Main Article Content
Aim: To determine the reasons why women deliver outside institutions where they register for antenatal care.
Study Design: Qualitative study.
Place and Duration of Study: Antenatal clinic of the University of Port Harcourt Teaching Hospital in February 2018.
Methodology: A qualitative study using in-depth interviews (IDIs) was conducted in Port Harcourt, Nigeria to collect information on various reasons why women do not deliver where they received antenatal care (ANC) or with skilled birth attendants (SBAs). This was done using structured interview guides. Specifically, we asked 30 pregnant women to elucidate the circumstances that lead women to deliver in places other than where they had received antenatal care, and recommendations to enhance the number of women delivering with skilled birth attendants. All in-depth interviews were audio-taped, transcribed and content-analyzed.
Results: Thirty IDIs were carried out. The women were all pregnant; aged 20 to 43 years old with mean age of 32.9 ± 5.5 years. The broad themes that emerged from their responses: Cost/financial reasons relating to inability to afford the cost of care in the hospitals, personal reasons such as fear of Caesarean section, and hospital-related reasons such as health workers’ strike action.
Conclusion: Evidence from our study indicates that pregnant women’s non-use of skilled birth attendants during childbirth even when they received antenatal care in the hospital is mainly due to financial, personal and hospital-related reasons. These factors are modifiable and should be targeted to increase delivery with skilled attendants, a key strategy for the reduction of maternal and neonatal mortality and morbidity.
Nigeria. Nigeria Demographic and Health Survey 2013 National Population Commission Federal Republic of Nigeria, Abuja; 2014.
Abou Zahr C, Wardlaw TM, World Health Organization., UNICEF. Antenatal care in developing countries : promises, achievements, and missed opportunities : An analysis of trends, levels, and differentials, 1990-2001. World Health Organization; 2003.
Houweling TAJ, Ronsmans C, Campbell OMR, Kunst AE. Huge poor-rich inequalities in maternity care: An international comparative study of maternity and childcare in developing countries. Bull World Health Organ. 2007; 85(10):745–54.
Simkhada B, Van Teijlingen ER, Porter M, Simkhada P. Factors affecting the utilization of antenatal care in developing countries: Systematic review of the literature. J Adv Nurs. 2008;61(3):244–60.
Ali AAA, Osman MM, Abbaker AO, Adam I. Use of antenatal care services in Kassala, eastern Sudan. BMC Pregnancy Childbirth. 2010;10:67.
Kabir M, Iliyasu Z, Abubakar IS, Asani A. Determinants of utilization of antenatal care services in Kumbotso Village, northern Nigeria. Trop Doct. 2005;35(2): 110–1.
Bassani DG, Surkan PJ, Olinto MTA. Inadequate use of prenatal services among Brazilian women: The role of maternal characteristics. Int Perspect Sex Reprod Health. 2009;35(1):15–20.
Kawungezi PC, AkiiBua D, Aleni C, Chitayi M, Niwaha A, Kazibwe A, et al. Attendance and Utilization of Antenatal Care (ANC) Services: Multi-Center Study in Upcountry Areas of Uganda. Open J Prev Med. 2015; 5(3):132.
Aldana JM, Piechulek H, Al-Sabir A. Client satisfaction and quality of health care in rural Bangladesh. Bull World Health Organ. 2001;79(6):512–7.
Bamidele AR, Hoque ME, van der Heever H. Patient satisfaction with the quality of care in a primary health care setting in Botswana. South African Fam Pract. 2011; 53(2):170–5.
Iliyasu Z, Abubakar IS, Abubakar S, Lawan UM, Gajida AU. Patients’ satisfaction with services obtained from aminu kano teaching hospital, kano, northern nigeria. Niger J Clin Pract. 2010;13(4):371–8.
Srivastava A, Avan BI, Rajbangshi P, Bhattacharyya S. Determinants of women’s satisfaction with maternal health care: A review of literature from developing countries. Myer L, editor. BMC Pregnancy Childbirth. 2015;15(1):97.
Akpala CO. An evaluation of the knowledge and practices of trained Traditional birth attendants in Bodinga, Sokoto State, Nigeria. J Trop Med Hyg. 1994;97(1):46–50.
Allotey P. Where there is no traditional birth attendants: Kassena Nankana District, Northern Ghana. In: Berer M, Ravindran S, editors. Safe Motherhood Initiative Critical Issues. 1st ed. Oxford: Blackwell Science; 1999;147–54.
Bang AT, Bang RA, Sontakke PG. Management of childhood pneumonia by traditional birth attendants. The SEARCH Team. Bull World Health Organ. 1994; 72(6):897.
Galadanci HS, Ejembi CL, Iliyasu Z, Alagh B, Umar US. Maternal health in Northern Nigeria: a far cry from ideal. BJOG: An International Journal of Obstetrics & Gynaecology. 2007;114(4):448-52.
Jin Y, Zhu W, Yuan B, Meng Q. Impact of health workforce availability on health care seeking behavior of patients with diabetes mellitus in China. Int J Equity Health. 2017; 16(1):80.
Hazarika. Health workforce in India: Assessment of availability, production and distribution. WHO South-East Asia J Public Heal. 2013;2(2):106.
Musoke D, Boynton P, Butler C, Musoke MB. Health seeking behaviour and challenges in utilising health facilities in Wakiso district, Uganda. Afr Health Sci. 2014;14(4):1046–55.
Michael GC, Grema BA, Yakubu SO, Aliyu I. Utilisation of staff clinic facility in a northwest nigeria hospital: Emerging challenges for the national health insurance scheme. South African Fam Pract. 2016;58(1):37–41.
Prakash B. Patient Satisfaction. J Cutan Aesthet Surg. 2010;3(3):151–5.
Shonibare D. Lagos State Teaching Hospital Children’s Emergency Ward In Deplorable State, Mosquito Infested With Neglected Toilet (Pictures). BlackBox Nigeria; 2019.
[Cited on: 2019 Sept 18]
Ojerinde D, Bakam A, Bamigbola B, Casmir, O, Itode S, Abraham J. Health sector crisis: Patients sleep on bare floors, battle mosquitoes in teaching hospitals. Punch Newspapers; 2019.
[Cited on: 2019 Sept 18]
Ogaji DS, Nwi-ue LB, Agalah HN, Ibok SG, N-ue DM. Impact and contributors to cost of managing long term conditions in a university hospital in Nigeria. Journal of Community Medicine and Primary Health Care. 2015;27(2):30-40.
Adamu H, Oche M. Determinants of patient waiting time in the general outpatient department of a tertiary health institution in North Western Nigeria. Ann Med Health Sci Res. 2013;3(4):588.
Ogaji D, Mezie-Okoye M. Waiting time and patient satisfaction: Survey of patients seeking care at the general outpatient clinic of the University of Port Harcourt Teaching Hospital. Port Harcourt Med J. 2017;11(3):148.
Oleribe OO, Ezieme IP, Oladipo O, Akinola EP, Udofia D, Taylor-Robinson SD. Industrial action by healthcare workers in Nigeria in 2013-2015: An inquiry into causes, consequences and control-a cross-sectional descriptive study. Hum Resour Health. 2016;14(1).
Oleribea OO, Udofia D, Oladipo O, Ishola TA, Taylor-Robinson SD. Healthcare workers’ industrial action in Nigeria: A cross-sectional survey of Nigerian physicians. Hum Resour Health. 2018; 16(1):54.
WHO. Laboratory quality management system: handbook. World Health Organization; 2011.
Poverty & Equity Data Portal: Nigeria [Internet]. World Bank; 2019.
[Cited on: 2019 Sept 20]
Ntoimo LFC, Okonofua FE, Igboin B, Ekwo C, Imongan W, Yaya S. Why rural women do not use primary health centres for pregnancy care: evidence from a qualitative study in Nigeria. BMC Pregnancy Childbirth. 2019;19(1).
Ogunyomi M, Ndikom C. Perceived factors influencing the utilization of traditional birth attendants’ services in Akinyele local government, Ibadan, Nigeria. J Community Med Prim Heal Care. 2016;28(2):40–8.
Joseph D. Investigating literacy and health literacy in Nigerian Prisons. International Journal of Humanities Social Sciences and Education (IJHSSE). 2014;1(8):139-48.
Adekoya-Cole TO, Akinmokun OI, Enweluzo GO, Badmus OO, Alabi EO. Poor health literacy in Nigeria: Causes, Consequences and Measures to improve it. Niger Q J Hosp Med. 2015; 25(2):122–7.
Adeniran AS, Aboyeji AP, Fawole AA, Balogun OR, Adesina KT, Isiaka-Lawal S. Evaluation of parturient perception and aversion before and after primary cesarean delivery in a low-resource country. Int J Gynecol Obstet. 2016;132(1):77–81.