Socio-Economic Determinants Of Choice Of Healthcare Facilities By Pregnant Women In Nigeria

Project and Seminar Material for Public Health

Abstract

This study was carried out to examine the socio-economic determinants of choice of healthcare facilities by pregnant women in FMC Owerri metropolis. The study was carried out to determine whether religious beliefs affects pregnant women choice of healthcare facilities in Nigeria, determine whether educational status affects pregnant women choice of healthcare facilities in Nigeria and determine whether income level affects pregnant women choice of healthcare facilities in Nigeria. The survey design was adopted and the simple random sampling techniques were employed in this study. The population size comprise of pregnant women attending antenatal in FMC Owerri metropolis. In determining the sample size, the researcher conveniently selected 70 respondents and 70 were validated. Self-constructed and validated questionnaire was used for data collection. The collected and validated questionnaires were analyzed using frequency tables. While the hypotheses were tested using Pearson correlation statistical tool, SPSS v23.The result of the findings reveals that religious beliefs affect pregnant women choice of healthcare facilities in Nigeria. Furthermore, the study also revealed that educational status affect pregnant women choice of healthcare facilities in Nigeria. Therefore, it is recommended that midwives and nurses, as the main ANC providers should be aware of potential barriers to health care utilization in Nigeria. They should be trained to be sensitive to the pregnant women’s socio-economic situation, their cultural and traditional beliefs and their communication skills should be improved. To mention but a few.

Table of Content

Title Page
Certification
Dedication
Acknowledgement
Table of Content
List of Tables
Abstract

Chapter One:

Introduction

1.1 Background of the Study
1.2 Statement of the Problem
1.3 Objective of the Study
1.4 Research Questions
1.5 Research Hypothesis
1.6 Significance of the Study
1.7 Scope of the Study
1.8 Limitation of the Study
1.9 Definition of Terms
1.10 Organisations of the Study

Chapter Two:

Review of Literature

2.1 Conceptual Framework
2.2 Theoretical Framework
2.3 Empirical Review

Chapter Three:

Research Methodology

3.1 Research Design
3.2 Population of the Study
3.3 Sample Size Determination
3.4 Sample Size Selection Technique and Procedure
3.5 Research Instrument and Administration
3.6 Method of Data Collection
3.7 Method of Data Analysis
3.8 Validity of the Study
3.9 Reliability of the Study
3.10 Ethical Consideration

Chapter Four:

Data Presentation and Analysis

4.1 Data Presentation
4.2 Analysis of Data
4.3 Answering Research Questions
4.4 Test of Hypotheses
4.5 Discussion of Findings

Chapter Five:

Summary, Conclusion and Recommendation

5.1 Summary
5.2 Conclusion
5.3 Recommendation
References
APPENDIX
QUESTIONNAIRE

Chapter One

Introduction

1.1 Background of the Study

Maternal health is of utmost importance to the global community, owing to the fact that around the world, women die every day from pregnancy and childbirth-related health problems. In 2015 alone, approximately 303,000 women died around the globe due to pregnancy and childbirth complications (UNPFA, 2016). Although the United Nations Population Fund acknowledges that the world has witnessed a 44 per cent decline in the rate of maternal death since the 1990s, the agency still stresses that about 830 women continue to die every day from pregnancy and childbirth, a figure which narrows down to about one maternal death every two minutes. With statistics such as this, it is certain that maternal mortality contributes significantly to the global death burden.

To safeguard maternal health, as well as ensure that maternal mortality is kept at the barest minimum, the United Nations listed maternal health as the fifth of the eight Millennium Development Goals (MDGs), set by all its 191 member states in 2000. The UN further sets the target of reducing the number of women dying as a result of pregnancy and childbirth by three quarters by the year 2015. To achieve this, attention was directed by the United Nations to the usage of skilled birth attendants, among other options during pregnancy and childbirth.

Although the cases of maternal deaths have remarkably decreased by about 35% at global level, the problem is still alarming in some specific countries (WHO, 2013). In the case of Nigeria for example, maternal deaths was about 630 per 100,000 live births (CIA, 2012). This was against the 160 per 100,000 live births in Botswana, 8 per 100,000 live births in United States and 400 per 100,000 live births worldwide in the year 2012. This has been the trend with Nigeria recording the relatively higher number of maternal mortality cases across the globe. However, lack of access and use of maternal healthcare services have been identified to be the major factor responsible for the high cases of maternal deaths. According to De Bernis, Sherratt, AbouZahr and VanLerberghe (2013), almost 4 million newly born infants were not been taken through consistent postnatal care; and a significant number of them were disabled mainly due to birth complications that were poorly attended. This has buttressed the report by the Federal Ministry of Health (FMOH, 2014) which posited that a large number of maternal mortality in Nigeria occurred at homes and that made it difficult for health agencies to see, assess and properly account for the cases in the official records of statistics.

The behaviour of pregnant women varies from place to place and from time to time. When a woman is pregnant the demand for healthcare service is determine by many factors, some factors could be based on religious belief, culture or social status of the woman. The demand and supply of health services during pregnancy, at birth and immediately after birth are notably important for the health and survival of the mother and child. According to WHO (2012), human capital is a set of cognitive, physical nutritional and biological aptitudes which reinforce human capacities. Human capital has two main components: education and health. When the two function well, the human capital becomes productive and develop rapidly. Studies have shown that African countries are lagging behind in terms of demand and supply of healthcare services.

In Africa, less than 50% of births were attended by a skilled worker (WHO, 2014) despite an increase from 55% to 66% between 1990 and 2011 in all developing regions as indicated by the 2013 Millennium Development Goals Report (The MDG Report, 2013). These figures are far lower than the global target for this indicator which aimed, and these are due to some factors faced by most of these pregnant women.

To most women, their health-seeking behaviour during pregnancy and childbirth will depend on their status in the society and the level and type of information to which they are exposed. Those with balanced religious teachings will likely conform by patronising conventional healthcare facilities. On the other hand, those who are religiously misinformed might innovate by seeking care outside institutionalised health institutions, such as TBAs and faith-based birth attendants, due to wrong religious teachings. All these factors play a paramount role in the choice of healthcare facilities by pregnant women thus this study seeks to examine the socio-economic determinants of choice of healthcare facilities by pregnant women in Nigeria.

1.2 Statement of the Problem

According to Babalola, & Adesegun (2009), utilization of maternal health services is associated with improved maternal and neonatal health outcomes. Considering global and national interests in the Millennium Development Goal and Nigeria’s high level of maternal mortality, understanding the factors affecting maternal health use and choice of helthcare facilities is crucial. Studies on the use of maternal care services have largely overlooked community and other contextual factors. Envuladu, Agbo, Lassa, Kigbu, and Zoakah (2013) noted that significant number of women in developing countries, particularly in the sub-Saharan countries, do not have the opportunity to be attended to by skilled personnel during childbirth mostly due to socio-economic factors. This is a major factor in maternal and infantile mortality.

Socioeconomic and geographical inequalities affects the utilization of health facility childbirth services to ensure safe birth and reduction of maternal mortality and a study revealed by Muhammad & Tepanata (2019) shows that Nigeria records a high prevalence of home deliveries with very low facility deliveries despite the efforts of government and international non-governmental organizations in supporting maternal health services due to this fact. Hence, this study seeks to address this.

1.3 Objectives of the Study

The main objective of this study is to examine the socio-economic determinants of choice of healthcare facilities by pregnant women in Nigeria.

Other objectives of this study are:

To determine whether religious beliefs affects pregnant women choice of healthcare facilities in Nigeria.
To determine whether educational status affects pregnant women choice of healthcare facilities in Nigeria.
To determine whether income level affects pregnant women choice of healthcare facilities in Nigeria.

1.4 Research Questions

The following research questions will be answered in this study:

Does religious beliefs affect pregnant women choice of healthcare facilities in Nigeria?
Does educational status affect pregnant women choice of healthcare facilities in Nigeria?
Does income level affect pregnant women choice of healthcare facilities in Nigeria?

1.5 Research Hypotheses

The following null hypotheses will validate this study:

H0: There is no significant relationship between socio-economic status and the choice of healthcare facilities among pregnant women.
Ha: There is a significant relationship between socio-economic status and the choice of healthcare facilities among pregnant women.

1.6 Significance of the Study

It is believed that at the end of this study the findings will be of utmost benefits to every health professionals as it will reveal the impact of a pregnant woman’s socio-economic status on her choice of healthcare facility. The ministry of health will also learn a great deal from the findings as it serves as a material for onward sensitization within cities and communities about the health of pregnant women.

Furthermore, the findings will also be relevant to those who intend to carry out a similar research topic as it has contributed to the existing literature. Finally, the research will serve as a fuel of new reasoning and further research work in nutritional knowledge and practice among expectant mothers, and to health science students, lecturers and the general public.

1.7 Scope of the Study

This study is focused on the socio-economic determinants of choice of healthcare facilities by pregnant women in Nigeria. Specifically, this study will focus on determining whether religious beliefs affects pregnant women choice of healthcare facilities in Nigeria, determining whether educational status affects pregnant women choice of healthcare facilities in Nigeria and determining whether income level affects pregnant women choice of healthcare facilities in Nigeria.

1.8 Limitations of the Study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. However, the researcher was able to manage these just to ensure the success of this study.

Moreover, the case study method utilized in the study posed some challenges to the investigator including the possibility of biases and poor judgment of issues. However, the investigator relied on respect for the general principles of procedures, justice, fairness, objectivity in observation and recording, and weighing of evidence to overcome the challenges.

1.9 Definition of Terms

Pregnant Women:

Pregnancy, also known as gestation, is the time during which one or more offspring develops inside a woman. Pregnancy can occur by sexual intercourse or assisted reproductive technology. Childbirth typically occurs around 40 weeks from the last menstrual period.

1.10 Organization Of The Study

The study is categorized into five chapters. The first chapter presents the background of the study, statement of the problem, objective of the study, research questions and hypothesis, the significance of the study, scope/limitations of the study, and definition of terms. The chapter two covers the review of literature with emphasis on conceptual framework, theoretical framework, and empirical review. Likewise, the chapter three which is the research methodology, specifically covers the research design, population of the study, sample size determination, sample size, and selection technique and procedure, research instrument and administration, method of data collection, method of data analysis, validity and reliability of the study, and ethical consideration. The second to last chapter being the chapter four presents the data presentation and analysis, while the last chapter(chapter five) contains the summary, conclusion and recommendation.

Chapter Five

Summary, Conclusion and Recommendation

5.1 Introduction

This chapter summarizes the findings on socio-economic determinants of choice of healthcare facilities by pregnant women in FMC Owerri metropolis. The chapter consists of summary of the study, conclusions, and recommendations.

5.1 Summary

In this study, our focus was to examine socio-economic determinants of choice of healthcare facilities by pregnant women in FMC Owerri metropolis. The study was specifically carried out to determine whether religious beliefs affects pregnant women choice of healthcare facilities in Nigeria, determine whether educational status affects pregnant women choice of healthcare facilities in Nigeria and determine whether income level affects pregnant women choice of healthcare facilities in Nigeria.

The study adopted the survey research design and randomly enrolled participants in the study. A total of 70 responses were validated from the enrolled participants where all respondent were pregnant women attending antenatalin FMC Owerri metropolis.

5.2 Conclusion

Based on the findings of this study, the researcher concluded that;

Religious beliefs affect pregnant women choice of healthcare facilities in Nigeria.
Educational status affect pregnant women choice of healthcare facilities in Nigeria.
Income level affect pregnant women choice of healthcare facilities in Nigeria.

5.4 Recommendations

Based on the findings of the study, the following recommendations are proffered.

Midwives and nurses, as the main ANC providers should be aware of potential barriers to health care utilization in Nigeria. They should be trained to be sensitive to the pregnant women’s socio-economic situation, their cultural and traditional beliefs and their communication skills should be improved.•
Government should ensure effective health policy formulation and implementation by states and area councils nation wide. There is need to ensure an effective health management information system and a communication strategy for mobilizing and sustaining the Health System Reform Programme (HSRP).