Psychosocial influences on pregnancy and childbirth behaviours in north-western Nigeria: a cross-sectional analysis.

Emily White Johansson,Mathew Okoh,Paul C Hewett,Udochisom Anaba,Shittu Abdu-Aguye,Paul L Hutchinson,Dele Abegunde

doi:10.1017/s0021932021000729

Abstract

Antenatal care (ANC) and facility delivery are essential maternal health services, but uptake remains low in north-western Nigeria. This study aimed to assess the psychosocial influences on pregnancy and childbirth behaviours in Nigeria. Data were from a cross-sectional population-based survey of randomly sampled women with a child under 2 years conducted in Kebbi, Sokoto and Zamfara states of north-western Nigeria in September 2019. Women were asked about their maternal health behaviours during their last pregnancy. Psychosocial metrics were developed using the Ideation Model of Strategic Communication and Behaviour Change. Predicted probabilities for visiting ANC four or more times (ANC4+) and giving birth in a facility were derived using mixed-effects logistic regression models adjusted for ideational and socio-demographic variables. Among the 3039 sample women, 23.6% (95% CI: 18.0-30.3%) attended ANC4+ times and 15.5% (95% CI: 11.8-20.1%) gave birth in a facility. Among women who did not attend ANC4+ times or have a facility-based delivery during their last pregnancy, the most commonly cited reasons for non-use were lack of perceived need (42% and 67%, respectively) and spousal opposition (25% and 27%, respectively). Women who knew any ANC benefit or the recommended number of ANC visits were 3.2 and 2.1 times more likely to attend ANC4+ times, respectively. Women who held positive views about health facilities for childbirth had 1.2 and 2.6 times higher likelihood of attending ANC4+ times and having a facility delivery, respectively, while women who believed ANC was only for sickness or pregnancy complications had a 17% lower likelihood of attending ANC4+ times. Self-efficacy and supportive spousal influence were also significantly associated with both outcomes. To improve pregnancy and childbirth practices in north-western Nigeria, Social and Behavioural Change programmes could address a range of psychosocial factors across cognitive, emotional and social domains which have been found in this study to be significantly associated with pregnancy and childbirth behaviours: raising knowledge and dispelling myths, building women's confidence to access services, engaging spousal support in decision-making and improving perceived (and actual) maternal health services quality.

Highlights

There are an estimated 300,000 maternal deaths each year, and approximately 20% of these occur in Nigeria (WHO, 2015)
It is likely that the MMR is much higher in north-western Nigeria where maternal health outcomes are typically worse than national averages (Government of Nigeria and Demographic and Health Survey (DHS) Program, 2019)
The World Health Organization (WHO) promotes giving birth in a health facility with skilled personnel, since most deaths are due to direct obstetric causes that occur around the time of delivery and are difficult to predict in advance (Sageer et al, 2019)

Summary

Introduction

There are an estimated 300,000 maternal deaths each year, and approximately 20% of these occur in Nigeria (WHO, 2015). Antenatal care (ANC) visits and facility-based deliveries are critical contact points with the formal health system that present opportunities to reach mothers and newborns with effective interventions to improve their chances of survival and well-being (WHO, 2016). The World Health Organization (WHO) has recommended at least four ANC visits (ANC4) during pregnancy, and more recently eight routine check-ups, in order to provide a range of interventions for a positive pregnancy experience (WHO, 2016). The WHO promotes giving birth in a health facility with skilled personnel, since most deaths are due to direct obstetric causes that occur around the time of delivery and are difficult to predict in advance (Sageer et al, 2019). Nigerian national guidelines for pregnancy and childbirth are closely aligned with these global recommendations (Government of Nigeria, 2017a)

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