1.1 Introduction
Utilization of skilled birth attendants refers to the use of trained and accredited health professionals such as doctors, nurses, and midwives who are proficient in managing normal pregnancies, childbirth, and the immediate postnatal period, as well as in identifying, managing, and referring complications in women and newborns (World Health Organization, 2023). The presence of skilled birth attendants during delivery is widely recognized as a key strategy for reducing maternal and neonatal morbidity and mortality, particularly in low- and middle-income countries where the burden of preventable deaths remains high.
Maternal health continues to be a major public health concern globally, with developing countries accounting for the vast majority of maternal deaths. Nigeria, in particular, contributes significantly to global maternal mortality figures, with many of these deaths occurring due to complications such as hemorrhage, sepsis, obstructed labor, and hypertensive disorders, which are largely preventable when skilled care is available during childbirth (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
The utilization of skilled birth attendants (SBAs) during childbirth is widely acknowledged as a fundamental component of safe motherhood and an essential strategy for reducing maternal and neonatal mortality. Skilled birth attendants refer to trained health professionals such as doctors, nurses, and midwives who are equipped with the necessary knowledge and skills to manage normal deliveries and identify, manage, or refer complications during pregnancy and childbirth. According to World Health Organization (2023), skilled attendance at birth is one of the most effective interventions for preventing maternal deaths and ensuring safe delivery outcomes, especially in low- and middle-income countries where maternal mortality remains high.
According to National Population Commission (NPC) and ICF (2019), maternal health indicators in Nigeria show that although antenatal clinic attendance has improved over the years, the proportion of women delivering under the supervision of skilled birth attendants remains suboptimal. The report stated that many pregnant women attend at least one antenatal visit but fail to complete recommended visits or deliver in health facilities (NPC and ICF, 2019),.
Adedokun and Uthman (2019) stated that, socio-economic disparities significantly influence the utilization of skilled birth attendants in Nigeria. The authors reported that women with higher levels of education and income are more likely to use skilled delivery services compared to those from low-income and less educated backgrounds. They further asserted that poverty remains a major barrier preventing many women from accessing facility-based delivery services even after attending antenatal clinics.
Gabrysch and Campbell (2009) articulated that, accessibility challenges such as long distances to health facilities, lack of transportation, and poor road networks significantly affect women's decision to utilize skilled birth attendants. The authors contend that even when women are aware of the importance of skilled delivery services, geographical barriers often prevent them from reaching health facilities in time, particularly during labor emergencies (Gabrysch and Campbell, 2009).
According to Bohren et al. (2014), the quality of care provided in health facilities plays a crucial role in determining whether pregnant women utilize skilled birth attendants. The authors reported that negative experiences such as disrespectful treatment, lack of privacy, and poor communication from healthcare providers discourage women from returning to health facilities for delivery. They affirmed that improving respectful maternity care is essential for increasing the uptake of skilled delivery services.
Kruk et al. (2018) affirmed that, the quality of healthcare systems is a major determinant of maternal health outcomes. The authors reported that poor-quality health systems reduce trust in healthcare facilities, leading many women to prefer home delivery or traditional birth attendants. According to Gabrysch and Campbell (2009), cultural beliefs and traditional practices also play a significant role in influencing delivery choices. The authors asserted that in many communities, childbirth is considered a natural process that does not always require medical intervention unless complications arise. They further noted that family influence, particularly from husbands and elders, often determines whether women utilize skilled birth attendants or not.
According to Sialubanje et al. (2015), traditional birth attendants remain a preferred option for many women in rural communities due to cultural acceptance, emotional support, and affordability. The authors reported that even when women attend antenatal clinics, they may still choose traditional birth attendants for delivery due to strong cultural beliefs and community influence. Similarly, according to UNICEF (2022), maternal health outcomes in Nigeria continue to be affected by inequalities in access to skilled birth attendance, especially in rural and underserved communities.
This study is set against the backdrop of the persistent gap between antenatal care attendance and the utilization of skilled birth attendants among pregnant women, particularly in developing settings where maternal mortality remains a major challenge.
1.3 Statement of Problems
Investigation revealed that the utilization of skilled birth attendants among pregnant women attending antenatal clinics remains a critical issue in maternal and child health, particularly in developing countries like Nigeria. Skilled birth attendants, defined as trained health professionals such as doctors, nurses, and midwives, play a vital role in ensuring safe delivery and reducing maternal and neonatal mortality. However, maternal mortality rates in Nigeria remain among the highest globally, with a significant proportion of deaths linked to complications that arise during childbirth and are preventable when attended by skilled personnel (World Health Organization, 2023).
Additionally, disparities exist between urban and rural areas in the utilization of skilled birth attendants. Women in rural settings often face greater challenges in accessing healthcare facilities due to poor transportation systems and limited availability of services, which further widens the gap in maternal health outcomes (National Population Commission [NPC] & ICF, 2019).
Furthermore, many pregnant women still opt for unskilled birth attendants or deliver at home due to various socio-cultural, economic, and institutional factors. Factors such as low level of education, cultural beliefs, financial constraints, distance to health facilities, and perceived poor quality of care contribute to this gap between antenatal attendance and skilled birth utilization (Adedokun & Uthman, 2019). In many communities, traditional birth attendants are still preferred due to trust, familiarity, and cultural alignment, even when antenatal services are accessed in formal health settings. It is against this backdrop that this study seeks to investigate the utilization of skilled birth attendants among pregnant women attending antenatal clinics.
1.4 Aim and Objectives of Study
The aim of this study is to assess the utilization of skilled birth attendants among pregnant women attending antenatal clinics. In achieving this aim, the following specific objectives were laid out as follows:
- To examine the level of utilization of skilled birth attendants among pregnant women attending antenatal clinics.
- To identify socio-economic factors influencing the utilization of skilled birth attendants.
- To assess healthcare system factors affecting the use of skilled birth attendants.
- To determine the influence of cultural beliefs on the utilization of skilled birth attendants.
- To evaluate the relationship between antenatal clinic attendance and utilization of skilled birth attendants during delivery.
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:
- What is the level of utilization of skilled birth attendants among pregnant women attending antenatal clinics?
- What socio-economic factors influence the utilization of skilled birth attendants?
- What healthcare system factors affect the use of skilled birth attendants?
- How do cultural beliefs influence the utilization of skilled birth attendants?
- What is the relationship between antenatal clinic attendance and utilization of skilled birth attendants during delivery?
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
There is no significant relationship between antenatal clinic attendance and utilization of skilled birth attendants.
There is a significant relationship between antenatal clinic attendance and utilization of skilled birth attendants.
Hypothesis One
- H0: There is no significant influence of socio-economic factors on the utilization of skilled birth attendants.
- H1: There is a significant influence of socio-economic factors on the utilization of skilled birth attendants.
Hypothesis Two
- H0: There is no significant effect of healthcare system factors on the utilization of skilled birth attendants.
- H1: There is a significant effect of healthcare system factors on the utilization of skilled birth attendants.
Hypothesis Three
- H0: There is no significant influence of cultural beliefs on the utilization of skilled birth attendants.
- H1: There is a significant influence of cultural beliefs on the utilization of skilled birth attendants.
Hypothesis Four
- H0: There is no significant difference between antenatal clinic attendance and actual utilization of skilled birth attendants.
- H1: There is a significant difference between antenatal clinic attendance and actual utilization of skilled birth attendants.
1.7 Significance of Study
It is believed that at the completion of the study, the findings will assist healthcare providers in identifying specific service delivery challenges affecting skilled birth utilization. The study will also benefit pregnant women by promoting awareness of the importance of skilled birth attendance.
Furthermore, the study will support public health organizations in evaluating maternal health interventions using factual data. In addition, it will provide documented evidence for public health organizations and government agencies to evaluate existing maternal health interventions and allocate resources effectively.
Lastly, the findings will contribute to academic literature by offering updated empirical data that can be used for further research in maternal and child health.
1.8 Scope of Study
The scope of the research is focused on the utilization of skilled birth attendants among pregnant women attending antenatal clinics in Lagos State, Nigeria, with particular reference to selected public healthcare facilities under the Lagos State Ministry of Health. It covers factors influencing utilization, including socio-economic, cultural, and healthcare system variables.
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
Utilization of Skilled Birth Attendants:
Utilization of Skilled Birth Attendants refers to the actual use of trained healthcare professionals such as doctors, nurses, and midwives during childbirth to ensure safe delivery and proper management of complications (World Health Organization, 2023).
Skilled Birth Attendants:
Skilled Birth Attendants are qualified health personnel who have been trained to manage normal pregnancy and childbirth, and to identify and refer complications when necessary (World Health Organization, 2023).
Antenatal Clinics:
Antenatal Clinics are healthcare facilities where pregnant women receive routine medical care, health education, and monitoring throughout pregnancy to ensure maternal and fetal well-being (NPC & ICF, 2019).
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