PATTERNS OF UTILIZATION OF MATERNAL HEALTH SERVICES IN PRIMARY HEALTH CARE FACILITIES

ABSTRACT

Women in most parts of Niger State face constraints in obtaining and utilizing quality maternal health services. This study was carried out to identify the availability, quality and patterns of utilization of maternal health services in Primary Health Care (PHC) facilities in Niger State, Nigeria. Utilizing the cross-sectional survey design, the political economy and the Health Belief Model theoretical perspectives, data were collected from 903 women of childbearing age, 69 married males and 24 maternal health care providers in 24 Primary Health Care centres located in six Local Government Areas in the state. The women of childbearing age were selected through a combination of cluster, systematic and purposive sampling techniques while the married males were selected based on availability and willingness to participate. The Primary Health Care facilities and the maternal health services providers were selected based on their location and service provision in the selected study communities. Data were obtained from the women of childbearing age through the questionnaire. In-depth interview and focus group discussions were utilized to collect data from the maternal health services providers and married males in the study communities respectively. Primary Health Care facilities were assessed with the aid of a United States Agency for International Developments‟ adapted maternal health services evaluation tool. In addition, focus group discussions elicited information on perceived causes of maternal health problems, maternal health behaviour of mothers and men‟s responsibilities in maternal health care. Findings revealed that most of the PHC centres were dilapidated. Some of the roofs were blown off and leaking, while the doors, windows and floors of some PHC clinics were damaged. There was shortage of medical equipment, consumables and drugs for basic maternal health services. Most of the clinics (75%) had only low level trained health personnel like Community Health Extension Workers and Environmental Health Officers as only six clinics had trained midwives provided through the Midwifery Service Scheme and the SURE-P programmes of the Federal Government. It was observed that the available facilities were poorly managed while the 2-way referral system was poorly implemented and in some instances non-existent. Similarly, there was poor community participation in the health facility management. More than 90% of the women of childbearing age were 18-41 years old, 84.9% had 1-4 children and only 44% practiced family planning. From the findings, 33.7% had no formal education and 15.8% had only primary education. Similarly, 29.7% and 10.3% of their husbands had no formal education and primary education respectively. Women and husbands‟ level of formal education was found to have influenced the utilization of maternal health services by women. Prolonged labour (19.3%), hypertension in pregnancy (18.9%), bleeding in pregnancy (12.6%), anaemia (11.5%), postpartum haemorrhage (8.8%) and retained placenta (6.8%) were common maternal health problems reported by women during their most recent pregnancies. Some women (3.3%) required 3-5 hours of walking to reach the nearest Primary Health Care centre and only about 50% always get attended to in the clinics. Provision for emergency obstetrics care (EmoC) was non-existent in most Primary Health Care facilities. Although most women utilized the antenatal care services (83.1%), only 60.5% delivered in the clinics. Very few utilized the postnatal, family planning and immunization services because many felt that these services are not necessary. Injectable contraceptives were the commonly utilized method of family planning. Although husbands usually pay for services utilized by their wives and occasionally gave other supports for services utilized, their consent was a strong condition for service utilization by women. Most women attended the antenatal clinics more than the recommended four times because of the health workers‟ inadequate knowledge of the new approach. Younger women utilized maternal health services more than the older women. Male dominance had significant impact on maternal health service utilization as most women required the permission and financial support of their husbands for service utilization. Similarly, ability to pay for maternal health services significantly influenced utilization of the services. Women who were gainfully employed utilized the services more than those not gainfully employed on account of their economic strength. It is therefore recommended that actions should be taken by members of the community, government and non-governmental organizations to renovate Primary Health Care facilities. The facilities should be adequately supplied with basic medical equipment, consumables and drugs to improve service delivery. The State and Local Governments should employ and equitably distribute more midwives Primary Health Care facilities to improve the quality of services at various levels of care. Also, public enlightenment on maternal health services utilization and male responsibilities should be effectively carried out in all communities especially among the Nupe and Hausa whose wives hardly utilize the ANC services. Women empowerment programmes should be put in place to improve the women‟s economic power, maternal health services should be made free as earlier proclaimed by the government. There should be effective community participation in facility management and other health care activities to encourage service utilization.