CHAPTER ONE

INTRODUCTION

BACKGROUND OF THE STUDY

Routine antenatal care includes medical interventions and advice that a woman receives during pregnancy and is a key entry point for pregnant women to receive a broad range of health promotion and preventive health services, including knowledge about healthy practices during pregnancy, nutritional support, prevention and treatment of anaemia, diagnosis and treatment of other diseases and tetanus toxoid immunization. In addition, routine antenatal care can be provided at both the household and primary health care level and helps to assure a link to higher levels of care when needed. The World Health Organization recommends that a woman without complications should have at least four antenatal care visits starting from the first trimester to get suicient prenatal care to minimize pregnancy-related complications. The availability and accessibility of modern health services in developing and low income countries have increased over the past decades. While the effectiveness in curing diseases may lead to greater utilization of modern health services compared to traditional practices, their utilization is likely to be higher among urban dwellers and those with higher socioeconomic status than by rural residents and groups with a lower socioeconomic status in developing countries. The predictors of the utilization of Antenatal care services in most developing countries include socio-demographic factors, availability and access to the health facilities, the educational level of the women and their husbands, perceptions of women regarding Antenatal care and their knowledge of the importance of antenatal care services. Demographic factors such as the number of previous pregnancies, the number of children, maternal age, and marital duration also are reported to have an influence on the utilization of antenatal care. “Attitude” is a state of readiness or tendency to respond in a certain manner when confronted with certain stimuli, is mostly dormant and is expressed in speech or behaviour only when the object or situation is encountered.

Studies have reported negative attitudes as a major barrier to antenatal care utilization. Previous studies in rural areas of the developing world have shown an association of specific attitudes with utilization of and access to health services. In addition, socioeconomic factors contribute to inequalities in health status. Consequently, poor women are disadvantaged in accessing antenatal care, like many other aspects of their lives. Utilization of routine antenatal care at government health facilities in Nigeria generally is low. According to National Demographic study of Nigeria, 70% of women do not get antenatal care, 23% get antenatal care by doctors, 3% by nurse, lady health visitors or family social worker and 4% by trained or untrained traditional birth attendant. Antenatal care services utilization in rural areas is lower at about 10%. The Health Information System in Nigeria reported only 15% of pregnant women registered for Antenatal care in 2010-11.

The Government of Nigeria has been providing maternal health services during the last two decades through primary, secondary, and tertiary health facilities, augmented by the Lady Health Workers (LHW) Program. About 100,000 LHWs are the backbone of the primary health care system. A number of maternal health projects have been launched with the cooperation of international donor agencies since the Alma-Ata Declaration in 1978 made a commitment to provide primary healthcare, including “safe motherhood”, women’s health projects, lady health worker projects, maternal and child health projects and maternal and neonatal child health projects. A literature review by the authors indicates that government services are utilized less than private health facilities in Nigeria. The Government is providing health services to only 30% of the population while the remaining 70% are receiving services through the private health sector. Antenatal care is considered as a back bone of obstetrical services of any health care delivery system. It is considered to be important for health of pregnant women and is the way in which maternal and foetal complications are detected and managed. Antenatal care has well established and recognized role by the pregnant patients in developed countries. In developing countries its importance is not well established and hence leads to poor attendance of antenatal clinics by the pregnant patient. The antenatal period presents important opportunities for reaching pregnant women to the hospital with a number of interventions that may be vital to their health and well being and that of their neonates. Confidential inquiries into maternal deaths in developing countries have found a positive association with inadequate antenatal care as a risk factor for maternal mortality.

1.2 STATEMENT OF PROBLEM

Maternal mortality has continued to be a major health problem in the Africa and Nigeria has one of the highest maternal mortality rates in the world, 704 deaths per 100,000 live births compared to less than 10 deaths per 100,000, births in developed countries. Deaths associated with pregnancy, delivery and first six weeks after delivery total approximately 600,000 women worldwide. Nearly half of these deaths occur in Africa, which constitutes only 12.0% of the total world population. Maternal mortality in Nigeria is one of the highest globally. Every 10 minutes, one woman dies on account of complications of pregnancy or childbirth in Nigeria, giving a total of 53,000 per year. This means that about 700 women die in every 100,000 live births. Many people do not readily appreciate this disaster because the deaths do not occur together in one place, as they occurred silently in many dierent communities in Nigeria. Antenatal care aims to promote better health, maternal education, screening and management of illnesses/ complications during pregnancy to ensure the delivery of a healthy baby to a healthy mother. Effective antenatal care can improve the health of the mother and give her a chance to deliver a healthy baby. Regular monitoring during pregnancy can help detect the complication at an early stage before they become life threatening emergency. However, one must realize that even the most effective scanning tools currently available; one cannot predict which will develop pregnancy related complication. Hence, every pregnant woman needs special care (Manchanda, 2011).