PERCEPTION OF HOME DELIVERY AMONG WOMEN OF CHILD BEARING AGE IN SOKOTO STATE, NIGERIA

CHAPTER ONE

INTRODUCTION

Background of the Study

Certain communities hold the belief that home deliveries symbolize strength and robust health for women, contrasting with facility-based deliveries, which are often associated with poor health. Women who opt for home births often view themselves as resilient, embodying pure African heritage, and possessing a strong spirit (Konje et al.,2020). Home delivery, defined as giving birth at one's residence, is a common occurrence globally, with nearly half of the estimated 130 million annual births taking place at home (Bhutta et al., 2019). These births can be either planned or unplanned and may pose risks to maternal health and well-being (Johnson & Daviss, 2019). In circumstances where medical care is unaffordable or inaccessible, particularly in developing countries, home birth may be the only feasible option for women, with or without the assistance of trained professionals such as obstetricians, doctors, or certified midwives (Johnson & Daviss, 2019; Vernon, 2019). Furthermore, unplanned home births are associated with adverse outcomes for both mother and baby, including higher rates of maternal, fetal, and neonatal mortality compared to hospital births (Menezes et al., 2020). In Nigeria, home births constitute a significant proportion, accounting for 63% of all births, and may occur with or without the presence of skilled birth attendants (NPC & ICF, 2018). Studies conducted in Africa, including Nigeria, have explored the factors associated with home delivery. These factors can be broadly grouped into a sociodemographic, household, healthcare, and community factors. According Bazzano (2018), sociodemographic factors associated with home delivery included multiparity, women’s poor socioeconomic status, place of residence, low maternal and husband education, older maternal age, lack of media exposure, and living in rural areas. Likewise, factors associated with home deliveries included household factors, such as living in male-headed households and husband preference for home delivery, as well as healthcare factors, such as poor attitude of nurses, low antenatal care (ANC) visits, and low-quality healthcare services(Adewuyi, 2019). Community factors, such as belonging to pastoralist communities and communities with positive perceptions for traditional birth. In addition to cultural beliefs, the accessibility of modern healthcare facilities poses a significant barrier to the utilization of facility-based delivery. This is a primary reason why many mothers prefer home delivery over hospital delivery (Wolderufael et al., 2019). Challenges such as distance to facilities, shortage of skilled healthcare professionals, inadequate equipment, and lack of essential medicines contribute to dissatisfaction among women regarding modern healthcare facilities, thus driving them towards home delivery (Wolderufael et al., 2019). The persistently high perception of pregnant women opting for home delivery, particularly evident among women of childbearing age in Binji Local Government Area, necessitates further investigation into this trend. Despite the health risks associated with home delivery, some pregnant women still prefer traditional birth attendants, even in the face of reported deaths. This poses a significant public health concern, prompting efforts to encourage pregnant women to utilize skilled birth attendants and modern healthcare services. However, the specific factors influencing their choice remain unclear. Therefore, a survey will be conducted on perception of home delivery among women of child bearing age in Sokoto state Nigeria.

Statement of the Problem

Home delivery is a nation’s health concern, mainly in the rural part of the country. However, complications during pregnancy and unsafe deliveries contribute to maternal and neonatal morbidity and mortality, posing a significant global public health concern. Rural areas, especially among impoverished communities, witness the highest incidence of maternal deaths. Additionally, young adolescents face a heightened risk of pregnancy and childbirth-related complications compared to older women. However, most of these deaths are preventable. Nigeria has implemented various strategies to enhance the presence of skilled birth attendants and reduce home delivery rates. Since 2003, maternal and child health services have been made freely accessible. Efforts to expand the number of healthcare facilities include aiming for one functional dispensary per village and a health center per ward. Human resources for health have been strengthened by increasing the enrollment of nurses and doctors and expanding the number of training institutions and absorption of trained personnel. Furthermore, in-service training on reproductive and child health services has been expanded to enhance the skills of available healthcare providers. Despite these initiatives, the prevalence of home deliveries remains unacceptably high, contributing to the elevated maternal mortality ratio. In the North western region, while 98% of women attend their initial antenatal visits, only 37% deliver at health facilities (Olutundun, 2018). Also, despite the collective efforts of stakeholders and medical practitioners, it remains unclear why a significant portion of women continue to opt for home births. It is in the light of these that the study seeks to investigate the perception of home delivery among women of child bearing age in Sokoto state Nigeria.

 1.3  Objectives of the Study

The main purpose of this study is to investigate the perception of home delivery among women of child bearing age in Sokoto state Nigeria. Specifically, the study will;

1.Determine the prevalence of home delivery among women of child bearing age in Sokoto state Nigeria.

2.Examine the level of awareness and knowledge about home delivery among women of child bearing age in Sokoto state Nigeria.

3.Assess the various risk factors associated with home delivery among women of child bearing age in Sokoto state Nigeria.

4.Provide recommendation for improving maternal healthcare services and promoting safe delivery practices among women in Sokoto State.

1.4 Research Questions

The following questions have been prepared for the study:

What is the prevalence of home delivery among women of child bearing age in Sokoto state, Nigeria?

What is the level of awareness and knowledge about home delivery among women of child bearing age in Sokoto state, Nigeria?

What are the various risk factors associated with home delivery among women of child bearing age in Sokoto state, Nigeria?

What are the ways of improving maternal healthcare services and promoting safe delivery practices among women in Sokoto State?

1.5 Research Hypotheses

Ho: There is no significant difference in the perception of home delivery among women of childbearing age in Sokoto State, Nigeria.

Ha: There is a significant difference in the perception of home delivery among women of childbearing age in Sokoto State, Nigeria.

1.6  Significance of the Study

In order to promote safer birthing practices in the community, community leaders and health officers will use the research findings to increase awareness of the value of expert birth attendance and the dangers of home delivery. Also, they can utilize the research findings to raise awareness about the importance of skilled birth attendance and the risks associated with home delivery, ultimately promoting safer birthing practices within the community.  Additionally, subsequent researchers will use it as a literature review. This means that other students who may decide to conduct studies in this area will have the opportunity to use this study as available literature that can be subjected to critical review. Invariably, the result of the study contributes immensely to the body of academic knowledge with regard to perception of home delivery among women of child bearing age in Sokoto state Nigeria.

1.7 Scope of the study

The scope of this study is boarded on perception of home delivery among women of child bearing age in Sokoto state Nigeria. Theoretically, this study will determine the prevalence of home delivery among women of child bearing age in Sokoto state Nigeria, examine the level of awareness and knowledge about home delivery among women of child bearing age in Sokoto state Nigeria, assess the various risk factors associated with home delivery among women of child bearing age in Sokoto state Nigeria and provide recommendation for improving maternal healthcare services and promoting safe delivery practices among women in Sokoto State.

Geographically, the study will be delimited to women in Binji LGA, Sokoto state, Nigeria.

1.8 Limitation of the study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. In addition, there was the element of researcher bias. Here, the researcher possessed some biases that may have been reflected in the way the data was collected, the type of people interviewed or sampled, and how the data gathered was interpreted thereafter. The potential for all this to influence the findings and conclusions could not be downplayed. 

More so, the findings of this study are limited to the sample population in the study area, hence they may not be suitable for use in comparison to other schools, local governments, states, and other countries in the world.

 1.9 Definition of Terms

Home delivery: refers to the process of giving birth at home instead of in a hospital or healthcare facility.

Antenatal Care (ANC): is an indicator of access and use of health care during pregnancy. The antenatal period presents opportunities for reaching pregnant women with interventions that may be vital to their health and wellbeing and that of their infants.

Socioeconomic: relating to or concerned with the interaction of social and economic factors.