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ASSOCIATION BETWEEN WOMEN’S STATUS AND USE OF MATERNAL HEALTH CARE SERVICES OF PRIMARY HEALTH CENTRES
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
Nigeria’s maternal mortality rate is considered to be one of the highest in the world (Ogujuyigbe & Liasu 2007, FMOH, 2012, WHO, 2013). Although Nigeria accounts for only 2% of the world’s population, it accounts for 10% of the global estimates for maternal deaths (FMOH, 2012).This is as a result of widespread ignorance, harmful cultural practices and limited access to health service (Ogujuyigbe & Liasu 2007,Ajaegbu, 2013). There is also documented evidence of underutilization of available health services (FMOH, 2012); this has greatly contributed to the high maternal mortality ratio in the country. The use of health facility during delivery is still very low. This is due to some perceived barriers such as lack of money to pay for these services. (Ajaegbu, 2013)
In many developing countries such as Nigeria, Ethiopia and others, women are disadvantaged, compared to men in terms of their access to assets, employment, healthcare and education. Women’s perceived inferior social status and status within the family have adversely affected their health by limiting their autonomy to take decisions on their health and ability to access health care where and when necessary (Mukesh & Kaushlendra, 2010, Kebebe et al,2012, Yar’zever & Said, 2013). Nigeria remains a patriarchal society where men continue to dominate all spheres of women’s lives. This male domination is protected fiercely by the cultural and traditional institutions. Traditionally in Nigeria and in many other African societies, women are not treated as equal to men; they expected to be seen and not heard. These traditional norms and practices limit women’s autonomous decisions on issues that affect their lives including the right to make decisions on their reproductive health. Decisions are taken by fathers, brothers, husbands, fathers-in-law and mothers-in-law (Federal Ministry of Women Affairs and Social Development, 2006; Ibrahim, Tripathy & Kuman, 2014).
Nando has four health centres and one health post. From interactions with these women, the researcher noticed that they do not utilise the health centres in the community. This was also confirmed from the records seen in these health centres. The records showed that in 2013, only a total of 239 women attended ANC, 180 women delivered their babies there and only 34 women came for postnatal care (PNC). The health workers allege that Nando women do not come for antenatal care as expected. Almost half of the people who come for antenatal services deliver their babies in traditional facilities such as the homes of the traditional birth attendants and they do not come for postnatal care. Since these health centres are the only health facilities in the village, the questions being raised in this study are: why are these women not utilising the health facilities provided? Does the status of women affect maternal and child health care utilisation? Is the decision making autonomy of women associated with maternal health care service utilisation? What is the level of education of these women? Seeking answers to these questions form the basis of this study
Purpose of the Study
The purpose of the study is to determine the association between women status and the utilization of maternal health care services of primary health care centres in Nando community.
Objectives of the Study
The objectives of this study are to:
- Determine the proportion of utilization of maternal health care services in primary health care centres by women in Nando.
- Determine the association between women’s decision making autonomy and use of maternal health care services of primary health care centres.
- Determine the association between educational status of women and use of maternal health care services of primary health care centres in Nando..
- Determine the association between occupational status and use of maternal health care services of primary health care centres in Nando..
- Determine the association between women economic status (e.g wealth index) and use of maternal health care services of primary health care centres in Nando.
- What is the proportion of women that utilise maternal health care services of primary health care centres in Nando?
- What is the association between women decision making autonomy and the use of maternal health care services of primary health care centres in Nando?
- What is the association between educational status of women and the use of maternal health care services of primary health care centres in Nando.?
- What is the association between occupational status and use of maternal health care services of primary health care centres in Nando?
- How does economic status of women influence use of maternal health care services of primary health care centres in Nando?
Significance of the Study
The first significance of this study must be the closing of the information gap on the association of women status and use of maternal health care services of primary health care centres with regard to our area. The findings from this study will reveal the decision making ability of women in the Nando community and how it determines their utilisation of maternal health care services. It will also determine the association between economic status of women, their educational and occupational status and their ability to utilise maternal healthcare services.
It is hoped that the findings from this study when communicated will cause a re-awakening among stakeholders in health and other non-governmental organisations to see the need to encourage girl child education and women empowerment so as to help boost their decision- making power on issues concerning their health and wellbeing.
The findings will also show the need for community health nurses to include home visiting as an important part of maternal health care services to enhance the use of health services. During home visiting, the husbands and relevant others will be seen and reproductive issues concerning these women will be discussed. The need for the women to see health personnel when necessary will also be stressed.
Finally, the findings from this study will serve as a source of literature as well as empirical reference for further studies.
Scope of the Study
The study sought to find the association between women status and use of maternal health care services of primary health care centres in Nando. It was delimited to women decision-making autonomy, the status of women in educational, occupational and economic matters. It was limited to women of child bearing age in the rural communities of Nando.
Operational Definition of Term
Maternal health care services (MHCS) refer to antenatal, delivery services and postnatal care services of the health centres. However, this study concentrated on antenatal and delivery care services in Nando.
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. In this study, women status will be measured by the following variables; women decision making autonomy, Occupational status of women, educational status and economic status. The study determined the association between the above variables and women’s use of maternal health care services of primary health care centres.
Women’s decision-making autonomy refers to the women’s capacity and freedom to act independently of the authority of others. It also encompasses the ability to make decisions regarding their reproductive health. Questions were asked on who takes decisions concerning their reproductive health behaviours.
Women’s educational status refers to the educational background of the respondents. The respondents were classified into no formal education, primary, secondary or tertiary levels of education.
Occupation refers to what the women do for a living e.g trading, farming, and the public service.
Economic status of the participants was measured based on the wealth index.
The wealth index is measured by a composite score of several indicators of household possessions. Participants were asked questions on possession of household items and facilities such as piped water, toilet, and type of floor, electricity, radio, television and bicycles; materials used for housing construction; and types of water access and sanitation facilities