Project – Barriers to Accessing Skilled Birth Attendance Among Pregnant Women in Rural and Peri-Urban Communities in Asokoro and Kuje

Chapter One: Introduction

1.1 Background of the Study

Maternal mortality remains a major public health challenge in developing countries, particularly in rural and peri-urban communities. Globally, about 295,000 women died from pregnancy- and childbirth-related complications in 2017, with sub-Saharan Africa accounting for approximately two-thirds of these deaths (World Health Organization [WHO], 2019). In Nigeria, the maternal mortality ratio remains high at 512 deaths per 100,000 live births, indicating persistent challenges in access to quality maternal health services (National Population Commission [NPC] & ICF, 2019).

Skilled birth attendance (SBA), defined as delivery care provided by trained health professionals such as doctors, midwives, and nurses, is a key strategy to reduce maternal and neonatal morbidity and mortality (WHO, 2022). SBA ensures timely identification and management of pregnancy and childbirth complications such as hemorrhage, obstructed labor, and sepsis. Evidence shows that countries with high SBA coverage experience significantly lower maternal and neonatal deaths (Campbell & Graham, 2016).

Despite these benefits, access to skilled birth attendants in Nigeria is limited, particularly in rural and peri-urban communities, due to factors such as poverty, long distances to health facilities, cultural beliefs, poor healthcare infrastructure, and inadequate health workforce (Okonofua et al., 2018). In the Federal Capital Territory (FCT), communities like Asokoro and Kuje have unique challenges: while Asokoro is more peri-urban with relatively better access to health facilities, Kuje remains largely rural with limited healthcare infrastructure. These disparities can significantly affect maternal health-seeking behavior and utilization of skilled birth services.

Understanding the barriers to accessing SBA in these communities is crucial to inform interventions that improve maternal and neonatal outcomes. Identifying socio-economic, cultural, and systemic obstacles can help policymakers, healthcare providers, and community stakeholders implement targeted strategies to increase SBA utilization.

1.2 Statement of the Problem

Maternal mortality in Nigeria remains unacceptably high despite interventions to improve maternal healthcare. One major contributing factor is the low utilization of skilled birth attendance, especially in rural and peri-urban communities (NPC & ICF, 2019). In areas like Kuje and Asokoro, several factors impede access to SBA, including the cost of services, long travel distances, inadequate transportation, cultural preference for traditional birth attendants, and low awareness of the benefits of skilled care (Okonofua et al., 2018).

Limited access to SBA exposes women to preventable complications during childbirth, increasing the risk of maternal and neonatal morbidity and mortality. Moreover, disparities between rural and peri-urban settings may exacerbate inequities in maternal health outcomes. While some studies have examined maternal health challenges in Nigeria broadly, there is limited empirical evidence specifically addressing barriers to SBA in Asokoro and Kuje. Therefore, this study seeks to evaluate the barriers to accessing skilled birth attendance among pregnant women in these communities to inform effective interventions.

1.3 Research Objectives

The primary objective of this study is to examine the barriers to accessing skilled birth attendance among pregnant women in rural and peri-urban communities in Asokoro and Kuje. The specific objectives are:

1. To assess the level of utilization of skilled birth attendants among pregnant women in Asokoro and Kuje.

2. To identify socio-economic factors affecting access to skilled birth attendance.

3. To examine cultural beliefs and practices that influence the choice of birth attendants.

4. To determine systemic and healthcare-related barriers to accessing skilled birth services.

1.4 Research Questions

1. What is the level of skilled birth attendance utilization among pregnant women in Asokoro and Kuje?

2. How do socio-economic factors affect access to skilled birth attendance in these communities?

3. What cultural beliefs and practices influence the choice of birth attendants among pregnant women?

4. What systemic and healthcare-related barriers hinder access to skilled birth services in Asokoro and Kuje?

1.5 Research Hypothesis

The study will test the following hypothesis:

H₀: Socio-economic, cultural, and systemic factors have no significant effect on accessing skilled birth attendance among pregnant women in rural and peri-urban communities in Asokoro and Kuje.

H₁: Socio-economic, cultural, and systemic factors have a significant effect on accessing skilled birth attendance among pregnant women in rural and peri-urban communities in Asokoro and Kuje.

1.6 Significance of the Study

This study is significant for several reasons:

1. It provides empirical evidence on barriers to accessing skilled birth attendance in rural and peri-urban communities of the FCT.

2. It identifies socio-economic, cultural, and systemic factors that influence maternal health-seeking behavior, informing policymakers and healthcare providers on strategies to improve SBA utilization.

3. The findings may guide community-based programs, awareness campaigns, and interventions aimed at increasing skilled birth attendance, thereby reducing maternal and neonatal mortality.

4. The study contributes to the academic literature on maternal health access and utilization in low-resource settings.

1.7 Scope of the Study

The study focuses on pregnant women in rural and peri-urban communities in Asokoro and Kuje, Federal Capital Territory. It examines their access to skilled birth attendants, socio-economic and cultural factors affecting utilization, and systemic barriers within the healthcare system. The study does not include high-income urban areas or private hospitals outside the selected communities.

1.8 Definition of Key Terms

• Skilled Birth Attendance (SBA): Delivery care provided by trained health professionals, including doctors, midwives, and nurses (WHO, 2022).

• Maternal Mortality: The death of a woman during pregnancy, childbirth, or within 42 days of termination of pregnancy from any cause related to or aggravated by the pregnancy (WHO, 2019).

• Rural Community: A community located in a non-urban area characterized by limited access to healthcare and infrastructure.

• Peri-Urban Community: A community situated at the outskirts of urban centers, often displaying characteristics of both urban and rural settings.

Project – Barriers to Accessing Skilled Birth Attendance Among Pregnant Women in Rural and Peri-Urban Communities in Asokoro and Kuje