TABLE OF CONTENTS

Title Page       –           –           –           –           –           –           –           –           i

Approval Page                   –           –           –           –           –           –           –           ii

Certification Page        –           –           –           –           –           –           iii

Dedication          –           –           –           –           –           –           –           –           iv

Acknowledgements    –      –           –           –           –           –           –           v

Table of Contents       –           –           –           –           –           –           vi

List of Tables  –      –           –           –           –           –           –           –           ix

List of Figures –         –           –           –           –           –           –           –           x

Abstract          –          –           –           –           –           –           –           –           xi

CHAPTER ONE: INTRODUCTION

Background to the Study       –        –           –           –           –           –           1

Statement of Problem –           –           –           –           –           –           –           3

Purpose of Study        –       –           –           –           –           –           –           4

Objectives of the Study          –           –           –           –           –           –           4

Research Questions     –          –           –           –           –           –           –           5

Significance of the Study       –           –           –           –           –           –           5

Scope of Study           –        –           –           –           –           –           –           6

Operational Definition of Terms              –           –           –           –           –           6

CHAPTER TWO: LITERATURE REVIEW

Maternal Health Services            –           –           –           –           –           –           8

Antenatal care Services          –           –           –           –           –           –           8

Intranatal Care            –            –           –           –           –           –           –           9

Postpartum Care                 –           –           –           –           –           –           10

Women Status –           –           –           –           –           –           –           –           11

Women Decision Making Autonomy and Maternal use of PHC Facility                    –         12

Women Employment Status and Maternal use of PHC Facility   13

Education and Maternal use of PHC Facility –       –           –           –           14

Wealth Index and Maternal use of PHC Facility    –           –           –           15

Theoretical Review     –             –           –           –           –           –           –           16

Anderson’s Health Behavioural Model                –           –           –           –           16

Review of Empirical Study   –           –           –           –           –           –           18

Summary of Literature Review             –           –           –           –           –           24

CHAPTER THREE: RESEARCH METHOD

Research Design               –           –           –           –           –           –           –           25

Area of Study –                   –           –           –           –           –           –           25

Population of Study    –          –           –           –           –           –           –           26

Sample                        –  –           –           –           –           –           –           –           26

Inclusion Criteria        –               –           –           –           –           –           –           26

Sampling Procedure    –           —           –           –           –           –           –           27

Instrument for Data Collection         –           –           –           –           –           28

Validity of Instrument            –                   –           –           –           –           28

Reliability of Instrument Ethical Consideration                 –           –           28

Ethical Consideration             –           –           –              –           –           –           –           29

Procedure for Data Collection                     –           –           –           –           29

Method of Data Analysis       –           –       –           –           –           –           29

CHAPTER FOUR: PRESENTATION OF RESULTS   –         –           31

CHAPTER FIVE: DISCUSSION OF FINDINGS

Proportion of women who utilise Maternal Health Care Services   –           –           45

Association between Women Decision Making Autonomy and use of Maternal Health Care Service   –                      –           –           –           45

Association between Women Education and use of Maternal Healthcare Services  –           45

Association between Women Occupation and use of Maternal Health

Care Services               –           –           –           –           –           –           46

Association between Women Economic Status and use Maternal Health

Care Services  –   –           –           –           –           –           –           –           47

Implication of the Findings to Nursing          –           –           –           48

Conclusion           –           –           –           –           –           –           –           48

Recommendation        –           –           –           –           –           –           –           49

Limitations      –      –           –           –           –           –           –           –           49

Suggestions for Further Studies        –           –           –           –           –           50

Summary         –         –           –           –           –           –           –           50

References      –           –           –           –           –           –           –           51

Appendix 1     –             –           –           –           –           –           –           56

Appendix 2     –        –           –           –           –           –           –           –           57

Appendix 3     –           –           –           –           –           –           –           –           59

Questionnaire  –            –           –           –           –           –           –           –           60

LIST OF TABLES

Table 1a:          Demographic characteristics of respondents              27

Table1b:          Socio demographic variables of the respondents  –              31

Table 2a:          Economic status (wealth index) of the respondents              33

Table 2b:         Economic status (wealth index) of the respondents contd-     34

Table 3a:          Utilisation of maternal health services (ANC)    –           35

Table 3b:         Utilisation of ANC contd           –           –           –           36

Table 3c:          Partner’s perception of ANC –            –           –           37

Table 4:           Utilisation of maternal health care services for delivery care (n=482)           38

Table 5:           Cross tabulation between decision making autonomy and utilization of antenatal services        –       –           –           –           –           40

Table 6:           Association between Educational status of women and use of maternal health care services    –           –        –           –           –           –           41

Table 7:           Association between women occupation and use of maternal health care Services          –           –           –           –           –           42

Table 8:           Association between  women economic status and use maternal health care Services             –           –           –           –           –           43

LIST OF FIGURES

Figure1:           Anderson’s behavioural model of health services utilization            –           18

Figure 2:          Conceptual model of the study –       –           –           –           18

ABSTRACT

The study examined the association between women’s status and utilisation of maternal health care services of primary health care centres in Nando, in Nando, Anambra east L.G.A of Anambra State. Five objectives were developed. A cross sectional descriptive research design was used. The study population consisted of women of child bearing age (15-49years) who had given birth in the last five years. A sample size of 500 participants was used after using the formula for estimating sample size from a finite population. However, only 482 copies of the questionnaire were returned, giving a response rate of 96.4%. The instrument for data collection was a questionnaire developed by the researcher based on literature review. Data were analysed using the statistical package for the social sciences (SPSS version 18). The major findings showed that 71.5% utilised ANC while 44.4% utilised delivery healthcare services; 40.2% of the women took decisions jointly with their husbands while 32.4% took decisions alone on utilisation of ANC. As regards utilisation of delivery care services, 39% took decisions alone while 36.5% took decisions jointly with their husbands on where to have their baby.  There is a statistical significant association between women decision making autonomy and utilisation, women educational and utilisation, and women economic status and maternal health care service utilisation. However, the study showed no statistical significant association between occupational status and utilisation of maternal health care services.  The study concluded that the factors that influence the utilisation of maternal health care services are women decision making autonomy, educational status and their economic status.

CHAPTER ONE

INTRODUCTION

Background to the Study

Giving birth is a positive and fulfilling experience that sometimes comes with risks (WHO, 2008). The health risk associated with reproduction affect virtually all women of reproductive age at some point in their lives (WHO, 2008). These risks are more marked in developing countries where a majority of the women are poor and have a low economic status (WHO, 2008). This low status deprives them of the decision-making power necessary to take prompt decisions on health care.  In developed countries where women are educated and earn a reasonable income, they have the power to make decisions concerning their health and have access to basic maternal health care services (WHO, 2008).

Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period (WHO 2008). It has been estimated by the Safe Motherhood Initiative (SMI) that 30 to 50 morbidities occur for each maternal death (SMI, 2009). The tragedy of not preventing these avoidable deaths resulted in 536,000 maternal deaths worldwide in 2009 (WHO 2010). Developing regions accounted for 99 percent (533,000) of these deaths, with sub-Saharan Africa and Southern Asia accounting for 86 percent of them (UN 2008,). For such women, pregnancy and childbirth led to illness and disability. Improving maternal health and reducing maternal mortality have been the main concerns of several international summits and conferences. The Millennium Summit in 2000 calls for a 75 percent reduction by 2015 in the maternal mortality ratio (UN, 2008,). However as the deadline approaches, these hopes have not been met, many countries are nowhere near achieving this objective, and there is no sure evidence that global maternal mortality levels has declined in the past decade by any significant degree (Rajesh, Prashant, Chandan & sing, 2013, WHO,2013). The utilization of maternal health care services, especially at the primary level, is one of the important factors that will help reduce the incidence of maternal mortality (SMI, 2008).

The use of health services is a complex behavioural phenomenon. It is related to the organization of the health-delivery system and is affected by the availability, quality, costs, continuity and comprehensiveness of services. Social structure and health beliefs also affect use (Anderson, 2005; Rajesh, Prashant, Chandan & Sing, 2013). For preventive services like prenatal care, family planning or immunizations, people do not perceive the need to visit health care facilities in absence of disease (Anderson, 2005; Rajesh, Prashant, Chandan & Sing, 2013). Beliefs about susceptibility, consequences and effectiveness of intervention also affect the utilization of health care services. (Anderson, 2005). However, some studies in preventive services have often found that the use of services is more strongly correlated with demographic and socioeconomic characteristics than with health beliefs (Digambar & Saho, 2011). Many studies in developing nations have found a strong relationship between maternal education and the use of maternal and child health services (Babalola & Fatusi, 2009; Ahmed, Creanga, Gillespie & Tsui, 2010). In some of these studies, the effect of education persisted even after the control of other variables. (Ahmed, Creanga, Gillespie & Tsui, 2010; Chiang, Inass, Kawaguchi, Nawal, Nagah, Michiyo et al, 2012).

The concept of women’s status is broad and can be measured from different angles. Women‘s status is defined as the accepted or official position of women in the society to which varying degrees of responsibility, privilege and esteem are attached to. A woman’s status is often described in terms of her income, employment, education, health and fertility as well as the role she plays within the family, community and the society. (WHO, 2008) Women status has been defined in literature using different kinds of terminology. Some of the commonly used terminologies are women’s empowerment, female autonomy, gender equality, prestige, access to and control over resources. (Babolola & Fatusi2009; Mukesh & Kaushlendra. 2010).Women autonomy and utilisation of maternal care services are positively related (Mukesh & Kaushlendra. 2010). According to the authors, women’s autonomy is dependent on many factors, the most important being education, place of residence (rural or urban), occupation and income. Women, who live in the urban areas, are generally educated and employed. They have a higher status and more decision making autonomy than those who live in the rural areas (Babolola & Fatusi, 2009; Mukesh & Kaushlendra, 2010, Aigbe,2011).

 In developing countries particularly in Nigeria, availability and utilization of maternal healthcare services are low (Ajaegbu, 2013).  It was estimated that only 13.9% of annual birth in 12 states in Nigeria took place in the health facilities (FMOH, 2010.). Ajaegbu (2013) noted that culture and educational status of mothers influence their utilisation of maternal health services. In Nigeria, especially in the rural areas, many factors affect utilization of maternal health services. They include health and religious beliefs about complications of pregnancy, financial factors and accessibility of health facilities.  Other factors include the fact that permission has to be taken from the husband before seeking healthcare services. (Ogujuyigbe & Liasu, 2007; Babolola & Fatusi, 2009; Ajaegbu, 2013)

According to the WHO (2007), there are three crucial factors underlying maternal deaths: Firstly, lack of access and utilization of essential obstetric services. Secondly is too much physical work together with poor diet which also contributes to poor maternal health outcomes. The third is the low social status of women in developing countries. The low status of women can limit their access to economic resources and basic education, and can also affect their ability to make decisions, including decisions related to their health and nutrition. Not much study has been done on the association between women’s status and maternal health care service utilisation in the south east of Nigeria. This study therefore seeks to investigate the association between women’s status and maternal use of primary health care facilities in Nnando, Anambra East Local Government Area of Anambra State.

Statement of Problem