ABSTRACT
Child delivery is a
critical and sensitive stage of pregnancy. The study assessed the determinant of birth-delivery intention
among pregnant women attending antenatal clinic in Abeokuta South Local
Government Area of Ogun State, Nigeria.
Research designs used
were descriptive and cross-sectional study design. The population of the study
comprised of pregnant women who attended antenatal clinic. Primary data were
collected through self-structured questionnaire and focus group discussion from
422 respondents through multi stage sampling procedure. Interview-guide was
used for those who could not read and write. The variables were measured
nominally and at interval levels. Data were analyzed using descriptive and
inferential statistics.
Results showed that the
majority (32.7%) of the pregnant women fell within the age interval of 26 - 30
years while 22.5% were within the age range of 21 – 25 and 31 – 35 years.
Religious wise, majority (61.8%) belongs to Christian’s category, 36.0% were
Muslims and very few (2.1%). Most (97.9%) of the pregnant women were Yoruba by
tribe, 94.5% of them has a formal education ranging from primary to tertiary
education which revealed high literacy level. Majority (33.4%) were on their 2nd
pregnancies while 32.5% were just on their 1st pregnancies. Almost
all (98.8%) knew the benefits of immunization, 98.6% of pregnant women has
knowledge that birth delivery at health institution is safe and 97.9% of them
reveals that health institutions provide vaccination for both mother and child.
Above half (57.1%) strongly agreed that immunization of a pregnant woman is
very important and 51.2% of the pregnant women
strongly agree that they have taken the necessary tests such as HIV/AIDS. Most
(88.9%) of the pregnant women reported seeing health workers who take good care
of them during Ante natal Clinics, 44.8% of the pregnant women reveal that the
level of exposure is one of the factors always influencing their decision
regarding their place of delivery and 39.3% always consider time and the
condition of the baby in choosing place of delivery. Chi- square result reveals
that there is significant relationship between age (x = 38.049, p< 0.05),
religion (x = 34.330, p < 0.05), educational level (x = 16.192, p <
0.05), occupation (x = 274.999, p < 0.05), number of pregnancies (x =
16.338, p < 0.05) and the attitude of pregnant women towards attending
ante-natal clinic in the study area.
The study concluded that there
is a growing preference for facility delivery particularly among women with
higher age group, education, income and those who had antenatal checkup. It is
therefore recommended that since antenatal clinicis a big pillar for the
remaining maternal health services, effort should be geared to increase
Antenatal Clinic service utilization in the study area.
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Child delivery is a critical and sensitive stage of
pregnancy. The day of delivery is a day when the pregnant woman needs the help
of someone to bring forth her child safely. As much as a personnel is needed to
help her in delivering safely, place of delivery is also important; Child birth
and its process are one of the most significant life events to a woman
(Yibeltal T., Yohana J.M & Thupayagale – Tshweneage G. 2015).During
pregnancy women have intention of delivering their babies in different places
of birth, which is personal to them. These pregnant women may register in
public health facilities with skilled birth attendants, but some also register
with places like Traditional Birth Attendants (TBAs), Faith-Based Organization
like Mission Birth Attendants (MBA) belonging to religious groups such as
churches and Muslims for different purposes, personal to them. Some women do
not register with Public Health Facilities at all, so they do not attend
Ante-Natal Clinics(ANC) until the day of delivery.
The Encarta dictionary defines intention as something
that somebody plans to do, or the quality or state of having a purpose in mind.
During pregnancy, women may decide to deliver their babies in different places
which can be in urban or rural area, and these pregnant women could be
literates or illiterates without considering the consequences of their decision
on themselves and the unborn babies.
According to WHO (2017), United Nations through Millennium
Development goals have galvanized efforts to improve child survival (MDG 4) and
maternal health (MDG 5). The goal of MDG 4 is to reduce child mortality by two
thirds which is under 5 mortality rate, while that of MDG 5 is to improve
maternal health by 2015 in which the target is to reduce by three-quarter both
between 1990 and 2015 (BMC Med. 2013). The global maternal mortality rate
declined by 44% during the MDG era equating to annual average of 2.3% between
1990 and 2015. To achieve the Sustainable Development Goal (SDG) by 2030,
accelerated progress is now needed in achieving the SDG 3.1 will require a
global annual reduction of at least 7.3 per cent (World Health Statistic 2016).
United Nations Secretary General opined that to achieve the ambitious target is
reducing maternal death to fewer than 70 per 100,000 live births globally (UNDP
2015).
According to UNICEF, (n. d.) having babies in
developing nations may be life threatening. Literally in every minute, a woman
dies from avoidable complications caused by pregnancy, this adds up to
approximately half a million fatalities per year. In Nigeria alone, maternal
mortality rate reaches up to 3,200 women (number of women per thousand births,
42 days after child birth). WHO (2015) opined that every day in 2015, 16,000
children under 5 continue to die mostly from preventable causes. Child survival
must remain a focus of the new sustainable development agenda (WHO 2017).
The major problem of high infant and maternal
mortality rate in Nigeria is lack of access to health care; and prevalence of
child marriage. Women in urban areas have more opportunity to receive health
care in public and private health facilities. Most of the women in the rural
area cannot afford the transport to the health facilities due to far distance
from their communities especially at night so, they have to settle for individuals,
quack doctors and nurses, TBAs, MBAs or no help at all during delivery. Many of
the TBAs do not have skills and training necessary for delivering a baby. For
example, they are not able to treat complications that occur during child birth
nor can they perform Cesarean section. Nigeria has a high poverty rate, according
to UNICEF (2010), Nigeria has a high poverty rate with 64.4% of the population
lived in extreme poverty and 83.9% of the population lived in moderate to
extreme poverty. The fact that many people cannot afford the health care needed
by them contributes to Nigerians high maternal mortality rate. Poverty can be a reason why pregnant women
may decide not to deliver at the health facilities where they do their ANC.
The major cause of neonatal death in 2010 were preterm
birth complication, intrapartum complications and pneumonia/sepsis while the
major causes of maternal death in 2010 were haemorrhage, hypertensive disorder, abortion, sepsis and other
direct or indirect causes (BMC 2013).However, to prevent intra partum
complication such as obstructed labour and haemorrhage, the two leading causes
of maternal death, managing babies that are born very early and treating
neonatal sepsis, all require good practices at the time of labour and delivery,
preferably access.
1.2 Statement of the Problem
The World Health Organization (WHO) estimates that
worldwide, 358,000 women die annually from pregnancy and child birth related
complications; with sub-Saharan Africa and South Asiaaccounting for 87% of
these deaths (Joyce et al, 2012, The World Bank, UNFPA, UNICEF n d WHO 2010). Maternal
mortality rate in Nigeria is high. RSS (2015) opined that Nigeria is second to
India in terms of the number of maternal deaths and its experiences, along with
four other countries (Pakistan, the democratic republic of Congo, China and
Ethiopia). So Nigeria is one of the groups that makes up more than 50% of the
maternal mortalities that occur in the world and the maternal mortality rate
was 560 per 100,000 live births in 2013. According to UNICEF, (2010) Nigeria
loses 145 women to maternal mortality each day which is also linked to
Nigeria’s high rate of deaths for children under five.
NDHS report (2008) states that 58% of women received
ante-natal care from a trained health professional at least once during their
pregnancy (87% in the South West and South East, 31% in the North West). Only
one percent of mothers with no education received ANC services from a health
professional, compared with 97% of mothers with more than a secondary
education. Thirty-nine percent were delivered by trained health professionals
and only thirty six percent had their babies in a health facility. From the
researcher’s experience in her place of work, many of the pregnant women who
registered in the health facilities and attended Ante-natal clinics are not
usually seen at the time of delivery.
Public health facilities seldom have unbooked patients
who are in labour and did not experience any ante-natal care during pregnancy
at all.Though, WHO recommends one midwife per every 175 pregnant women but this
standard could not be achieved because many countries like Nigeria have
shortage of medical professionals (Naume et.al
2014). Since the outcome of each person’s labour and delivery cannot be
predicted, there has been a serious concern because some women develop life
threatening complications during pregnancy, labour and puperium which needs the
attention of skilled health worker (midwife) - this results to death of some
women or newborn babies.The aim of this study is to examine the determinants of
birth delivery intention among pregnant women in Abeokuta South Local
Government area of Ogun State, Nigeria.
1.3 Objective of the Study
The
general objective of this study is to examine the determinants of
birth-delivery intentions among women in Abeokuta South Local Government Area
of Ogun State, Nigeria. The specific objectives are to:
1.
describe the
socio-demographic characteristic of the women in the study area;
2.
examine the factors
that lead to either home or institutional delivery among women in the study
areas;
3.
determine the knowledge
of women about the birth-delivery intention at health institutions in the study
area;
4.
examine the
determinants of home and institutional delivery by women in the study area;
5.
determine the
perception of women towards attending ante natal clinics in the study area and
6.
Identify the challenges
facing women about birth-delivery intention in the study area.
1.4 Research Questions
The following research questions were
determined;
1. What
are the socio-demographic characteristic of the women in the study area?
2. What
are factors that led to either home or institutional delivery among pregnant
women in the study area.
3. How
knowledgeable are the women about the birth-delivery at health institutions in
the study area??
4. What
are the determinants of home and institution delivery by women in the study
area
5. What
are the perceptions of women towards home or institutional delivery by the
women in the study area?
6. What
are the challenges facing women about birth-delivery in the study area?
1.5 Hypotheses
The hypotheses of the
study are all stated in null form
H01. There is no significant relationship between
the socio-demographic characteristics of the women and the determinants of home
and institutional delivery by women in the study area.
H02There
is no significant association between the socio-demographic characteristic of the
women and the perceptions of women towards home or institutional delivery by
the women in the study area.
1.6 Justification for the Study
The
main justification in this study is that when women of childbearing age get
pregnant, their intention to deliver is often directed towards delivering in
the health facility that is established or delivering outside the health
facility in the care of TBAs or Faith Based Organization who are also called
Mission Birth Attendants. Most often, these women that deliver outside the
health facility experience complications and are rushed to hospital for
completing the delivery. This experience is said to contribute to maternal
mortality prevalence in Nigeria. A number of studies had been done why this
changing decision to deliver in the place that is known to be safer, but
outcome of these studies are not satisfactory to explain the dynamics of what
is going on. However, a study that will explore determinants of birth-delivery
intention may be well positioned to provide explanation for the various
reasons
offered to elect to deliver outside the health facility. This study is
significant because measuring level of birth – delivery intention serves as a
predictor of actual delivery and therefore factors that will influence this
birth – delivery intention will adequately inform on the likelihood of delivery
in a recognized health facility.
The
instrument developed in this study will serve as a rapid assessment tool to
determine the likelihood of pregnant
women delivering in the health facility or outside the health facility so that
individual can be followed up carefully to ensure that they deliver safely in
the accredited delivery health facility. Skilled antenatal care and birth
attendance has been advocated globally as the most crucial intervention to
reduce maternal mortality. Maternal deaths could be prevented if women were
able to access and utilize good quality health services, especially when
complications arise (Thaddeus and Maine, 2009). However, in reality, most women
experience serious barriers to accessing services or even if they do reach
them, the services themselves are often of insufficient quality or
effectiveness.
Access
to information about maternal services should be available in the community to
help women make choices about who to see and where to go, as well as decide the
type of care they require. Information about family planning services can help
reduce unwanted pregnancies and their adverse consequences. Access to health
care particularly at the critical time of birth, can help ensure that
childbirth is a joyful event (WHO, 2010). Access means that women can reach
maternal health care easily and not be deterred by cost or poor treatment by
staff. Women have been seen to travel long distances to access quality health
care despite a ready availability of primary health care facilities around
where they live, work and school. However, lack of transport makes it difficult
for pregnant women or women in labour to reach help quickly. Fees charged for
health care often put women off having their babies in hospitals or even
seeking help when complications arise. Many women also say they prefer to rely
on traditional birth attendants because health workers are rude and
unsympathetic.
The
role of TBAs remains significantly important at the community level as well as
to pregnant mothers. Several qualitative studies in developing countries
suggest that for many women, TBAs are the preferred community-based provider to
consult with and to help them during delivery. This phenomenon might stem from
either the role of TBAs in helping pregnant mothers during delivery; supporting
services for household chores in the week after delivery; or the elderly
perception that the majority of birth outcomes are positive after getting help
from TBAs. Additionally, the spiritual role of TBAs and FBOs in appealing for
the blessing of the spiritual ancestors of the community and family is also
thought to be important.
1.7 Operational Definition of Terms
Antenatal Care: refers to
the proportion of pregnant women who had attended ante natal clinic at least
one or four times and the service was provided by skilled health worker
(doctors, nurse, midwives). Antenatal Care (ANC) means “care before birth”, and
includes education, counseling, screening and treatment to monitor and to
promote the well-being of the mother and feotus.
Intention: refers to
the extent to which a woman is capable to make independent decisions and take
appropriate action on matters bordering them on their reproductive health
choices and behaviors.
Women: refers to
married or in union who are on modern contraception methods
Home Deliveries: refers to
the proportion of women that gave birth in homes or places that are not health
care facility within the study areas.
Institutional Deliveries: refer to
the percentage of women that gave birth in modern health facilities whether
public or private owns.
Maternal Death: refer to
as the death of any woman while pregnant or within 42 days of termination of
pregnancy that may be from any cause related to or aggravated by pregnancy or
its management schedule, irrespective of the duration and size of the pregnancy,
but not from accidental or incidental causes.
Maternal Mortality Rate: refers to
as the annual number offemale deaths per 1,000 live births women in the
reproductive age-group (15 − 49 years) in a particular year.
Traditional Birth Attendants: refers to
non-formally trained community based individuals that provide prenatal, natal
and post-natal care to women and other health related issues.
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