A REVIEW OF THE BARRIERS AND SOCIO-CULTURAL FACTORS INFLUENCING THE ACCESS TO MATERNAL HEALTH CARE SERVICES IN NIGERIA

ABSTRACT

Access means that services are available whenever and wherever the patient needs them and that the point of entry is defined.

Access to maternal healthcare facility is vital for both the wellbeing of the mother and survival of the child during pregnancy and childbirth.

The objective of the thesis was to review the barriers and socio-cultural factors influencing the access to maternal healthcare services in Nigeria. “The review answered the following questions:”

What factors prevent access to maternal healthcare services in Nigeria?

What are the socio-cultural factors that hinder/prevent women from utilizing mater-nal health services in Nigeria?

The study was literature based and an extensive search was carried out to find relevant studies. A range of electronic databases was searched for articles published from 1998 to 2013.

The results of the review showed that factors that influence the access and utilization of maternal health care services were economic, socio-cultural, and health sys-tem factors. These factors include to a larger extent the household, community, the state, the health institution and also the social and political environment.

The study recommends reducing the cost of care and improving the quality of maternal health care especially for the poor and rural dwellers and also the empowerment of women as prerequisites for any tangible improvement in the access and utilization of maternal health care and obstetric delivery services in Nigeria.

TABLE OF CONTENTS

1        Introduction

          1.1     Background

          1.2     Brief History about Nigeria

          1.2     Maternal Health in Nigeria

2        Background literature review

          2.1     Women’s Health

          2.2     Maternal Mortality

          2.3     Fertility Rates and Access to Contraceptive Methods

          2.4     Sexually Transmitted Diseases

          2.5     Component of Maternal Healthcare Services

                   2.5.1  Antenatal Care:

                   2.5.2  Skilled Birth Attendance:

                   2.5.3  Post natal Care:

          2.6     Access to Health Care

          2.7     Factors influencing the use of Health services

                   2.7.1  Availability

                   2.7.2  Traditional Medicine

                   2.7.3  Affordability

                   2.7.4  Quality of care

                   2.7.5  Socio-cultural

          2.8     Consequences on Women:

2.9     Quality of Maternal Health Care Services and Women Experience of Care

                   2.9.1  Challenges Faced by Maternal Health Care Providers

                   2.9.2  How Quality of Healthcare reduce Maternal Mortality

          2.10   Summary of background literature review

3        Data Collection and Method

          3.1     Search Strategy/search engines and database

          3.2     Search Words

          3.3     Search Results

          3.4     Organizing documents for review

          3.5     Abstraction of information from articles

          3.6     Inclusion Criteria Used

          3.7     Exclusion Criteria

          3.8     Data description

          3.9     Flowchart of search strategy

          3.10   Quality appraisal

          3.11   Items used to assess the quality of studies

          3.12   Ethical Considerations

4        Description of articles

          4.1     Synthesis of the findings from the articles

5        Results of empirical studies

          5.1     Socio-cultural factors to access

          5.2     Consequences/ Adverse of effects of Lack of access to maternal healthcare facilities

                   5.2.1  Intensity of the problem

                   5.2.2   Population that is affected

                   5.2.3  Risk Factors

                   5.2.4   Social and Economic Consequences:

          5.4     Validity and Reliability of the Study

          5.5     Business implication of this thesis

6        Conclusion/Recommendation

          6.1     Recommendations Appendices

          7.1     Table Summary of reviewed articles

          7.2     Appendix 2:

                   Table  showing  summary  of  classification,  synthesis  and  comparison  of articles in terms of quality rankings  

1     Introduction

1.1     Background

The term maternal health includes the health of women during pregnancy, childbirth and the postpartum period. It encompasses the health care dimension of family planning, preconception, prenatal and postnatal care in order to reduce maternal morbidity and mortality (World Health Organization, 2012.Maternal Health). In developing countries like Nigeria, pregnancy and child birth compli-cations are major causes of maternal and child death and these deaths are at-tributed to the fact that most pregnant mothers do not get the appropriate care they need as a result of certain barriers to the health care facilities.

Therefore, the aim of this review is to identify these factors that prevent women from having appropriate access to maternal health care services in Nigeria. The study will answer the following questions:

(a)  What factors prevent access to maternal healthcare services in Nigeria?

(b)  What are the social cultural factors that hinder/prevent women from utilizing

maternal health services in Nigeria?

1.2    Brief History about Nigeria

Nigeria is a big country comprising many ethnic group and different religious belief. It is reported that about 374 identifiable ethnic groups (NDHS, 2008) exist and the major religions are Islam and Christianity. Apart from the two major reli-gions, a few people also participate in traditional religions. Nigeria is a major producer and exporter of oil in Africa. There are six geographical zones in Nige-ria, these zones include, North Central, North East, North West, South East, South South, and South West. It is pertinent to note that the socioeconomic, cultural and religion pattern of the Southern and Northern region of Nigeria are not a similar. They differ in all ramifications. There is also a wide difference in the literacy rate between the different regions in Nigeria. The people from the southern part of Nigeria are more educated than their counterparts in the North-ern region. According to previous reports, approximately 70% of women and half of men do not have education in the North East and North West compared 15% of Women and 8% of men in the South South .The South West records highest proportion of women 16% and men 21% who have completed more than a secondary level of education (NDHS, 2008). More women in the South-ern region are more gainfully employed in professional, technical or managerial occupations and this places them in a higher wealth quintiles compared to their Northern counterpart. This could be attributed as the main reason for the differ-ences observed in utilization of various Maternal Health Care Services across the country. For instance, the births percentage that is handled by a skilled pro-fessional range from as high of 81.8% in the South East as low as 9.8% in the North West. Similarly, 90.1% of women in the North West are more likely to give birth at home compared to 22.5% in the South West (NDHS, 2008).

It is believed that about 10% of all maternal deaths globally come from Nigeria. Nigeria is the second highest in maternal mortality rate in the world after India. It is reported that for every women that dies from pregnancy related causes, 20 to 30 more will develop short and long term damage to their reproductive organs resulting in disability such as obstetric fistula, pelvic inflammatory diseases, a ruptured uterus etc. (MNPI report, n.d.; Ogunjuyigbe & Liasu, n.d.; WHO, 2007). This high morbidity and mortality rates make maternal health a huge public health issue in Nigeria and most developing countries.

1.2    Maternal Health in Nigeria

Nigeria has experience some progress in the last two decades in reducing ma-ternal deaths, but unfortunately, the number of women that die during pregnan-cy and childbirth from complications arising from childbirth remains appallingly high. Nigeria is the most populous and one of the wealthiest countries in Africa but with all these wealth, the country continues to experience high rates of ma-ternal deaths. Nigeria has the 10^th highest maternal mortality ratio (MMR) in the world, according to UN estimates, with 630 women dying per 100,000 birth

a    higher proportion than in Afghanistan or Haiti, and only slightly lower than in Liberia or Sudan. (Ibid, p.23). An estimated 40,000 Nigerian women die in preg-nancy or childbirth each year and another 1 million to 1.6 million suffer from se-rious disabilities from pregnancy and birth related causes annually (WHO,

UNICEF,UNFPA and WORLD BANK, 2012 ). Nigerian women have an average total of 5.7 births in their life with each pregnancy exposing them to the risk of...

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