LEVEL OF UTILIZATION OF ANTE-NATAL CARE SERVICES, PLACE OF DELIVERY AND BIRTH OUTCOMES AMONG MOTHERS OF UNDER 5 CHILDREN IN ODUKPANI LOCAL GOVERNMENT AREA, CROSS RIVER STATE, NIGERIA
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- Background of the study
Pregnancy and childbirth is a period of joy and happiness to the woman and the entire family. It is an experience that every woman wishes to go through but the challenges of complications and mortality that accrue from it make it a thing of concern in the society. It is noted that the extent of utilization of maternal and child healthcare services is a major determinant of maternal and child morbidity and mortality. It is also observed that women who adequately utilize these services are relatively free from traumas of pregnancy and child birth and also have children that will be free from childhood problems (Azubuike, 2014).
Globally, more than 200 million women become pregnant each year and 40% are estimated to experience pregnancy related health problems with 15% experiencing serious or long term complications and 1.7% developing fatal complications. The lifetime risk of deaths due to pregnancy related complications is 250 folds higher among women in developing countries including Nigeria. It is estimated that 88 – 98% of these deaths are avoidable and 70% are related to five direct obstetric complications: – postpartum haemorrhage, puerperal pre –eclampsia and eclampsia, obstructed labour and abortion (Nwokoro, 2014). AbouZahr cited in Yanagisawa andWakai (2016), stated that the prevention and management of these complications is the key to improving maternal health. It is estimated that 97% of pregnant women in developed countries receive antenatal care (ANC) services and 99% use skilled obstetric services during delivery.
According to World Health Organization (WHO) (2015), it has been recorded that every year, 3.3 million babies are stillborn and maternal deaths have also continued unabated. More than half a million women die of pregnancy related complications with ninety-nine percent (99%) of these deaths occurring in developing regions particularly Africa and Asia (WHO, 2015). World Health Organization further maintained that the implication is that every minute, at least a woman dies from pregnancy and childbirth in these regions. Comparing with other regions of the world, the lifetime risk of maternal deaths in sub Saharan Africa is 1 in 22 mothers. North Africa has 1 in 210, 1 in 62 for Oceania, 1 in 120 for Asia, and 1in 290 for Latin America and the Caribbean (WHO, 2015).Women and children all over the world are experiencing life threatening problems and deaths due to pregnancy and childbirth. This may be attributed to the availability, accessibility and extent of utilization of maternal and child healthcare services among them. Adamu (2011) opined that the extent of utilization of maternal and child healthcare services is the proximate factor behind the high rate of maternal and child morbidity and mortality. The high rate of maternal and child morbidity and mortality has become a serious challenge to the global public health especially in developing countries like Nigeria (Babalola andFatusi, 2015).This is why all nations around the world have decided to sign up under Sustainable Development Goals to reduce maternal and child mortality by at least 2/3 and 3/4 before 2030 respectively through improving maternal and child health (Azubuike, 2014).
As stated by Ugbor, Onyinye, Arua and Nwanosike (2017), measures of maternal deaths are critical as they reflect a woman’s access to essential services during pregnancy, childbirth, general health, nutritional status, getting to reproductive care services as way as family planning. The indices such as economic status, education, birth level, and birth interval are key predictors of health services utilization (Ugbor, Onyinye, Arua andNwanosike, 2017). Components of MCH according to Chandihouk (2016) include family planning, antenatal services, delivery care service, malaria prophylactic, iron and foliate supplement, children screening, immunization, growth monitoring, school health services and adolescent health care. Adamu (2011) listed some components of MCH to include antenatal care, skilled birth attendants, post natal care, family planning, and immunization and iron supplements.
Antenatal care (ANC) is a type of health care service rendered to a woman during the period of pregnancy. ANC is the care for effective prevention of negative pregnancy outcomes when it is sought early in pregnancy and continues throughout delivery (Babalola and Fatusi, 2015). Antenatal care service according to Elo (2014) is the care given to pregnant mothers so that they will have safe pregnancy and healthy babies. Babalola and Fatusi (2015) suggested that ANC gives opportunities for providing health care services, such as prophylactic treatment of malaria, and immunization against neonatal tetanus. They further stated that ANC are those cares given to pregnant women to help prevent or minimize complications of pregnancy so as to have healthy babies. Ajaegbu (2013) noted that ANC is very necessary because it helps in the diagnosis and treatment of complications that could endanger the life of mother and child during pregnancy and delivery. In this study, antenatal care can be defined as care given to a pregnant woman throughout the period of pregnancy to ensure safe delivery and to have a healthy baby. Antenatal care service also helps in identifying women with problem, treating them, counseling and educating them about their own health and that of their babies till the time of delivery.
Iyaniwure and Yusuf (2014) observed that it is not enough to receive ANC only. This is because majority of the complications that cause maternal death occur during or shortly after delivery. It is therefore important that pregnant women have skilled obstetric attendance during delivery because pregnancy related complications are a leading cause of death among women in developing countries. According to joint WHO/UNFPA/UNICEF/World Bank cited in Federal Ministry of Health Nigeria (2013), skilled obstetric care or attendance refers to the process by which a pregnant woman and her infant are provided with adequate care during pregnancy, labor, birth, postpartum and immediate newborn period, whether the place of delivery is the home or hospital. In order for this process to take place, the attendant must have the necessary skills and must be supported by an enabling environment at various levels of the healthcare system (FMOH, 2013). For the world’s 60million non-facility based births, addressing who is currently attending these births and what effects they have on birth outcomes is a key starting point towards improving care during delivery (Darmstadt, 2012).However, the choice of birthplace and use of birth attendant during delivery is very important for women and their families because it determines to a large extent the outcome of pregnancies and child births. Also, is a very critical period, a period when almost all the complications that bring about maternal morbidity and mortality occur. Women need not die in childbirth; for optimum safety, every pregnant woman without exception needs professional skilled care when giving birth. This can avert, contain or mitigate many of the life-threatening problems during childbirth and reduce maternal morbidity and mortality to a significant low level (Gayawan, 2012). Gayawan further opined that access to quality healthcare during pregnancy and in particular, during delivery is a crucial factor in explaining the huge disparity in maternal and perinatal morbidity and mortality between developing and the industrialized world (Gayawan, 2012). Physical access to health facilities through distance and/or lack of transport, and economic considerations are important barriers for women to delivering in a health facility in Nigeria. Some women do not perceive a need to deliver in a health facility and may value health facility delivery less with subsequent deliveries. Access to appropriate transport for mothers in labour and improving the experiences and outcomes for mothers using health facilities at childbirth augmented by health education may increase uptake of health facility delivery in Nigeria (Ugbor, Onyinye, Arua andNwanosike, 2017). According to the World Health Organization, (2015), besides, access to quality healthcare during pregnancy, the history of success in reducing maternal death and newborn mortalities show that skilled professional care during and after childbirth can make the difference between life and death for both women and their newborn babies (WHO, 2015). The converse is true as well; a breakdown of access to skilled care may rapidly lead to increased unfavorable outcomes. Yanagisawa and Wakai (2016), assert that obstetric complications are the leading cause of death among women in many developing countries.
According to Bell, Curtis and Alayon (2014), a skilled birth attendant refers exclusively to people with midwifery skills (e.g. doctors, midwives, nurses) who have been trained to proficiency in the skills necessary to manage normal deliveries and diagnose, manage or refer obstetric complications (Bell, Curtis and Alayon, 2014). Bell, Curtis andAlayon went on to maintained that they must be able to recognize the onset of complications, perform essential interventions, start treatment and supervise the referral of mother and baby for interventions that are beyond their competence or not possible in a particular setting. Skilled birth attendants (SBAs) are professionals that take care of pregnant mothers. They are trained to recognize the signs of complication early enough, to intervene and manage the situation and make quick referral to higher levels of care as may be indicated (Bell et al, 2014).
World Health Organization (2010) stated that the provision of skilled birth attendant for delivery along with equipments, drugs and supplies is necessary for effective management of obstetric complications. World Health Organizaton also stated that the use of Skilled Birth Attendants (SBAs) has been described as the single most important factor in preventing maternal deaths. Delivery or obstetric care services are given to monitor the women during delivery and since there is no reliable way to predict which woman will develop complications during delivery, it is therefore very necessary for it to be within the reach of the pregnant woman for easy access during delivery and postnatal period. In the context of this study, delivery care can be seen as services rendered to pregnant woman during labour and delivery so as to avoid complications, avoid death and have healthy babies. These services range from hospital delivery, delivery by SBAs, forceps delivery to vacuum extractor.
On the other hand, childbearing mothers (CBMs) are women of childbearing age (15-49 years of age). They are the most vulnerable in the society because of the life-threatening problems and death associated with pregnancy and childbirth. Berg (2015) noted that childbearing mothers are the most vulnerable population in the society that need genuine caring as unique individuals because of the complications and risks apparent in childbearing. Childbearing however is defined as the period during pregnancy, childbirth and early post partum phase. Furthermore, pregnancy and child birth has become a thing of concern to this group of people because every one of them is expected to go through the ordeal of pregnancy to answer a woman. Thus, they are exposed to all sorts of complications which can equally affect their children.