Abstract
BackgroundWhile Primary Health Care has been designed to provide universal access to skilled pregnancy care for the prevention of maternal deaths in Nigeria, available evidence suggests that pregnant women in rural communities often do not use Primary Health Care Centres for skilled care. The objective of this study was to investigate the reasons why women do not use PHC for skilled pregnancy care in rural Nigeria.MethodsQualitative data were obtained from twenty focus group discussions conducted with women and men in marital union to elicit their perceptions about utilisation of maternal and child health care services in PHC centres. Groups were constituted along the focus of sex and age. The group discussions were tape-recorded, transcribed verbatim and analyzed thematically.ResultsThe four broad categories of reasons for non-use identified in the study were: 1) accessibility factors – poor roads, difficulty with transportation, long distances, and facility not always open; 2) perceptions relating to poor quality of care, including inadequate drugs and consumables, abusive care by health providers, providers not in sufficient numbers and not always available in the facilities, long waiting times, and inappropriate referrals; 3) high costs of services, which include the inability to pay for services even when costs are not excessive, and the introduction of informal payments by staff; and 4) Other comprising partner support and misinterpretation of signs of pregnancy complications.ConclusionAddressing these factors through adequate budgetary provisions, programs to reduce out-of-pocket expenses for maternal health, adequate staffing and training, innovative methods of transportation and male involvement are critical in efforts to improve rural women’s access to skilled pregnancy care in primary health care centres in the country.
Highlights
While Primary Health Care has been designed to provide universal access to skilled pregnancy care for the prevention of maternal deaths in Nigeria, available evidence suggests that pregnant women in rural communities often do not use Primary Health Care Centres for skilled care
Specific associations were identified in the cross-sectional survey between various independent variables and women’s likelihood to use skilled pregnancy care in primary health care (PHC) centres, we decided it was important to hear the voices of women and their partners through qualitative research to identify reasons that primary healthcare facilities may not be used for skilled pregnancy care
The reasons proffered can be broadly categorized into 1) accessibility factors – poor roads, difficulty with transportation, long distances to PHC facilities and that the PHC centres are not always open; 2) perceptions relating to poor quality of care in PHC centres, including inadequate drugs and consumables, abusive care by health providers, providers not in sufficient numbers and not always available in the facilities, long waiting times, and inappropriate referrals; and 3) high costs of services, which include the inability to pay for services even when costs are not excessive, and the introduction of informal payments by staff
Summary
While Primary Health Care has been designed to provide universal access to skilled pregnancy care for the prevention of maternal deaths in Nigeria, available evidence suggests that pregnant women in rural communities often do not use Primary Health Care Centres for skilled care. The Federal Government of Nigeria has adopted primary health care (PHC) as a policy to achieve universal health coverage for citizens and to ensure that women, especially in rural areas, gain access to evidence-based. Despite these efforts, available reports indicate substantial under-utilisation of PHC centres for skilled pregnancy care by vulnerable rural women throughout the country [7,8,9,10]. Several demand and supply factors have been identified in quantitative research as reasons why women do not use maternal health services in Nigeria. We believe that hearing the voices of rural women and men on these issues will provide a greater understanding of the related issues and lead to a more accurate design of interventions to improve women’s access to skilled pregnancy care in the country
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
