Background to the study
Health has been given a wide interpretation because it covers everything from mental and social wellbeing of an individual to his physical soundness, adequate spiritual state, adequate occupation and environment. The widely accepted definition is that of WHO, defined as a state of complete physical, mental & social well-being and not merely the absence of disease or infirmity (WHO, 1948). Health in itself is of great value as it enables people to enjoy their potential as human beings. Therefore, it is important to protect health through healthcare services (WHO, 2009). Health care refers to the prevention, treatment and management of illness and preservation of mental and physical well-being through the services offered by medical, nursing and allied health professions (WHO, 2010) as well as care received in the family nexus.
This study focuses on the health care seeking behaviour of women during pregnancy and delivery. Uzochukwu and Onwujekwe, (2004) viewed health care seeking behaviour as activities undertaken by individuals who perceive they have a health problem or are ill for the purpose of finding an appropriate remedy. It also focuses on specific steps taken in response to illness and what is done and why (Gotsadze, Bennett, Ranson and Gzirishvili, 2005). Maternal health care is defined as the promotive, preventive, curative and rehabilitative health care for mothers during pregnancy, childbirth and 42 days after childbirth (Park, 2002). Childbirth is one of the important events affecting the health of a woman, especially in developing countries like Nigeria (Raj, 2005). In many Nigerian communities, utilization of maternal health services is often influenced by factors like traditional health seeking behaviour, access and attitude of the health care providers (Garba, Hellanden, Ajayi, Suleyman and Oluwabamide, 2011).This results in seeking maternal health services from traditional healers, traditional birth attendants and unskilled family members with resultant consequences such as maternal and child morbidity and mortality. Maternal mortality is an important indicator of maternal health and wellbeing in any country (Ogujuyigbe & Liasu, 2007). Consequently, the reduction of maternal mortality level is a key Millennium Development Goal, and efforts to improve women’s health in the country have been undertaken by local, national and international organizations (Palto, 2008).
Globally, health care seeking behaviour of women is poor. Baroon (2007) noted that in some part of United States, women receive little or no prenatal care. Keily and Kogan (2008) indicate that most women who receive prenatal care do that late and many do not complete four antenatal visits. According to Azuogu, Azuogu and Nwonu (2011), the health care seeking behaviuor of Nigerian women remains poor and possess one of the greatest challenges to maternal mortality reduction in the country. UNICEF (2008) reveals that in Nigeria, skilled birth attendants attend to only 42 percent of birth. According to Oladapo and Osiberu (2008), many pregnant women in Nigeria avoid seeking care until they go into labour. Ufford and Menkiti (2008) note that about 37% of all deliveries take place in health care facility with less than half of the deliveries attended to by skilled attendants. Statistics from Monitoring and Evaluation Unit of Nnewi North for a three-year evaluation period revealed that for the year 2007, the average number of women that visited antenatal clinic was one hundred and forty three (143). Among the 143 women that attended antenatal clinic, 46 (38%) visited once while only 27 (19%) delivered in the health facilities with the assistance of trained health workers; for the year 2008, an average of one hundred and thirty seven (137) women attended antenatal clinic, 47(34%) attended once and 29 (21%) delivered in the health facilities. Similarly in 2009, an average of one hundred and forty-eight (148) pregnant women visited antenatal clinic, 54 (36%) visited once while only 28 (18%) delivered in the health facilities and with assistance of trained health workers. Hence this study was geared towards the health care seeking behaviour of women during pregnancy and delivery.
Statement of Problem
Health care seeking behaviors of consumers of health care services are important factors in health management, but these factors are often ignored while considering schemes for providing health facilities to people. As a result, new schemes providing health care do not get the desired acceptance of the community, and are therefore rendered unsuccessful (Singh & Gupta, 2006). For instance, many developing countries’ governmental policies including Nigeria have given attention to health reforms aimed at reducing maternal mortality (White, Small, Frederic, Joseph, Bateau & Kershaw, 2006).
Available evidence shows that Nigeria has some of the worst statistics relating to maternal mortality in the developing world. Indeed (with range of 339/100,000 to 1,716/100,000), Nigeria’s maternal mortality ratio is considered to be the second highest in the world (Garba, Ajayi, Isa, Umar & Onubanjor, 2008; WHO, 2007; Osubor, Fatusi & Chiwuzie, 2006). There are problems involved in estimating MMR, particularly in the absence of reliable data. Consequently, among the accepted proxies for monitoring progress towards reducing MMR include trends in antenatal, delivery care, and postnatal care.
Programs have included extension of health services to increase access to health care for pregnant women. Some state governments have gone to the extent of providing free maternal health services to pregnant women. Nnewi in Anambra State where this study was carried out has up to twenty-four (24) primary health centers / health clinics on ground in a bid to increase access to health care of pregnant women. From the researcher observation, women in Nnewi do not access care in these health centers even though they offer services at little or no cost. If these women do not have access to maternal health care services, progress towards reduction of maternal morbidity and mortality rate cannot be successful. However, the researcher is aware of the fact that the only tertiary health institution in Anambra State is situated at Nnewi. Apart from the teaching hospital, there are many private hospitals and maternities, patent medicine stores, TBA homes and faith based facilities that are likely to offer services to pregnant women. Based on the above submission, the researcher was interested in empirically finding out where and how these women actually seek antenatal and delivery services as well as determine socio-demographic factors that influence their health care seeking behaviours.
Purpose of the Study
The purpose of the study is to determine the health care seeking behaviour of childbearing women in Nnewi North during pregnancy and delivery as well as factors influencing those behaviours.
- To identify the respondents’ patterns of antenatal care seeking.
- To identify the respondents’ patterns of delivery care seeking.
- To determine the influence of socio-demographic characteristics of the respondents on their health seeking behaviours during pregnancy and delivery.
- What are the respondents’ patterns of antenatal care seeking behaviour?
- What are the respondents’ patterns of delivery care seeking behaviour?
- To what extent do socio-demographic characteristics (age, marital status, level of education and socio-economic status) of the respondents influence their health care seeking behaviour?
Significance of the Study
Understanding behaviour is prerequisite to changing the behaviour and improved health practices. Health care seeking behaviour of pregnant women is a vital factor in addressing potential fatal pregnancy complications.
Findings of this study will reveal where and how pregnant women seek antenatal and delivery services. It will also unveil some of the social and demographic characteristics that influence those behaviours. Findings of this study will be communicated to appropriate authorities who will use the findings to improve maternal health care. It will also serve as basis for community health programmes among nurses, midwives and other health workers with a view to improving maternal health services and reducing maternal morbidity and mortality.