Use of motorised transport and pathways to childbirth care in health facilities: Evidence from the 2018 Nigeria Demographic and Health Survey

Abstract

In Nigeria, 59% of pregnant women deliver at home, despite evidence about the benefits of childbirth in health facilities. While different modes of transport can be used to access childbirth care, motorised transport guarantees quicker transfer compared to non-motorised forms. Our study uses the 2018 Nigeria Demographic and Health Survey (NDHS) to describe the pathways to childbirth care and the determinants of using motorised transport to reach this care. The most recent live birth of women 15–49 years within the five years preceding the NDHS were included. The main outcome of the study was the use of motorised transport to childbirth. Explanatory variables were women’s socio-demographic characteristics and pregnancy-related factors. Descriptive, crude, and adjusted logistic regression analyses were conducted to assess the determinants of use of motorised transport. Overall, 31% of all women in Nigeria used motorised transport to get to their place of childbirth. Among women who delivered in health facilities, 77% used motorised transport; among women referred during childbirth from one facility to another, this was 98%. Among all women, adjusted odds of using motorised transport increased with increasing wealth quintile and educational level. Among women who gave birth in a health facility, there was no difference in the adjusted odds of motorised transport across wealth quintiles or educational status, but higher for women who were referred between health facilities (aOR = 8.87, 95% CI 1.90–41.40). Women who experienced at least one complication of labour/childbirth had higher odds of motorised transport use (aOR = 3.01, 95% CI 2.55–3.55, all women sample). Our study shows that women with higher education and wealth and women travelling to health facilities because of pregnancy complications were more likely to use motorised transport. Obstetric transport interventions targeting particularly vulnerable, less educated, and less privileged pregnant women should bridge the equity gap in accessing childbirth services.

Emergency obstetric care access dynamics in Africa’s cities: Analysis of women’s self-reported care-seeking pathways in Kampala city, Uganda

“…[22][23][24] Studies in urban settings in SSA elaborate travel dynamics of women in emergency situations, highlighting different patterns and determinants. 22,25,26 However, these insights emerge from a few cities in the region, yet women's care-seeking processes might differ in other cities due to differences in resource availability, governance structures and population dynamics, which influence organization of and timely access to health services. 27 Additionally, existing studies largely use data from medical records rather than women's first-hand accounts and provide less information on intermediate steps between place of origin and where women receive care.…”

Status, associated factors, and reasons for bypassing the childbirth center among postpartum women in the Dire Dawa Administration, Ethiopia: A Mixed Study

“…Still, avoiding the nearby health facility exposes the woman and her family to additional costs and wastes health-care resources (6,(18)(19)(20). Moreover, bypassing the nearby health facility creates an inappropriate self-referral burden on the other health facility, and this again indirectly affects other obstetric care using women, like long waiting times, delayed emergency obstetric care (11,15,21,22), unequal distribution of skilled birth attendants, and associated complications of labour and childbirth (15,22,23). Furthermore, avoiding available childbirth facilities has serious consequences for maternal health service delivery and human resources within a health system (13,20,(24)(25)(26)(27).…”

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“…Still, avoiding the nearby health facility exposes the woman and her family to additional costs and wastes health-care resources [6,[18][19][20]. Moreover, bypassing the nearby health facility creates an inappropriate self-referral burden on the other health facility, and this again indirectly affects other obstetric care using women, like long waiting times, delayed emergency obstetric care, unequal distribution of skilled birth attendants, and associated complications of labour and childbirth [11,15,[21][22][23]. Furthermore, avoiding available childbirth facilities has serious consequences for maternal health service delivery and human resources within a health system [13,20,[24][25][26][27].…”