Effect of the Mandatory Community Midwifery Service on Maternal Health Care Utilization in Nigeria

Abstract

The unacceptably high maternal mortality in Nigeria led the Nursing and Midwifery Council of Nigeria to introduce the basic midwifery training with the view of producing skilled personnel to provide midwifery services. Built into the programme is the one-year mandatory community service. The one-year mandatory community service in an intervention aimed at ensuring the availability of midwives (skilled attendants) to provide maternal care in the communities and thus encourage women to access care at the health centre. The study investigated the variation in the levels of utilization of maternal healthcare before and after the inception of the one year mandatory midwives’ community service by assessing the perceptions of the Midwives regarding the impact of the mandatory service on the utilization of maternal care services. The General System Theory and the Logic Model were the theoretical models used in this study. The research was conducted in three selected local government areas (LGAs) out of the eighteen (18) LGAs in Ondo State. The time-series type of non-controlled experimental design was the research design used for the study. Records of maternal health care attendance from the selected health facilities from July 2002 to July 2010 were assessed to generate data for the study. The study population comprised the midwives who had participated in the mandatory service in the three selected communities where the three primary health care centres are located. Multistage sampling technique was adopted to select three Local Government Areas (LGAs) from where data was collected. All midwives that have served or are still serving in the selected PHCs were purposely involved, a total of 50 in number. In-depth interview guide and format for recording data from records were used in the study. The interview guide was divided into two sections. Section A, was a checklist was used to explore the participants’ opinions on the mandatory community service and Section B was a questionnaire to assess the midwives experience, opinions and challenges. Lastly, a format/checklist was developed to record data from records (antenatal care attendance, deliveries and postnatal care attendance between July 2002 and July 2011). Data from the study was analyzed using both descriptive and inferential statistics utilizing the Statistical Package for the Social Sciences (SPSS) Correlation coefficient was used. The result obtained from the study indicated that there was no significant difference in the levels of utilization of maternal care services before and after the inception of the mandatory community service except for the slight increase in antenatal care utilization. The majority of the midwives claimed that their presence had increased the patronage of maternal care services. However this subjective data was not justified by the statistics obtained. The midwives also highlighted their challenges as well as the way forward.