Abstract
Background: Maternal mortality remains as high as 567 deaths per thousand live births in Nigeria and 1, 549 deaths per 100,000 live birthsin the Northern regions of the country. Despite overwhelming evidence that maternal deaths can be averted with presence of a skilled attendant during delivery, most women in the rural communities in Northern Nigeria prefer to deliver at home. This study aimed at understanding women’s perception of place of delivery options and factors that influence and guide the choice of place of delivery amongst pregnant women.
Methods: A qualitative study, from a social constructionist viewpoint, was conducted in a rural community in Northeast Nigeria. Through purposeful sampling, women who recently delivered and those who were over 35 weeks of gestation participated in 12 in-depth interviews and 7 FGDs.
Results: Three themes emerged from this study: perception of facility healthcare services, especially delivery service, as less than adequate; health seeking behaviour was influenced by incidence of complications in pregnancy, husband and home environment; while social support and the opinion of the community influence women decision on place of delivery. Husband and in-laws took prime position in making key decisions; the role of the Traditional Birth Attendant (TBA) was not an important factor for making decision on place of delivery.
Conclusion: A combination of factors influenced women’s decisions on where to deliver. Future intervention should be context specific; individual and cultural context in relation to maternal health of women should be taken into account before formulating interventions, while community education can change perceptions of the risk associated with deliveries and the need for skilled attendant at delivery.
Keywords: choice of place of delivery, skilled birth attendant, Nigeria.
References
- Hogan MCea: Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5.): . The Lancet 2011, 375((9726):1609 – 1162.
- Ibeh CC: Is poor maternal mortality index in Nigeria a problem of care utilization? A case study of Anambra State. Afr J Reprod Health 2008, 12(2):132-140.
- Adamu YM, Salihu HM: Barriers to the use of antenatal and obstetric care services in rural Kano, Nigeria. J Obstet Gynaecol 2002, 22(6):600-603.
- Babalola S, Fatusi A: Determinants of use of maternal health services in Nigeria--looking beyond individual and household factors. BMC Pregnancy Childbirth 2009, 9:43.
- Oti S OC: Perinatal mortality in Nigeria: Do place of delivery and delivery assistants matter?The Open Demography Journal 2011,, 4::1-10.
- Berhan Y BA: Skilled Health Personnel Attended Delivery as a Proxy Indicator for Maternal and Perinatal Mortality: A Systematic Review. Ethiopian Journal of Health Sciences , 2014, 24.
- HMN U, WHO: Countdown to 2015 and the Health Metrics Network: Monitoring maternal, newborn and child health: understanding key progress indicators. . 2015.
- Kabakyenga JK, Ostergren PO, Turyakira E, Pettersson KO: Influence of birth preparedness, decision-making on location of birth and assistance by skilled birth attendants among women in south-western Uganda. PLoS One 2012, 7(4):e35747.
- WHO: Maternal Health: Investing in the Lifeline of Healthy Societies & Economies. . September 2010,.
- Hazarika I: Women's reproductive health in slum populations in India: evidence from NFHS-3. J Urban Health 2010, 87(2):264-277.
- Bell J CS, Alayón S: Trends in delivery care in six countries. . DHSORC Macro
- Nation U: The Millennium Development Goals Report 2006. . 2006.
- Moore BM, Alex-Hart BA, George IO: Utilization of health care services by pregnant mothers during delivery: a community based study in Nigeria. East Afr J Public Health 2011, 8(1):49-51.
- Wanjira C, Mwangi M, Mathenge E, Mbugua G, Ng'ang'a Z: Delivery practices and associated factors among mothers seeking child welfare services in selected health facilities in Nyandarua South District, Kenya. BMC Public Health 2011, 11:360.
- Tuladhar H, Khanal R, Kayastha S, Shrestha P, Giri A: Complications of home delivery: our experience at Nepal Medical College Teaching Hospital. Nepal Med Coll J 2009, 11(3):164-169.
- National Population Commission (NPC), ICF Macro. 2009: Nigeria Demographic and Health Survey 2008: Key Findings. In. Calverton, Maryland, USA; 2009: 15.
- Doctor HV, Olatunji A, Findley SE, Afenyadu GY, Abdulwahab A, Jumare A: Maternal mortality in northern Nigeria: findings of a health and demographic surveillance system in Zamfara State, Nigeria. Trop Doct 2012, 42(3):140-143.
- Gabrysch S, Campbell OM: Still too far to walk: literature review of the determinants of delivery service use. BMC Pregnancy Childbirth 2009, 9:34.
- Abimbola S, Okoli U, Olubajo O, Abdullahi MJ, Pate MA: The midwives service scheme in Nigeria. PLoS Med 2012, 9(5):e1001211.
- Fapohunda BM, Orobaton NG: When women deliver with no one present in Nigeria: who, what, where and so what?PLoS One 2013, 8(7):e69569.
- Darlaston-jones D: Making connections: The relationship between epistemology and research methods. Australian Community Psychologist, 2007, 19(1):19-27.
- Iyaniwura CA, Yussuf Q: Utilization of antenatal care and delivery services in Sagamu, south western Nigeria. Afr J Reprod Health 2009, 13(3):111-122.
- Fotso J-C, Ezeh A, Madise N, Ziraba A, Ogollah R: What does Access to Maternal Care Mean Among the Urban Poor? Factors Associated with Use of Appropriate Maternal Health Services in the Slum Settlements of Nairobi, Kenya. Matern Child Health J 2009, 13(1):130-137.
- Dhakal S, van Teijlingen E, Raja EA, Dhakal KB: Skilled care at birth among rural women in Nepal: practice and challenges. J Health Popul Nutr 2011, 29(4):371-378.
- Seljeskog L, Sundby J, Chimango J: Factors influencing women's choice of place of delivery in rural Malawi--an explorative study. Afr J Reprod Health 2006, 10(3):66-75.
- S H, Gwarzo. U M D, U SA: Determinants of place of delivery among women in a semi-urban settlement in Zaria, northern Nigeria. Annals of African Medicine 2006, 5(2).
- Titaley CR, Hunter CL, Heywood P, Dibley MJ: Why don't some women attend antenatal and postnatal care services?: a qualitative study of community members' perspectives in Garut, Sukabumi and Ciamis districts of West Java Province, Indonesia. BMC Pregnancy Childbirth 2010, 10:61.
- Titaley CR, Dibley MJ, Roberts CL: Factors associated with underutilization of antenatal care services in Indonesia: results of Indonesia Demographic and Health Survey 2002/2003 and 2007. BMC Public Health 2010, 10:485.
- Titaley CR, Hunter CL, Dibley MJ, Heywood P: Why do some women still prefer traditional birth attendants and home delivery?: a qualitative study on delivery care services in West Java Province, Indonesia. BMC Pregnancy Childbirth 2010, 10:43.
- Falkingham J, Akkazieva, B., & Baschieri, A.: Trends in out-of-pocket payments for health care in Kyrgyzstan, 2001–2007.http://doi.org/10.1093/heapol/czq011. Health Policy and Planning 2010, 25(5):427–436.
- Aremu O, Lawoko S, Dalal K: Neighbor-hood socioeconomic disadvantage, individual wealth status and patterns of delivery care utilization in Nigeria: a multilevel discrete choice analysis. Int J Womens Health 2011, 3:167-174.
- Emeka Obioha, Fashagba. A: Socio-cultural factors influencing expectant mothers' access and choice of child birth setting/maternity services in Ibadan metropolis, Nigeria. In: Union for African Population Studies Fifth African Population Conference. Arusha, Tanzania; 2007.
- MB: Women's Decision-Making And Factors Affecting Their Choice Of Place Of Delivery: Systematic Review And Qualitative Study Survey Research Insight: European Institute of Health and Medical Sciences University of Surrey; 2001.
- Miller AC, Shriver TE: Women's childbirth preferences and practices in the United States. Soc Sci Med 2012, 75(4):709-716.
- Gerein N, Mayhew S, Lubben M: A framework for a new approach to antenatal care. Int J Gynaecol Obstet 2003, 80(2):175-182.
Corresponding Author
Halima Mukaddas
No 16 Gamawa Close Federal Low-cost Bauchi, Bauchi State, Nigeria
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