CHAPTER ONE

INTRODUCTION

Background of the Study

Maternal and child health is a global priority. It refers to the period in women’s life that involves pregnancy; Child Birth and postnatal care. It is integrally linked to the prenatal care of children. This being the period of gestation and the month after birth. Numerous treaties, initiatives and programmes have been formulated to try and improve the health and well being of pregnant women and children. The latest effort is that of the Millennium Development Goals that aim to inspire countries to drastically reduce maternal and child mortality and address. Specific diseases and relate challenges (United National Millennium Development 2015).

Balliere’s Nurse Dictionary (1995) defines pregnancy as being with child, the condition from conception to the expulsion of the foetus. The normal period is 280 days or 40 weeks. During this period expectant mother care must be more intensified to be able to carry out necessary supervision care and advice to women during pregnancy, labour and post partum – this referred to anti-natal, which should be responsibilities to conduct deliveries and care of the new born and infants. This anti-natal includes preventive measures, early detection of abnormal condition in mother and child, and an advice on execution of emergency measures in the absence of medical help.

According to World Health Organization (WHO 2011), maternal and child health has been described as one of the foremost and the most neglected health problem, and human right abuse in the world, violating the right of about 515,000 women annually (Nyles, 2001). Whatever stage of development a country is, it is essential that the health policy of the country includes activities toward the care of mothers and children, especially during pregnancy and delivery in order to reduce the rate of maternal morbidity and mortality prevalent in women aged 15-49 years and children of all ages (WHO, 2011). The International Federation of Gynecologist and Obstetrician (EGO) define maternal health as one occurring during pregnancy, labour or as a consequence of pregnancy within 42 days after delivery or abortion.

According to United Nation Fund for Population Activities (UNFPA 2010), Nigeria maternal mortality situation has been indicated as one of the highest to the world. The most recent official document indicated a figure of 630 maternal deaths, per 100,000 live birth of 116/100,000 in contrast with developed countries. The health status of mother and children, remain poor in most developing countries. The same is true for South Africa despite its middle income status, local data shows an increase in infant, less than 5 mortality and material health status is also not optimal. South Africa adopted almost all international treaties, initiatives and programs concerted effort must therefore be made to rectify and address the contributing factors to poor maternal and child health care many of these lie outside of the health sectors. The health services have a significant contribution to make and at the very least health intervention with known effectiveness must be implemented in the best possible way. All sectors need to be held accountable for their role in improving maternal and child health (WHO, 2010). In general, health is scarce commodity that everybody strives to posses, it can be influenced by several factors and some of these factors are; Cultural factors which is defined as the way people live. This way of life include arrangement and method of obtaining food from the convenient and method of adapting it. It also includes rules and regulations that cover people’s behavior in a particular society. It also include beliefs, religion, moral behavior and whatever the people concerned have produced using their available resource and knowledge, culture is something that has evolved overtime from 2 people’s experience. Example custom of letting a woman to go back to her paternal home for child birth and remaining there until the baby is wearned. This is common practice in many rural Nigeria (PHCFMOH, 1990). Economic factor that can influence one’s health is his education which leads to enlightenments, educated people are less likely to become controlled by various cultural beliefs, practice and taboos which tends to become detrimental to health, hence the higher educated the population, the higher health status. Poverty and ignorance is a prevalent problem in Nigerian community. Because all the above factors may result to ill health and other conditions like, malnutrition and anemia.

Statement of the Problem

All pregnant women are expected to attend an approve health facility because care of the children begins from the first trimester of pregnancy. Statistical data has shown the rate of poor attendance in Kano Municipal Council from 2016 – 2017 as 2,625 registered for antenatal, but only 1085 women delivered (Health Department Monitoring Evaluation Unit, Kano Municipal Council of Kano State.

Nigeria is still passing through various stages of development, many women still deliver their babies at home, without attending Antenatal Clinic, while some pregnant mothers visit the clinic only for them to have the card and for emergency reason. Some of the women after registration do not attend the clinic, do not return to post-natal care, this is according to the record of those that registered.

All the concept of health is being on preventive rather than curative, health facilities are sited within communities so proximity is not a problem as to attend, yet the utilization among pregnant mothers is not encouraging. It is important therefore to help and motivate the pregnant mothers to utilize the government health services in the maternal and child health centers, effectively.

The trend in ante-natal clinic records in Kano Municipal Council, shows that it has been found that the number of pregnant mothers that were booked in ante-natal clinic was 1,320 from July – 2016 – July 2017, 120 pregnant women booked every week, 480 pregnant mothers per month. But recently from August 2016 – July 2017 the figure has declined from 480 – 400 every month and total population of 1,200 pregnant mothers were recorded. All this could be a promotive measure towards increasing both maternal and infant’s mortality and morbidity rate.

The role of health workers in the management of pregnant mothers’ is very important for ensuring that clients receive appropriate care from the state of conception, birth and post partum. Unfortunately today many women see health workers role differently being hostile, in confident, unnecessary delay, aggressive and not competent enough. The challenge now is what are responsible for the sudden poor attendance of pregnant mothers in ante-natal clinics. Based on the sudden change and attitude of pregnant mothers towards attending ANC, the researcher intend to find out strategies for improvement of utilization of ante-natal services in Kano Municipal Council of Kano State.

Purpose of the Study

Generally, the study is designed to find out the strategies for improving utilization of Ante-natal health services by women of child bearing age. Specifically, the study is to:

i.                   Ascertain the attitude of pregnant women toward health services.

ii.                 Identify the factors that hinder women of child bearing age from attending the maternal and child health services.

iii.              Identify strategies for improving the utilization of health services by 
pregnant women in Kano Municipal Council of Kano State.

Significance of the Study

This study is intended to raise the awareness of pregnant mothers towards effective utilization of the government health services. Also with hope that local government concerned will be aware of the important of motivating the bearing mother to utilize maternal and child health service and for the authority to understand the problem that hinder clinic and utilize it so that maternal death will reduce and also increase chance of having good access and good utilization.

This study will also help the health workers working in the health facility to understand and realize their weakness and the strategies in rendering services that will improve the maternal and child health services thereby improving the chances of its utilization by women.

Findings of the study will help in reducing the mortality rate among pregnant women and improve the overall well being of women in the community thereby reducing resources and manpower wastages. Also when the study is completed, factors responsible for poor attendance of pregnant mothers’ in the ante-natal clinics, the result will effect positive changes especially when it involves appropriate knowledge, skills, attitude, values and code of conduct of health workers. The result will serve as a significant tool to the clinician, the pregnant mother’s and the management concerned.

Research Questions

The study is to find out the strategies for improving utilization of ante-natal health services by women of child bearing age. Therefore, the study will be guided by the following research questions:-

i.                   What are the attitudes of pregnant mothers towards ante-natal health services?

ii.                What is the relationship between health workers and the pregnant
mothers attending ante-natal clinic in Kano Municipal Council of Kano State?

iii.             What are the strategies for improving the utilization of health services by pregnant mother’s in Kano Municipal Council of Kano State?

Scope of the Study

The study seek to ascertain the attitude of pregnant women toward the utilization of health services in Kano Municipal Council, through identification of strategies for improving the utilization of services by pregnant mothers in the Local Government.