Abstract
Introductionannually, about 67,000 of the 196,000 maternal deaths in sub-Saharan Africa occur in Nigeria, second only to India. Though health facility childbirths have been linked with improved health outcomes, evidence suggests that experiences of care influence future use. This study explored the expectations and experiences of health facility childbirths for mothers in Imo State, Nigeria.Methodsthis qualitative study utilised in-depth interviews with 22 purposively sampled mothers who delivered in different types (private and public) and levels (primary, secondary, tertiary) of health facilities in Imo State. Interviews were digitally recorded, transcribed verbatim and analysed following Braun and Clarke´s six-stage thematic analysis.Resultsfour key themes emerged from the analysis. Generally, women saw value in facility-based delivery. However, they had varying expectations for seeking care with different care providers. For those who sought care from public hospitals, the availability of “experts” was a key driver. While those who used private facilities went there because of their perceived empathy and dignity. However, while experiences of disrespect, abuse and health worker expectation for them to cooperate were reported in both public and private facilities, long waiting times, unconducive environments, and lack of privacy were experienced in public facilities.Conclusionevery woman deserves a positive experience of childbirth. To achieve this, mothers´ perceptions of different providers need to be heard. Going forward, strategies ensuring that both public and private sector providers can guarantee holistic care for every woman will be key to realising the maternal mortality target of the Sustainable Development Goal 3.
Highlights
About 540 women die in sub-Saharan Africa (SSA) from preventable pregnancy and childbirthrelated causes [1]
In Nigeria, only 39.4% of childbirths occur in health facilities with significant geographical disparities, which have persisted over time [8]
This study identified the expectations and experiences of mothers who accessed health facility childbirths in Owerri, primarily as the State has continually maintained the highest coverage in Nigeria over the last decade [8,22]
Summary
About 540 women die in sub-Saharan Africa (SSA) from preventable pregnancy and childbirthrelated causes [1]. With a maternal mortality ratio of 542 per 100,000 births [2], SSA accounts for over two-thirds (68%) of the global maternal deaths annually [3]. The 2018 demographic health survey estimates that 556 maternal deaths occur for every 100,000 live births in Nigeria [4]. Evidence suggests that quality obstetric care in the period just before, during and immediately after birth is critical, as three-quarters of maternal deaths occur in this period [5]. Health Facilitybased childbirths in centres which provide emergency obstetric care (EmOC) has been associated with maternal death reductions [5]. The coverage for health facility-based childbirths in SSA pales at 22% [6] in comparison with the global coverage (76%) [7]. As countries in SSA strengthen their health systems and commitment to increasing health facility childbirths, insights from regions with consistent high demands will become invaluable
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