1.1 Introduction
Maternal mortality is defined as the death of a woman during pregnancy, childbirth, or within forty two days of 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 (World Health Organization [WHO], 2019). Globally, significant progress has been made in reducing maternal mortality over the past few decades, particularly through improved antenatal care, skilled birth attendance, and access to emergency obstetric services (WHO, UNICEF, UNFPA, World Bank Group, & UNDESA, 2023). Nigeria, in particular, contributes a substantial share of global maternal deaths, reflecting persistent challenges related to healthcare access, health system financing, human resources for health, and sociocultural barriers that influence health seeking behavior (National Population Commission [NPC] & ICF, 2019).
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 mortality has remained a persistent public health challenge globally, particularly in low and middle income countries where health systems face structural and resource related constraints. According to the World Health Organization, maternal mortality reflects deaths resulting from complications related to pregnancy and childbirth and is widely used as a measure of the effectiveness of healthcare systems and social development (WHO, 2019). In the Nigerian context, maternal mortality remains alarmingly high. According to the National Population Commission and ICF, Nigeria accounts for a significant proportion of global maternal deaths, despite having a relatively small share of the world's population (NPC & ICF, 2019).
The report stated that factors such as inadequate access to skilled birth attendants, limited utilization of antenatal care services, and delayed referral to appropriate health facilities continue to contribute to preventable maternal deaths. These challenges are further compounded by socioeconomic inequalities, poor health seeking behavior, and weaknesses in health system financing. Thaddeus and Maine asserted that maternal deaths often result from delays in deciding to seek care, delays in reaching appropriate healthcare facilities, and delays in receiving adequate treatment upon arrival at health institutions. In many cases, women experience complications that could be effectively managed if timely and quality care were accessible.
Several studies have emphasized the importance of healthcare access in reducing maternal mortality. Say et al. reported that the leading causes of maternal death, including hemorrhage, sepsis, and hypertensive disorders, are largely preventable through effective antenatal care, skilled delivery, and prompt emergency obstetric services. However, these services remain unevenly distributed and underutilized in many parts of Nigeria. Urban centers, while better equipped than rural areas, still experience challenges related to overcrowding, and inequitable access to care.
The National Hospital Abuja plays a pivotal role within Nigeria's healthcare system as a tertiary and referral institution providing specialized maternal and neonatal services. The hospital receives complex obstetric cases from the Federal Capital Territory and surrounding states, many of which involve severe complications arising from delayed or inadequate care at lower levels of the health system. Ameh and van den Broek affirmed that tertiary hospitals in Nigeria frequently manage advanced obstetric complications, reflecting broader systemic gaps in primary and secondary healthcare delivery. Furthermore, disparities in healthcare access persist even in urban environments like Abuja. WHO stated that factors such as cost of care, availability of skilled personnel, quality of services, and efficiency of referral systems influence whether women can obtain timely maternal healthcare. On the other hand, socioeconomic status, education level, and cultural beliefs also shape patterns of service utilization.
Existing literature contends that facility based studies are essential for understanding context specific drivers of maternal mortality. While national statistics provide an overview of the burden, they often obscure variations in trends and access related challenges within individual health institutions. This study is set against the backdrop of persistent maternal mortality in Nigeria, ongoing efforts to improve healthcare access, and the critical role of tertiary institutions such as the National Hospital Abuja in managing obstetric complications.
1.3 Statement of Problems
Investigation revealed that maternal deaths continue to occur even within tertiary healthcare institutions, raising critical questions about the effectiveness, reach, and quality of existing maternal health interventions. Access to healthcare is not limited to physical proximity to a hospital. It also includes affordability of services, timeliness of care, availability of skilled providers, adequacy of medical equipment, and the responsiveness of the health system to obstetric emergencies. When any of these elements is weak, the likelihood of adverse maternal outcomes increases significantly (Thaddeus & Maine, 1994; WHO, 2015).
Within the context of the National Hospital Abuja, there is limited empirical evidence that clearly links trends in maternal mortality to patterns of healthcare access over time. While the hospital serves as a major referral center for complex obstetric cases from within Abuja and surrounding states, many women arrive late with severe complications that could have been prevented or managed earlier at lower levels of care.
Furthermore, some maternal deaths occur despite early presentation at the hospital, indicating possible gaps in quality of care, resource availability, or clinical decision making within the facility itself. It is against this backdrop that this study seeks to examine trends in maternal mortality and healthcare access.
1.4 Aim and Objectives of Study
The aim of this study is to analyze trends in maternal mortality in relation to healthcare access at the National Hospital Abuja.
To achieve this aim, the study has the following objectives:
- To examine the trend of maternal mortality over a specified period at the National Hospital Abuja.
- To assess healthcare access factors affecting maternal outcomes within the hospital's catchment and referral system.
- To identify existing system issues influencing maternal mortality at the hospital.
- To determine the relationship between healthcare access and maternal mortality outcomes.
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:
- Which healthcare access factors within the existing system affect maternal outcomes at the National Hospital Abuja?
- What are the observed trends in maternal mortality at the National Hospital Abuja over the study period?
- What system related challenges influence maternal mortality at the National Hospital Abuja?
- What relationship exists between healthcare access and maternal mortality at the National Hospital Abuja?
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 healthcare access and maternal mortality at the National Hospital Abuja.
- H1: There is a significant relationship between healthcare access and maternal mortality at the National Hospital Abuja.
Hypothesis Two
- H0: Healthcare system issues do not significantly influence maternal mortality outcomes at the National Hospital Abuja.
- H1: Healthcare system issues significantly influence maternal mortality outcomes at the National Hospital Abuja.
1.7 Significance of Study
It is believed that at the completion of the study, policymakers will benefit from evidence that will guide maternal health policy formulation and resource allocation. Also, healthcare providers will benefit from findings that will enhance clinical decision making and emergency obstetric care practices.
Furthermore, women and families will indirectly benefit from improved maternal healthcare services and reduced preventable deaths. In addition, the research will assist healthcare administrators and hospital management in identifying gaps in service delivery, referral systems, and resource allocation that contribute to maternal mortality.
Lastly, researchers and academics will use the findings as a reference for further studies on maternal health and healthcare access.
1.8 Scope and Limitations of the Study
The study focuses on trends in maternal mortality and healthcare access at the National Hospital Abuja, Federal Capital Territory, Nigeria. The scope covers maternal deaths recorded within the hospital and access related factors within its referral network.
The study was limited by challenges inherent in hospital based research, including restricted access to some records and reliance on available institutional data.
1.9 Definition of Terms
Maternal Mortality: refers to the death of a woman during pregnancy, childbirth, or within forty two days of termination of pregnancy from causes related to or aggravated by pregnancy or its management (World Health Organization [WHO], 2019).
Maternal mortality ratio is the number of maternal deaths per one hundred thousand live births within a specified period and location and is used to measure the level of maternal health risk (WHO, 2019).
Healthcare Access: describes the ability of women to obtain timely, affordable, acceptable, and quality maternal health services when needed, including antenatal, delivery, and postnatal care (Peters et al., 2008).
Skilled Birth Attendance: refers to childbirth assisted by trained health professionals such as doctors, nurses, or midwives who are competent in managing normal deliveries and identifying complications (WHO, 2018).
Referral System: is the structured process through which patients are transferred from lower level health facilities to higher level institutions for specialized care (Thaddeus & Maine, 1994).
Tertiary Healthcare Facility: refers to a specialized health institution that provides advanced medical and surgical care, including management of complicated maternal cases, such as the National Hospital Abuja.
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