CHAPTER ONE

INTRODUCTION

1.1   BACKGROUND OF THE STUDY

Maternal and child health has emerged as the most important issue that determined global and national wellbeing.  This is because every individual, family and community is at some point intimately involved in pregnancy and the success of childbirth (WHO, 2006).  Despite the honour bestowed on womanhood and the

appreciation of the birth of a new born baby, pregnancy and childbirth is still considered a perilous journey. The situation of maternal and child health in Nigeria is among the worst in Africa and has not improved substantially and in some areas of the country, has worsened over the past decade (Ladipo, 2009).  The maternal mortality ratio ranges between 800-15000 per 100,000 live births (Nigeria Demographic and Health Survey, 2003), with marked variation between geo-political zones – 165 in South West compared with 1,549 in the North-East and between urban and rural areas (Ladipo,

2009).  Total fertility rate is 5.7 births per woman and it is estimated that approximately 59,000 of maternal deaths take place annually in Nigeria as a result of pregnancy, delivery and post-delivery complications (WHO, UNICEF, UNFPA, 2007).

Research (Ladipo, 2009) indicated close link between the health of the new born with the health of their mothers.  About 30-40% of neonatal and infant deaths result from poor maternal health and inadequate care during pregnancy, delivery and the critical immediate postpartum period (Ladipo, 2009).  In Nigeria 340,000 infants die every year during delivery and shortly afterwards especially if the mother dies in childbirth (WHO, UNICEF, UNFPA, 2007). The under-five mortality ratio is 200 per 1000 live births (WHO, 2006).  These deaths are not unconnected with the poor maternal health services in the country and could be avoided through provision of quality and effective maternal and child health services.

Nigeria is one of the African countries with a rapidly growing population.  As a nation with a growing economy, one of the major health challenges facing the country today is the capacity to sustain the increasing infant and maternal health.  The most common recorded cause of perinatal deaths are similar to those of other less developed countries, and the common denominators are early childbearing poor maternal health and above all, the lack of appropriate and quality services (Okereke, Kanu, Nwachukwu, Anyanwu, Ehiri & Merick, 2005).  Although life-saving practices for most infants have been known for decades, currently one third of the mothers still have no access to health care services during pregnancy and almost half do not have access to health care services during childbirth (Okereke, et al., 2005). In the light of rapid population growth and increased risks of adverse environmental health exposures, maternal and child health prospects could be a serious national public health problem due to factors such as ignorance, apathy, poverty, lack of commitment, illiteracy and corruption (Opara & Ellah, 2007).

The Millennium Development Goal (MDG) 4 and 5 require improvement of maternal and child health. Target 6 of MDG5 specified that between 1990 and 2015, maternal mortality ratio be reduced by three quarters. The chances of attaining this target depend on how policy, plans and int erventions address the comprehensive set of social, economic, cultural as well as medical causes of maternal mortality in Nigeria

(Ladipo, 2009).

The 2006 census estimated that there were about 65 million females in Nigeria, out of which 30 million were of reproductive age (15-49 years).  Each year about 6 million women become pregnant, 5 million of these pregnancies resulted in child birth (WHO, UNICEF, UNFPA, 2007). Yearly, about 1,080,000-1,620,000 Nigerian women and girls suffer disabilities caused by complications during pregnancy and child birth (HILL, Abouzahr & Wardlaw, 2001).  For every one that dies, 20-30 more suffer long term and short term disabilities such as chronic anaemia, maternal exhaustion or physical weakness, vesico-vaginal or recto-vaginal fistulae, stress incontinence, chronic pelvic pain, infertility, ectopic pregnancy, and emotional depression (Ladipo, 2009).  Child survival is equally affected too as the chances of survival of a child in the absence of his or her mother is greatly reduced.

Maternal heath and the health of new born children are critical topics in global development. When women are able to access needed quality health care services and protect themselves from the many health risks they face,l ong-term social and economic progress can be achieved.  The health and well-being of mother, infants, and young children are of critical importance, both as reflections of the current health status of individuals, local communities and the nation as a whole and as predictors of the health of the next generation (Okereke, et al, 2005).  In several key areas of health care, mothers and young children of several communities of developing countries are not receiving the health care services they need, and the result is premature illness and preventable death (Okereke, et al, 2005).  The foregoing, prompted the researcher to undertake research study on the provision and utilization of maternal and child health care services among women of child bearing age in Benue State.

1.2   STATEMENT OF THE PROBLEM

Every minute in a day, somewhere in the world, a woman dies due to complications arising from pregnancy and childbirth (Ladipo, 2009).  In Nigeria, 150 of such women die daily; it is the leading cause of death among women of reproductive age.  The tragedy is that these women do not die from diseases, but during a normal, life-enhancing process of procreation.  Even more tragic, is the fact that these deaths are avoidable if preventive measures are taken and adequate care is available (Ladipo, 2009).

Nigeria has had a very poor record regarding maternal and child health outcomes.  Statistics depicting maternal and child health status in Nigeria call for a public health action (Adebayo, 2001). An estimated 53,000 women and 250,000 new born die annually mostly as a result of preventable causes (National Primary Health Care Development Agency, 2006).  Over the years, several initiative programmes have been introduced to reduce the rate of mortality among mothers and children in Nigeria. Despite these efforts, poor maternal and child health indices have continued to be one of the most serious development challenges facing the country (NPHCDA, 2006).  In the year 2000, Nigeria and other members of the United Nations agreed on a number of Millennium Development Goals (MDGs) to improve the welfare of the people in their countries in the 21st century. Two of the health related goals concern reducing death among children under 5 years old by two-third (MDG 4, that is, reduction from 230 to 77 per 100,000 live births) and reducing maternal deaths by three-quarter (MDG 5) by the year 2015, when compared with the 1990 figures – from 1000/100,000 live births to 250 (NPHCDA, 2006).  One year to 2015, Nigeria still records a rather appalling maternal, neonatal, and infant mortality rates compared with developed countries. Although many of these deaths are preventable, the coverage and quality of health care services in Nigeria continue to fail women and children. Every single day, Nigeria loses about 2,300 under five year olds and 145 women of child bearing age, which marked the country the second largest contributor to the under-five and maternal mortality rate in the world (Okereke, et al, 2004).  Underneath the statistics lies the pain of human tragedy, for thousand of families who have lost their children. Even more devastating is the knowledge that essential interventions reaching women and babies on time would have averted most of these deaths. Although, analysis of recentt rends shows that the country is making progress in cutting down infants and under-five mortality rates, the pace still remains too slow to achieve the millennium development goals of reducing child mortality by a third by 2015.  Presently, less than 20 percent of health facilities in Nigeria offer emergency obstetric care and only 34 percent of deliveries are attended by skilled birth attendants (Okereke, et al, 2005).  The state of health of Nigerians, and especially of our women, is to say the least, obnoxious and scandalous.  Health services in Nigeria have been unable to satisfy the needs, desires, aspirations of the consumers who seek health assistance, counselling and diagnosis.  This holds that the consumers of health care services in Nigeria are largely unsatisfied as a result of the poor quality and quantity of health services and their providers as well as financial constraints (Ladipo, 2009).

Despite the efforts in raising MCH services, some women still do not avail themselves of the opportunity even when provided free of charge.  It is not uncommon to hear that some women reject modern medical and health care services on the ground that they are not in consonance with the system the people are already used to.  Therefore, this study is designed to assess the provision and utilization of maternal and child health care services among women of child bearing age in Benue State.  The study attempted to find answers to the following specific research questions.

1.3    RESEARCH QUESTIONS

1. Are maternal and child health care services adequately provided to mothers seeking child welfare services in Nigeria?
2. Does the location of health care facility influence the utilization of maternal and child health care services among mothers seeking child welfare services in Nigeria?
3. Does educational status influence utilization of maternal and child health care services among mothers seeking child welfare services in Nigeria?
4. Does attitude of health care personnel at maternal and child health care service centres in Nigeria significantly influence utilization of the services among mothers seeking child welfare services in Nigeria?
5. Does cultural belief influence the utilization of maternal and child health care services among mothers seeking child welfare services in Nigeria?

1.4    PURPOSE OF THE STUDY

The primary purpose of this study was to assess the provision and utilization of maternal and child-health care services among women of child bearing age in Benue State.  The specific purposes were:

1. To determine the adequacy of maternal and child health care services provided to mothers seeking child welfare services in Nigeria.
2. To assess the influence of location of health care facilities on utilization of maternal and child health care services among mothers seeking child welfare services in Nigeria.
3. To assess the influence of educational status on utilization of maternal and child health care services among mothers seeking child welfare services in Nigeria.
4. To investigate the influence of attitude of health care personnel on utilization of maternal and child health care services among mothers seeking child welfare services in Nigeria.
5. To examine the influence of cultural belief on the utilization of maternal and child health care services among mothers seeking child welfare services in Nigeria.

1.5     SIGNIFICANCE OF THE STUDY

The outcome of this study would be significant to mothers seeking child welfare services in Nigeria in general in the following ways:

1. The findings of this study would provide information on the adequacy or otherwise of maternal and child health services provided to mothers seeking child welfare services in Nigeria with a view to improving the services.
2. The findings of this study would help policy makers to understand problems militating against effective utilization of maternal and child health services among mothers seeking child welfare services in Nigeria and the way forward.
3. It would provide a basis for further research to other interested researchers.
4. The findings of this study would contribute to existing knowledge on the provision and utilization of maternal and child health services.

1.6    HYPOTHESIS

In order to achieve the purpose of this study and address the questions raised in the study, the following hypotheses were formulated.

1.6.1     Major Hypothesis

Provision and utilization of maternal and child health care services among mothers seeking child welfare services in Nigeria is not significantly influenced by adequacy of health facilities.

1.6.2    Sub-hypotheses

1. Provision of maternal and child healthcare services to mothers seeking child welfare services in Nigeria are not significantly adequate.
2. Utilization of maternal and child health care services among mothers seeking child welfare services in Nigeria, is not significantly influenced by location of health care facilities.
3. Utilization of maternal and child health care services among mothers seeking child welfare services in Nigeria is not significantly influenced by their educational status.
4. Utilization of maternal and child health care services among mothers seeking child welfare services in Nigeria is not significantly influenced by attitude of the health care personnel at service centres.
5. Utilization of maternal and child health care services among mothers seeking child welfare services in Nigeria is not significantly influenced by cultural belief.

1.7   BASIC ASSUMPTION    

This study was based on the following assumptions:

1. Adequate provision of maternal and child health care services are necessary to protect and promote the health of mothers and children.
2. Place of residence can constitute a strong barrier in the use of maternal and

child health care services among women of child-bearing age.

1. Level of education can constitute a strong predictor of maternal and child health care service utilization among women of child-bearing age.
2. The attitude with which health care providers handle consumers of maternal and child health care services in Benue State can affect the subsequent use of the services.
3. Cultural belief can constitute a strong determinant of choice/use of health care services among women of child-bearing age.

1.8    DELIMITATION OF THE STUDY

This study was delimited to the provision and utilization of maternal and child health care services among women of child-bearing age (15-49 years) in six Local Government Areas selected from the three Senatorial Zones in Benue State.  They include Katsina-Ala, Vandeikya (Zone A); Gboko, Makurdi (Zone B), and Ogbadibo, Otukpo (Zone C).  Specifically, only women of child-bearing age attending antenatal and postnatal clinic at the General Hospitals in the selected Local Government Areas were involved in the study.

1.9     LIMITATION OF THE STUDY

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