Assessing the quality of antenatal care provision by midwives: a mixed-method study of three levels of healthcare in southwestern Nigeria

Abstract

Background Antenatal care allows healthcare providers to assess the wellbeing of pregnant women and their fetuses, leading to positive maternal and fetal outcomes. This study assessed the available facilities for antenatal care provided by midwives, and factors that influenced the quality of care provided. Methods This study used a mixed-method descriptive design based on the Donabedian model to explore the quality of care at 27 health facilities across the three levels of healthcare in Osun State. Qualitative data were collected from 11 purposively selected midwives using an in-depth interview guide, and a hospital checklist was used to collect quantitative data. Data were gathered over 12 weeks, then transcribed and analysed using content and thematic analysis. Results Some facilities (9.1%) did not offer all components of antenatal care. When examining the process and structure of care, 98.6% of healthcare facilities were found to have inadequate human resources. Although the equipment at the facilities was functional, it was reportedly inadequate in 27 (84.3%) facilities. Midwives reported that a lack of education, poor working conditions, interprofessional barriers and burnout hindered the provision of quality antenatal care, while community support and regular continuing education were motivating factors. Conclusions The quality of antenatal care was rated adequate, but there was a lack of resources, standard guidelines and retraining opportunities for midwives. Adequate manpower and resources are needed to enhance the quality of antenatal care in health facilities in Osun State.