Abstract
BackgroundThe reasons for low utilisation of maternal health services in settings where the user-fee removal policy has been implemented continue to generate scholarly debates. Evidence of whether user-fee removal benefits the poor women in underserved settings is scanty and inconsistent. This article examines use of maternal health care services in the context of free maternal healthcare and profiles the beneficiaries of user-fee removal.MethodsThe study adopted a descriptive design. A three-stage cluster sampling method was used to select a representative sample of 1227 women who gave birth between 2011 and 2015. Questionnaires were administered using a face-to-face interview approach and data generated were analysed using descriptive and inferential statistics.ResultsThe analysis shows that the use of maternal healthcare services has improved considerably in North Central and Southwestern Nigeria. While socioeconomic and geographical inequality in the use of maternal healthcare services appear to be disappearing in Southwestern Nigeria, it appears to be widening in North Central Nigeria. The findings indicate that 33.6% of women reported to have benefitted from the free child-delivery programme; however, substantial variation exists across the two regions. The proportion of beneficiaries of user-fee removal policy was highest in urban areas (35.9%), among women belonging to the middle income category (38.3%), among women who gave birth in primary health centres (63.1%) and among women who resided in communities where there was availability of health facilities (37.2%).ConclusionThe study concludes that low coverage of the free maternal health programme, especially among women of low socioeconomic status residing in underserved settings is among the reasons for persistent poor maternal health outcomes in the context of free maternal healthcare. A model towards improving maternal health in underserved settings, especially in North Central Nigeria, would entail provisioning of health facilities as well as focusing on implementing equitable maternal health policies.
Highlights
The reasons for low utilisation of maternal health services in settings where the user-fee removal policy has been implemented continue to generate scholarly debates
Factors associated with facility-based childbirth The analysis reveals that place of residence, educational level and socioeconomic status were associated with facility-based childbirth in Ekiti State, whereas only educational level was significantly associated with facilitybased childbirth in Ondo State (Table 2)
The proportion of beneficiaries of user-fee removal policy was highest in urban areas (35.9%), women belonging to the middle income category (38.3%), women who gave birth in primary health centres (63.1%) and among women who resided in communities where there was availability of health facilities (37.2%)
Summary
The reasons for low utilisation of maternal health services in settings where the user-fee removal policy has been implemented continue to generate scholarly debates. Despite the introduction of user-fee removal for maternal healthcare services, maternal health outcomes of women in the lowest wealth index remain persistently poor [1, 4]. The reasons for this are not well understood and continue to generate scholarly debates. Lack of transportation, poverty, and poor quality maternal health services were among the common explanations advanced for poor maternal outcomes despite scaling up of maternal health interventions in many developing countries [9,10,11] These reasons do not sufficiently explain why maternal health outcomes of women in the lowest wealth index remain persistently poor. Some scholars have begun to express doubts about whether the removal of user fees for maternal health guarantees universal access to maternal health care services [12, 13]
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