those who experience delays in accessing these services.
- H1: Pregnant women who receive timely emergency obstetric care have lower rates of obstetric complications compared to those who experience delays in accessing these services
1.7 Significance of Study
The significance of studying the utilization impact of emergency obstetric care services lies in its potential to improve maternal and neonatal health outcomes and reduce maternal and neonatal mortality rates. Here are some key points highlighting its significance:
- Reducing Maternal Mortality: Maternal mortality remains a significant public health challenge globally. Access to timely and appropriate emergency obstetric care services is critical for managing complications during pregnancy and childbirth, thereby reducing maternal mortality rates.
- Preventing Neonatal Mortality: Neonatal mortality is closely linked to maternal health and the quality of obstetric care. Utilization of emergency obstetric care services can help prevent neonatal deaths by addressing maternal complications and ensuring safe delivery practices.
- Addressing Health Inequities: In many regions, disparities in access to emergency obstetric care services contribute to preventable maternal and neonatal deaths, particularly among marginalized populations. Understanding the utilization patterns can help identify barriers and design targeted interventions to address health inequities.
- Economic and Social Benefits: Investing in maternal and neonatal health yields significant economic and social benefits. By reducing maternal and neonatal mortality rates, societies can save lives, improve productivity, and alleviate the burden on healthcare systems.
- Informing Policy and Practice: Research on the utilization impact of emergency obstetric care services provides valuable evidence for policymakers and healthcare providers. It informs the development of policies, guidelines, and interventions aimed at improving maternal and neonatal health outcomes.
- Empowering Women and Communities: Access to emergency obstetric care services empowers women to make informed decisions about their reproductive health and seek timely care when needed. Community engagement efforts can raise awareness and promote positive health-seeking behaviors.
- Contributing to Global Health Security: Ensuring access to emergency obstetric care services is essential for strengthening health systems and responding to public health emergencies, such as pandemics or natural disasters, which can disrupt routine healthcare services.
Finally, this research work will be beneficial to obstetric health care provider, by providing relevant information about the effects and benefits of emergency obstetric care service. Besides, the study will serve as reference material for subsequent researcher in the field or related topics.
1.7 Scope of Study
The scope of this research is focused on the Utilization Impact of Emergency Obstetric Care Services using Mbaise and Ikeduru Local Government Area in Imo State, Nigeria as a case study.
1.8 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).
- 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.
