1.0 Introduction
1.1 Background of the Study
In recent years, Nigeria has made strides in policy formulation and implementation to enhance maternal health services. The National Health Policy and the National Strategic Health Development Plan (NSHDP) outline the country's commitment to improving healthcare delivery, including maternal and child health services (FMOH, 2016). The introduction of the Midwives Service Scheme (MSS) in 2009 aimed to deploy skilled midwives to underserved rural areas, thereby increasing access to skilled birth attendants (FMOH, 2010). Despite these efforts, the utilization of antenatal and maternity services remains inconsistent. According to the Nigeria Demographic and Health Survey (NDHS) 2018, while there has been some improvement, significant gaps persist. For instance, the survey reported that only 57% of women attended at least four antenatal care visits during their last pregnancy, and only 39% of births occurred in health facilities (NPC & ICF, 2019).
The utilization of antenatal and maternity services is pivotal for ensuring positive maternal and neonatal health outcomes. In Nigeria, these services are designed to provide comprehensive healthcare to expectant mothers, encompassing routine medical examinations, nutritional advice, health education, and the management of pregnancy-related complications. Despite the established benefits of antenatal care (ANC) and skilled maternity services, their utilization remains suboptimal across many regions of the country, contributing to persistently high rates of maternal and infant mortality (National Population Commission [NPC] & ICF, 2019).
The World Health Organization (WHO) recommends that pregnant women attend at least four ANC visits to monitor their pregnancy and receive essential health interventions (WHO, 2016). However, in Nigeria, a significant proportion of women do not meet this recommendation. The Nigeria Demographic and Health Survey (NDHS) 2018 reports that only 57% of pregnant women had four or more ANC visits, and just 39% delivered in a health facility (NPC & ICF, 2019). Various factors such as socio-economic status, education, cultural practices, and geographical accessibility influence these statistics.
Socio-economic barriers, including poverty and lack of health insurance, hinder access to maternal healthcare services. Women from low-income households often cannot afford the costs associated with ANC visits and skilled birth attendance. Additionally, educational attainment plays a crucial role, as women with higher levels of education are more likely to utilize maternal health services. Cultural beliefs and practices also significantly impact service utilization. In some communities, traditional beliefs and preferences for home births with traditional birth attendants prevail over institutional deliveries. Geographical factors further complicate access to maternal healthcare in Nigeria. Rural areas, in particular, face a shortage of healthcare facilities and skilled health professionals, making it challenging for pregnant women to access the necessary care. The disparity in healthcare infrastructure between urban and rural regions exacerbates the issue, leading to unequal health outcomes.
In Nigeria, the uptake of these services remains suboptimal due to a variety of factors, including socio-economic barriers, cultural beliefs, geographic inaccessibility, and inadequate healthcare infrastructure. These challenges contribute to the high rates of maternal and infant mortality observed in the country. According to the World Health Organization (WHO), Nigeria is among the countries with the highest maternal mortality ratios, which underscores the need for improved utilization of maternal health services (WHO, 2020). The utilization of antenatal and maternity services is a critical component of maternal and child health. Despite global efforts to improve maternal health outcomes, Nigeria still faces significant challenges in ensuring that expectant mothers receive adequate and timely healthcare services. Antenatal care (ANC) services are essential for monitoring the health of both the mother and the fetus, identifying and managing potential complications, and providing health education and counseling. Similarly, maternity services, including skilled birth attendance and postnatal care, are vital for reducing maternal and neonatal morbidity and mortality.
Therefore, in Nigeria where the research was carried out, the activities that was conducted is to know the Utilization of Antenatal and Maternity Services by Mothers Seeking Child Welfare Services.
1.2 Statement of Problems
Investigation revealed that many women in Nigeria do not utilize antenatal and maternity services as recommended. According to the Nigeria Demographic and Health Survey (NDHS) 2018, only 57% of pregnant women attended four or more antenatal care visits, and just 39% of deliveries occurred in health facilities (National Population Commission [NPC] & ICF, 2019). This low utilization of services increases the risk of complications during pregnancy and childbirth, contributing to high maternal and infant mortality rates.
Additionally, poverty is a significant barrier to accessing maternal health services. Many women, especially those in rural and underserved areas, cannot afford the costs associated with antenatal care visits, delivery services, and transportation to health facilities. This economic constraint forces many women to rely on traditional birth attendants or to forego necessary healthcare altogether (Okonofua et al., 2018).
More so, many women, particularly in rural and low-income areas, lack adequate knowledge about the importance of antenatal and maternity care. This gap in health education leads to misconceptions and undervaluation of the benefits of these services, resulting in low utilization rates (Adedokun & Uthman, 2019).
Furthermore, Nigeria's healthcare system faces issues such as inadequate staffing, insufficient medical supplies, and poor facility conditions. These deficiencies undermine the quality of care provided and discourage women from utilizing available services. For instance, the shortage of skilled health professionals, particularly midwives, in rural areas exacerbates the problem (Adewemimo et al., 2014). Hence, it is against this backdrop that this study aims to examine the utilization of antenatal and maternity services by mothers seeking child welfare services in Nigeria.
1.3 Aim and Objectives of Study
The aim of the study is to investigate the factors influencing the utilization of antenatal and maternity services among mothers seeking child welfare services in Nigeria. In achieving this aim, the following specific objectives were laid out as follows:
- To examine the level of awareness and health education regarding antenatal and maternity services among mothers;
- To examine the impact of household income, education level, and employment status on service utilization;
- To evaluate the role of cultural beliefs and practices in the utilization of antenatal and maternity services;
- To assess the current utilization rates of antenatal and maternity services among mothers in Nigeria;
- To identify socio-economic factors that influence the utilization of antenatal and maternity services; and
- To propose recommendations for improving the utilization of antenatal and maternity services based on the study findings.
1.4 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:
- What is the relationship between household income and the frequency of antenatal care visits?
- How does the education level of mothers affect their use of maternal health services?
- What role do cultural beliefs and practices play in the utilization of antenatal and maternity services?
- How do socio-economic factors influence the utilization of antenatal and maternity services?
- What are the current utilization rates of antenatal and maternity services among mothers seeking child welfare services in Nigeria?
1.5 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: Higher educational attainment of mothers is not significantly associated with increased utilization of antenatal and maternity services
- H1: Higher educational attainment of mothers is significantly associated with increased utilization of antenatal and maternity services
Hypothesis Two
- H0: There is no significant positive relationship between household income and the utilization of antenatal and maternity services among mothers in Nigeria
- H1: There is a significant positive relationship between household income and the utilization of antenatal and maternity services among mothers in Nigeria
1.6 Significance of Study
The outcome of this research will be relevant to the following stakeholders:
- For Mothers and Families: Improved utilization of antenatal and maternity services ensures better health outcomes for mothers and their children. By identifying and addressing barriers to service utilization, the study can help reduce maternal and infant mortality rates. Families benefit from enhanced knowledge and access to healthcare, leading to healthier pregnancies and safer deliveries.
- For Healthcare Providers: Healthcare providers can gain insights into the specific needs and challenges faced by their patients. The findings can inform training programs and resource allocation, ensuring that healthcare workers are better equipped to deliver effective maternal health services. Enhanced provider-patient interactions can lead to improved trust and service uptake.
- For Policymakers: The study offers evidence-based recommendations that can inform policy decisions and health sector reforms. Policymakers can use the data to design targeted interventions and allocate resources more efficiently, addressing the socio-economic, cultural, and geographic barriers that hinder service utilization. Effective policies can lead to systemic improvements in maternal health services across the country.
- For Community Leaders and Organizations: Community leaders and non-governmental organizations (NGOs) can leverage the findings to advocate for better maternal health services and educate their communities. Understanding the cultural and socio-economic factors that influence service utilization allows these stakeholders to develop tailored outreach programs that encourage the use of antenatal and maternity services.
- For International Donors and Development Partners: International donors and development partners can align their funding and programs with the identified needs and gaps in maternal health services. The study provides a comprehensive understanding of the local context, enabling these stakeholders to support effective interventions and partnerships that enhance maternal and child health outcomes in Nigeria.
1.7 Scope of Study
The scope of the research is focused on the Utilization of Antenatal and Maternity Services by Mothers Seeking Child Welfare Services in Nigeria.
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).
1.9 Definition of Terms
1.9.1 Antenatal Care (ANC)
Antenatal care refers to the routine health check-ups, education, and medical interventions provided to pregnant women to ensure the health of both the mother and the fetus. It includes services such as screening tests, nutritional advice, and management of pregnancy-related complications (World Health Organization [WHO], 2016).
1.9.2 Maternity Services
Maternity services encompass the comprehensive healthcare provided to women during pregnancy, childbirth, and the postnatal period. This includes skilled birth attendance, emergency obstetric care, and postnatal check-ups to ensure the health and well-being of both the mother and the newborn (WHO, 2016).
1.9.3 Utilization
Utilization refers to the extent to which pregnant women access and use antenatal and maternity healthcare services. It involves the frequency and timing of antenatal visits, place of delivery, and postnatal care practices (Andersen & Newman, 2005).
1.9.4 Child Welfare Services
Child welfare services are a range of social services designed to ensure the well-being of children. These services include health care, nutrition, education, and protection from abuse and neglect, aiming to support the healthy development of children (United Nations Children's Fund [UNICEF], 2006).
1.9.5 Maternal Mortality
Maternal mortality refers to the death of a woman during pregnancy, childbirth, or within 42 days of termination of pregnancy, due to causes related to or aggravated by the pregnancy or its management (WHO, 2020).
1.9.6 Infant Mortality
Infant mortality is the death of a child before their first birthday. This is often measured as the number of deaths per 1,000 live births within a given time period and is an important indicator of the overall health of a population (WHO, 2020).
1.9.7 Socio-economic Barriers
Socio-economic barriers are obstacles that individuals face due to their socio-economic status, including poverty, lack of education, and unemployment. These barriers can limit access to healthcare services and other resources necessary for good health (Gwatkin, Rutstein, Johnson, Suliman, Wagstaff, & Amouzou, 2007).
1.9.8 Healthcare Infrastructure
Healthcare infrastructure includes the physical and organizational structures needed for the operation of healthcare services. This encompasses hospitals, clinics, medical equipment, and the availability of healthcare professionals (World Bank, 2017).
1.9.9 Skilled Birth Attendant
A skilled birth attendant is a health professional, such as a midwife, doctor, or nurse, who has been trained to manage normal pregnancies, childbirth, and the immediate postnatal period, and to identify, manage, or refer complications in women and newborns (WHO, 2018).
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