Maternal Health Seeking Behavior in Rural Nigeria

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Author: Inegbenebor, Ute

Introduction

Maternal health is an essential component of primary health care. It is designed to reduce maternal mortality to a minimal level. However, the realization of this goal is dependent on the utilization of maternal health services. Despite the fact that 70% of Nigerian population is rural and programs exist such as better life and family support programs, studies show that rural women are generally more disadvantaged than urban women. Women have less access to health services in the rural areas. Rates of maternal morbidity and mortality are higher. Only 30% of rural women know at least one contraceptive. Only 47% of rural women are ever enrolled in schools as compared to 72% percent of their urban counterparts. Only 20% percent of those in rural areas have access to good water

1 Maternal mortality rates in countries south of Sahara are known to range from 500-1100 per 100,000 live births. In the year 2000, maternal mortality in Nigeria was the second highest in the world, after India, with a total number of 37000. It was also reported that maternal mortality rate in Nigeria was 830 per 100,000.

2 This stems not only from inadequate health services but is also a result of interplay of many antecedent factors that could be social, cultural, economic and logistic coupled with very high fertility. In developing countries such as Nigeria, this has been attributed to three phases of delay in seeking treatment from health institutions.

3 Phase one delay is the time wasted in reaching a consensus on the need to seek health care, in a health facility with the aid of a decision maker in the family, who could be the woman herself, husband, parent, and mother in law or any other significant person in the family. The health seeking behavior of women of reproductive age can determine the absence or presence of phase one delay and affect the incidence of maternal mortality in most communities in the developing world. This study was carried out to find out the extent rural women in the reproductive age group can take decisions, on their own, on the need to seek modern health care among alternative choices in the community. These alternatives include self-treatment, medication by traditional healers or unqualified persons, dispensary, and private or public medical institutions.

4 Materials and Methods

This study was carried out in Ubierumu, a rural community in Edo central senatorial district of Nigeria with a population of about three thousand people. It has one primary health center, one secondary school and two primary schools. Almost half of the population (forty-eight percent) have attained not more than primary education and are mostly farmers. Most of those with post-primary education (51%) are adolescents and are currently in school. Only one percent had had post-secondary education. Majority of the indigenes, who have either acquired a skill or western education have migrated to urban areas because of lack of basic amenities such as potable water, electricity and job opportunities. One hundred and eighty questionnaires with structured and unstructured components were administered to women of reproductive age group in Ubierumu community by a trained interviewer. The women were selected by stratified random sampling. They were required to state the person who takes decision on when and where to obtain treatment and antenatal care, when they are ill and pregnant respectively. Data analysis was done with percentages and cross tabulation.

Results

Seventy five percent (75%) of the rural women in the study group were responsible for making the decision on whether to visit a health care facility or not. However, parents were responsible for decision making in 67% of the adolescents studied. Majority of the women (94%) preferred modern health care to other forms of treatment such as self-treatment, traditional medical treatment and patent medicines. Among the modern heath facilities, primary health care, district hospital and private medical centers were preferred by 51%, 36% and 7% of the women respectively.

Discussion

The aim of maternal health is to reduce maternal morbidity and mortality to a minimal level. The realization of this goal is dependent on the utilization of maternal services, which can occur if there is a favorable mix of attitude, beliefs, customs and values in the community. This leads to the development of the right health-seeking behavior, which makes the women seek modern health care. Choosing the right option of modern medical treatment gives her a better health care service, which will ensure optimal health status. In this study, 169 (94%) of the women interviewed preferred modern health care facilities. However, the preference for modern health care may not come to reality if her ability to use the facility is dependent on the decision of other people who may be her husband, parents or other significant person.

Health education targeted at those close associates who are able to influence decision-making among women will be able to make modern health services her first choice. Preference for the primary health care by most (51%) of the women may be due to proximity, convenience, lower cost of transportation and treatment compared to the district hospital. The non-preference for the private medical centers may be due to the high service bill charged by these fee-for-service general practitioners. Most people in the study community live on an income below one dollar a day (125 Nigerian Naira) and cannot be expected to embrace any health care facility that is expensive. It was also found that 135 (75%) of the women studied could make their own decision regarding health service utilization. The ability to make self-decision was related to age and the level of education attained. Decision making ability may also be related to financial independence, which may explain why adolescents who are either in school or in the process of skill acquisition are dependent on parents while the older age groups who are able to fend for themselves are not. Adolescents were more likely to depend on decision made by parents while the less educated older women were more likely to depend on decisions made by their husbands. Recommendations Any forms of health education targeted at adolescents are more likely to succeed if parents and guardians are involved. Where health education is targeted at older and less educated women, their husbands should be involved in the program if success is to be realized.

Conclusion

Women empowerment through improved girl child education, skill acquisition and financial independence will increase the level of independence in decision making and generate the appropriate health seeking behavior which can improve maternal and child survival in the developing countries.

References

1. Ezekwem, U. Social practices harmful to women in Nigeria. Tropical journal of Obstetrics and Gynecology (Ibadan) 2002 : 19(1) 22-25 2. WHO. Maternal mortality in 2000: Estimates developed by WHO, UNICEF and UNFPA. Geneva: WHO, 2004: 38 3. Thaddeus, S. Maine, D. Too far to walk: Maternal mortality in context. Soc.sci.med. 1994: Apr. 38(8) 1091-1110 4. Lucas AO, Gilles HM. Access to and Utilization of Health Services. In: Lucas AO, Gilles HM eds. Short Textbook of Public Health Medicine for the Tropics. 4th Edition. London: BookPower, 2006: 4