CHAPTER ONE

Introduction

1. Background to the study

Improving maternal health is one of the World Health Organization (WHO) Millennium Development Goals (MDGs) and professional health care during child birth is one of the process indicators in assessing progress towards these goals^[1]. WHO has recommended four strategic interventions or four pillars for safe motherhood. These include; Family planning, Antenatal care (ANC), Clean/ safe delivery and Emergency obstetric care. Some of the interventions that have been shown to be effective in detecting, treating or preventing conditions in pregnant women that might otherwise give rise to serious morbidity and mortality are: detection and investigation of anaemia, pregnancy induced hypertension, treatment of severe pre-eclampsia, screening and prevention of infection and diagnosis of obstructed labour. For all the benefits that have been attributable to ANC, the effectiveness of antenatal care in actually reducing maternal and fatal morbidity and mortality, has never been scientifically proven and because of ethical considerations may never be proven^[1]. Utilization of ANC services has been identified in a number of studies as an important factor determining maternal and infant mortality. However, the use of health services is a complex behavioral phenomenon. It is affected by socio-demographic factors (such as age, occupation, education, and marital status, religion and income level.), accessibility of the health facility, knowledge about antenatal care services and the quality of care services provided at the health facility. In a study on the determinants of maternal health services in the rural India, it was found that, there is a correlation between household income and utilization of maternal health services ^[1]. It was evident that as a result of lack of productive resources for women, income earned by women had negative impact on utilization of ANC and Post Natal Care (PNC)^[2].

Lack of knowledge about the ANC services could be a major barrier to women’s utilization of ANC services. Due to lack of knowledge pregnant women are likely to have limited knowledge and experiences in seeking health care. Matua^[2] cited lack of adequate knowledge and information about pregnancy, laboratory tests results and dangers of late bookings or not attending ANC at all, as contributors to the poor utilization of ANC services. Lack of knowledge about the dangers of not seeking health care in pregnancy and delivery were major barriers to seeking health care among pregnant women in Uganda^[2]. It is evident from previous researches that, the knowledge about the antenatal care services, availability and accessibility of the services, the distance to the facility, the efficiency and skills of the staff/ workers hence quality of the services, costs incurred, that is the screening charges, transport costs, and the treatment costs, continuity and comprehensiveness of services, all play a part in influencing the utilization of antenatal care services. This however did not tell us to what extents these factors influence the utilization of ANC services. Furthermore, it is also affected by cultural beliefs, as well as personal characteristics of the user of these services. Sometimes the government policy too may affect ANC utilization.

Nigerian Health Review^[3], reports that one of the major causes of maternal deaths is inadequate motherhood services such as antennal care. Approximately two-thirds of all Nigerian women and three-quarters of rural Nigerian women deliver outside of health facilities and without medically-skilled attendants present. Data from the Nigerian Demographic and Health Surveys indicated that among pregnant Nigerian women, only about 64% receive antenatal care from a qualified health care provider. There are wide regional variations, with only about 28% of women in the Northwest Zone and 54% in the Northeast Zone receiving antenatal care from trained health providers (NHR^[4]. The rest either do not receive antenatal care at all or receive care from untrained traditional birth attendants, herbalists, or religious diviners.

There are studies in Nigeria that have related maternal health to care utilization and other risk factors. For example, Ibeh^[5]studied maternal mortality index in Nigeria in relation to care utilization using Anambra state as case study and attributes high maternal mortality to poor socioeconomic development, weak health care system, low socioeconomic status of women, and socio-cultural barriers to care utilization. He found that about 99.7 percent of women in the locality studied attended antenatal clinics with 92.3 percent of them making 4 or more visits before delivery.

Ajayiet al., ^[6] studied the attitude of pregnant women to a new antenatal care model with four antenatal visits (focused antenatal care) using a cross-sectional survey data and multiple logistic regression analysis in Enugu, Nigeria. Only 20.3% of the parturient desired a change to the new model. The most common reasons for desiring the change were convenience (65.1%) and cost considerations (24.1%).