Pregnancy Duration And Choice Of Ante-Natal And Delivery Care

Project and Seminar Material for Public Health

Abstract

Pregnancy duration and choice of care for maternal health are crucial primary health issues that the World Health Organization (WHO) keeps constant in the campaign for all round healthcare delivery for mother and child. To be sure, there is consensus on the need for optimal care for the mother and baby; this is believed to enhance the mother and child social development and biological growth and to reduce maternal and infant mortality and morbidity which are prevalent in Nigeria and other Sub-Saharan Africa countries.

The study thus, investigates challenges being faced by the mothers, which are sometime inconsistent to their socio-economic pursuits, growth and maternal well being. Other objectives include understanding of inhibitions and determinants to pregnant healthcare consumptions contribution in terms of culture, income, occupation etc. Methodologically, sample size of 152 respondents was selected for interview through purposeful random sampling among the pregnant and nursing mothers between the age of 15 to 49 years in Ijebu- Yoruba south western Nigeria involving mixed urban (i.e. informal and informal sectors) and the rural societies. The methods of data collection were survey method and in-depth (IDI) interviews. 10 in-depth interviews for mothers, fathers, health givers and opinions leaders were conducted.

The data were analyzed through simple statistical method and content analysis for IDI. Data revealed strong significant but inverse relationship between the socio-cultural factors and choice of health care also incongruous relationship between the pregnant woman and nursing mother‘s residence and healthcare consumption. The results amongst other things saw culture of patriarch , income ,occupation and where one reside acting as determinants for when commences care and the choice of healthcare centre.

The ethnographic result also confirmed this much that men are the key to their wives choice of care during pregnancy this is because majority of them still pay the medical bill. It is therefore suggested that government, international agencies and concerned nongovernmental organization (NGOs) should intensify effort to open up rural and mixed urban settlements to Human Development Amenities (HDA) and bring about a strong intervention to bring about adequate maternal healthcare delivery.

Chapter One

Introduction

1.1 Background of the Study

Antenatal care refers to the care that is given to a pregnant women woman from the time that conception is confirmed until the beginning of labour. This is also viewed as an important point of contact between health workers and women and an opportunity for provision of health education including how to detect pregnancy complications and development of a birth plan to ensure delivery at a health facility. The purpose of antenatal care is to monitor and improve the wellbeing of the mother and the foetus, for this reason the benefits of antenatal care cannot be over emphasized. Antenatal care is one of the important measures used in reducing maternal morbidity. Moreover, antenatal isa type of preventive healthcare, with the goal of providing regular checkups that allow doctors and midwives to treat and prevent potential health problems throughout the course of the pregnancy while promoting healthy lifestyles that benefit mother and child.

The concept of antenatal care (ANC) as an effective public health strategy is credited to the dramatic improvements in maternal and prenatal outcomes witnessed in Europe in the last century, but the impact of antenatal care in these settings has not recorded the desired results. Whereas acceptance of antenatal care in industrialized countries is near universal, in developing countries, the uptake is less, and a large proportion of women deliver outside the health care system. About 63.6% of Nigerian mothers receive antenatal care, while trained personnel attend 41.6% of births. Consequently, high maternal mortality figures and rising perinatal mortality rates are the norm (Fawole, Okunlola&Adekunle, 2008). Nwaeze, Enabor, oluwasola and Aimakhu (2013) further reported that the proportion of Nigerian women that receive antenatal care and those that are delivered by skilled birth attendants have however remained far from acceptance.

The World Health Organization (WHO) reported in 2015 thataround 830 women died every day from problems in pregnancy and childbirth. The WHO recommends that pregnant women should all receive 4 antenatal visits to spot and treat problems and give immunization. Although antenatal care is important for improving the health of the mother and the baby, Nigeria unfortunately is among the countries worst hit by maternal death challenges. According to the World Health organization (WHO, 2007) report, Nigeria is the 2nd in the world after India in terms of maternal and infant deaths. The international community has committed to improving maternal health by 2015 with millennium development goal number 5, which aims to reduce maternal mortality by three quarters and reach universal access to reproductive health care. According to WHO, a maternal mortality ratio in 2013 was estimated to be 230 per 100,000 live births in developing countries to 16 per 100,000 live births in developed countries. Even with this commitment, many countries have failed to implement effective programs to reduce maternal morbidity and women continue to suffer from the complications of pregnancy and childbirth.

Many countries have made targeted efforts to ensure the provision and utilization of timely and adequate ANC (Bbaale, 2011). The most common indicators of health and reproductive behavior include utilization rates of antenatal care, age when women give birth, pregnancy order and birth spacing. These factors can be modified if the services can be made accessible and affordable to women and their families. The role of timely and adequate antenatal care visits in ensuring maternal and neonatal health cannot be underestimated. Early antenatal care visits facilitates the follow up and monitoring of fetal growth and maternal health by physicians (Bbaale, 2011). During antenatal care visits, mothers can be informed about the warning signs and symptoms during pregnancy, preventive care and treatment strategies, proper nutrition, breastfeeding, use of contraceptive methods for family planning, prevention of mother to child transmission of HIV (PMTCT), use of Sulfadoxine Pyrimethamine (IPTp) (Bbaale, 2011). Overall the mentioned issues show the critical need for early initiation of antenatal care (ANC).

Women’s perception of antenatal visits significantly influence their assessment of quality services and are widely recognized as a tool to improve health services in many developed countries. Women’s perceived quality is defined as subjective and dynamic perception of the extent to which expected health care is received by the person. Since the perceived quality invariably affects mothers’ behaviour, a mother may choose not to return and may result in adverse outcome to the mother and child and also result in poor utilization of antenatal care services. Satisfied women are likely to come back for the services and recommend services to others (Wijesinghe and Fernado, 2014). Various factors including attitude of staff, cost of care time spent at the hospital and doctor’s communication have been found to influence patient satisfaction.

1.2 Statement of Problem

Annually, an estimated 529,000 women die from complications of pregnancy and childbirth globally. Ninety nine percent (99%) of these antenatal deaths occur in the developing countries and one percent (1%) in the developed countries. This means that every year, close to nine (9) million women suffer some type of injury from pregnancy or childbirth that can have profound effect on their lives and families. Since Nigeria is regarded as a developing country and one of the major sectors of the economy is health which looks to take care of the health status of the people, progress in improving antenatal care, disparities on access to antenatal care remain significant. Women that are with tertiary education are likely to have antenatal care and report four or more antenatal visit as women with secondary or no education. All these are indications that despite the high antenatal coverage, some registrants may not be deriving maximum benefit from the services. Based on these, the researcher intends to find the perception of pregnant women towards antenatal care services and their level of satisfaction.

1.3 Objective of the Study

The main objective of this study was to determine the pregnancy duration and choice of ante-natal and delivery care in Ijebu South while the specific objectives were to:

To determine the perception of pregnant women towards the quality of antenatal care services in Ijebu South
To examine providers’ processes of care in delivering antenatal services in Ijebu South.
To determine the level of client satisfaction with antenatal services provided in Ijebu South.

1.4 Significance of the Study:

The findings of this study when communicated will:

To the pregnant women: Alleviate the complications resulting from maternal and child mortality rate in Nigeria especially in Ogun State.
To nurses and midwives: Assist in planning and educating pregnant women attending antenatal clinic in NAUTH on the importance of antenatal care services in Nigeria
To the researcher: Acts also as a guide for further studies

1.5 Research Questions

What is the perception of pregnant women towards the quality of antenatal care services in Ijebu South?
What are the providers’ processes of care in delivering antenatal services in Ijebu South?
What is the level of client satisfaction with antenatal services provided in Ijebu South?

1.6 Scope of the Study

This study is to determine the perception and satisfaction of pregnant women towards the quality of antenatal care services in Ijebu South, Ogun state.

1.7 Operational Definition of Terms

Antenatal:

Before birth

Pregnancy:

The condition from conception to the expulsion of the foetus

Festus:

The term used eight (8) weeks after conception until birth.

Client:

Pregnant women receiving advice and treatment in the hospital/ antenatal clinic

Perception:

An overview of a pregnant woman’s thought, belief, idea and ability to understand the true meaning and impact antenatal care would make towards health, baby, family and entire populace at large.

Quality Antenatal Care:

The ability of pregnant women to receive 4 or more antenatal care visits with all necessary care rendered during the visits.

Satisfaction:

The extent to which specific needs of pregnant women on antenatal care are met.

Chapter Five

Summary of Findings, Conclusion and Recommendation

5.1 Summary of Findings

Findings from this study showed good quality with regards to process of care and very good quality with regards to structural and outcome attribute of quality. There was a high level of client satisfaction with antenatal care received (86.8%). A significant association was observed between client satisfaction and marital status, educational level and occupational group (P<0.05) but no association was observed with parity (P>0.05). The gap in health worker’s availability in health facilities for antenatal care seems to be a recurring issue as many studies reported same. This is an issue that need to be addressed especially in the area of training to expand workers’ capacity. Regular in-service training comes highly recommended, supervision and various form of motivation to boost the productivity of the available workers. The observation of processes of care revealed poor practice of the minimum procedures to be done in antenatal consultations. A very important aspect of quality is client satisfaction with service provision and there are many determinants to that. This study has an overall clients’ satisfaction of 86.8% with 84.8% and 83.7% of the clients admitting willingness to come back in subsequent pregnancies and recommend the facility to someone else respectively. Many respondents had to wait for longer than one hour before being attended to but it is worth noting that the time they responded that they wait includes the time usually devoted to group health talk.
The importance of high quality antenatal care cannot be overemphasized at it will not only ensure women attendance to the clinics but will also contribute in combating maternal mortality which is high in this part of the world. Clients’ perspective of quality of care with regards to their satisfaction with service provision is also a vital part that should always be considered to have an improved service delivery.

5.2 Conclusion

The main objective of this study was to determine the pregnancy duration and choice of ante-natal and delivery care in Ijebu South.

There is no doubt that the antenatal care services provided in the hospital is very good despite some observed shortcomings. Lack of enough manpower is a very big challenge to providing adequate antenatal service especially the lower cadre of staff. This is very important as everybody has a role to play at different stages in accessing care.

5.3 Recommendation

The following recommendations were made based on the findings of the study;

There should be a periodic assessment of quality of antenatal care as this will help for continuous improvement in service delivery especially looking at quality from the clients’ perspectives.
The authority should employ workers in the primary health centres especially the lower cadre of staff that provide allied services in the centre like personnel, pharmacy technician etc.
There should be regular supervision and in-service training for the staff to keep them abreast with recent development on best practices in patient care with regards to things like client privacy, health education etc.
There should be awareness creation on the part of the service providers on the need to reduce client waiting time as it is a major cause of dissatisfaction and also on the part of the government to employ more staff to meet the required minimum standard so as to reduce provider-client ratio.