A qualitative study of community elders’ perceptions about the underutilization of formal maternal care and maternal death in rural Nigeria

Abstract

BackgroundUnderutilization of formal maternal care services and accredited health attendants is a major contributor to the high maternal mortality rates in rural communities in Nigeria. Perceptions of a poor quality of care and inaccessible services in health facilities strongly influence the low use of formal maternal care services. There is therefore a need to understand local perceptions about maternal health services utilization and maternal death. This study thereby aims to explore perceptions and beliefs about the underutilization of formal care and causes of maternal death, as well as to identify potential solutions to improve use and reduce maternal mortality in rural Nigeria.MethodsData were collected through 9 community conversations, which were conducted with 158 community elders in 9 rural communities in Edo State, Nigeria. Data from transcripts were analyzed through inductive thematic analysis using NVivo 12 software.ResultsPerceived reasons for the underutilization of formal maternal care included poor qualities of care, physical inaccessibility, financial inaccessibility, and lack of community knowledge. Perceived reasons for maternal death were related to medical causes, maternal healthcare services deficiencies, uptake of native maternal care, and poor community awareness and negligence. Elders identified increased access to adequate maternal care, health promotion and education, community support, and supernatural assistance from a deity as solutions for increasing use of formal maternal care and reducing maternal mortality rates.ConclusionStudy results revealed that multifaceted approaches that consider community contexts, challenges, and needs are required to develop acceptable, effective and long-lasting positive changes. Interventions aiming to increase use of formal care services and curb maternal mortality rates must target improvements to the technical and interpersonal qualities of care, ease of access, community awareness and knowledge, and allow community members to actively engage in implementation phases.

Influence of Conditional Cash Transfers on the Uptake of Maternal and Child Health Services in Nigeria: Insights From a Mixed-Methods Study

“…The implication is that CCT was a good motivating factor for some women. It undoubtedly took care of some financial barriers which are a major reason for poor health-seeking behavior especially among rural residents in SSA (34)(35)(36) as well as the opportunity cost of being away from income-generating activities during a healthcare-seeking time (3,37). Since the incentive was paid post-behavior, those motivated by the CCT had to have some prior resources that allowed them to perform the desired behavior (e.g., pay for transport) before collecting the money weeks or months later.…”

Using the Health Belief Model to explore rural maternal utilisation of skilled health personnel for childbirth delivery: a qualitative study in three districts of the Eastern Region of Ghana

“…The research took place in the Eastern Region of Ghana, a primarily rural region, with nearly two-thirds of the population of 2,106,696 residing in rural areas. 19 The primary industry is agriculture, followed by wholesale or retail trade. 19 The most common type of home is constructed of mud entailing one to two rooms.…”

“…19 The primary industry is agriculture, followed by wholesale or retail trade. 19 The most common type of home is constructed of mud entailing one to two rooms. 19 The Region is divided into 26 administrative districts.…”

“…19 The most common type of home is constructed of mud entailing one to two rooms. 19 The Region is divided into 26 administrative districts. Three districts were selected to be included in our study based on proximity and accessibility to researchers: Lower Manya Krobo, Yilo Krobo, and Asuogyaman Districts.…”

Effect of a multifaceted intervention on the utilisation of primary health for maternal and child health care in rural Nigeria: a quasi-experimental study

“…In assessing the use of PHCs for skilled pregnancy care, our team conducted initial formative research that showed that less than 47% of pregnant women in rural Edo used any of the available PHCs for care 16. We further ascertained through mixed qualitative research that these were due to perceptions relating to poor-quality services, high-cost of services, poor roads and transportation difficulty, gender and cultural issues and perceptions that PHCs may not be the appropriate places for women to receive antenatal and delivery care 10 17–19. To address these concerns, we worked with leaders in 20 communities in the area in collaboration with policymakers, sector planners and other stakeholders to design interventions to address the bottlenecks identified as preventing the use of skilled care by pregnant women in the communities.…”