Project – Factors Associated with the Utilisation of Antenatal Care Services Among Pregnant Women: A Study of Selected Primary Healthcare Centres in Makurdi Local Government Area, Benue State.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Antenatal care (ANC) is an essential component of maternal healthcare that aims to protect the health and wellbeing of pregnant women and their unborn children throughout pregnancy. It involves regular contact with skilled healthcare providers for the assessment of maternal and fetal health, early identification of pregnancy-related complications, preventive interventions, health education, nutritional counselling, and preparation for childbirth. The World Health Organization (WHO, 2016) recommends a positive, person-centred approach to antenatal care that addresses not only the prevention of illness and death but also the physical, emotional, and social needs of pregnant women. Regular antenatal care can help healthcare professionals identify conditions such as hypertension, anaemia, infections, and other complications that may threaten maternal or fetal wellbeing. However, the benefits of these services depend partly on whether women initiate care early, attend the recommended number of contacts, and receive the appropriate interventions during each contact. Therefore, understanding the factors that encourage or discourage antenatal care utilisation is important for improving maternal healthcare outcomes.

The importance of antenatal care is particularly evident in countries where maternal morbidity and mortality remain significant public health concerns. The WHO (2016) recommends a minimum of eight antenatal care contacts during pregnancy, beginning in the first trimester, to improve maternal and perinatal outcomes and women’s experience of care. These contacts provide opportunities for monitoring pregnancy progress, screening for health conditions, administering recommended preventive interventions, and providing advice on nutrition, birth preparedness, danger signs, and appropriate care-seeking behaviour. However, access to antenatal care does not always translate into adequate utilisation. Some women may attend only once or twice, initiate care late in pregnancy, or fail to complete the recommended contacts. Such patterns can reduce opportunities for early detection and management of complications. Consequently, antenatal care utilisation should be understood in terms of both initial attendance and continuity of contact throughout pregnancy, rather than simply whether a pregnant woman has visited a health facility at least once.

In Nigeria, antenatal care utilisation is influenced by a combination of individual, household, community, and health-system factors. National evidence has shown that maternal education, household wealth, geographical location, health insurance, parity, access to health information, and the availability of transport can be associated with the number of antenatal care contacts women receive. Using data from the 2018 Nigeria Demographic and Health Survey, Ali and colleagues’ research on antenatal care utilisation found that only a minority of women completed eight or more contacts, with important differences between population groups and geographical settings (Fagbamigbe et al., 2021). A separate analysis of the same national survey also identified disparities between rural and urban areas in the utilisation of recommended antenatal care contacts and receipt of service components (Adeniran et al., 2024). These findings demonstrate that antenatal care utilisation is not determined solely by a woman’s awareness of its importance. Financial resources, social circumstances, accessibility of facilities, and the organisation of services may also determine whether she can obtain care consistently.

The educational and socioeconomic circumstances of pregnant women may affect their ability to recognise the importance of antenatal care and make informed decisions about seeking it. Women with greater access to education and health information may be better positioned to understand the benefits of early registration, routine check-ups, preventive medication, and professional advice. In contrast, low educational attainment, limited health literacy, financial dependence, and restricted decision-making power may contribute to delayed or irregular attendance. Household responsibilities, paid employment, childcare demands, and the need to obtain permission or financial support from a partner or family member may also influence whether a woman can attend scheduled appointments. Research using Nigerian demographic and health data has identified educational attainment, household wealth, maternal characteristics, and other individual and community-level variables as important correlates of antenatal care utilisation (Fagbamigbe et al., 2021). These findings indicate that strategies for improving attendance should consider women’s wider social and economic circumstances rather than focusing exclusively on individual knowledge.

Geographical accessibility and the quality of healthcare services are additional factors that may influence antenatal care utilisation. The distance between a woman’s home and a primary healthcare centre, the availability and cost of transport, road conditions, waiting times, and the availability of trained personnel may determine whether attending antenatal appointments is convenient or difficult. Even when a healthcare facility is physically accessible, women may be discouraged from returning if they experience disrespectful treatment, inadequate communication, long delays, shortages of essential supplies, or concerns about confidentiality. The WHO (2016) emphasises that antenatal care should provide a positive experience and that service quality is important alongside the delivery of clinical interventions. Research on antenatal care utilisation in Nigeria has similarly identified geographical, financial, and health-system barriers as relevant considerations in service access (Fagbamigbe et al., 2021). Accordingly, examining women’s utilisation patterns requires attention to the availability, accessibility, affordability, and perceived quality of services at the facilities they attend.

Cultural beliefs, family influence, previous pregnancy experiences, and community attitudes may also shape decisions about antenatal care. Some pregnant women may seek formal care early because they trust healthcare professionals or have experienced complications in previous pregnancies. Others may initially rely on advice from relatives, traditional birth attendants, religious leaders, or community members before attending a health facility. These choices may be influenced by cultural expectations, perceptions of pregnancy as a normal condition that requires care only when symptoms develop, fear of medical procedures, or concerns about how healthcare workers treat patients. The WHO (2016) recommends people-centred antenatal care that responds to women’s needs and experiences, while national studies indicate that social, demographic, and contextual differences are associated with variations in antenatal care attendance in Nigeria (Fagbamigbe et al., 2021). Understanding these influences is important because effective maternal health programmes need to engage women and their communities respectfully while communicating the value of routine antenatal assessment.

At the local level, primary healthcare centres are particularly important because they provide first-contact maternal healthcare services for many communities and can support early registration, routine monitoring, health education, preventive interventions, and referrals when complications require higher-level care. In Makurdi Local Government Area of Benue State, pregnant women’s use of selected primary healthcare centres may be influenced by their awareness of antenatal care, educational and financial circumstances, distance from facilities, family support, previous experiences with healthcare providers, and perceptions of service quality. Although national studies establish that these factors are relevant to antenatal care utilisation, national-level findings cannot determine the precise circumstances affecting women who attend particular primary healthcare centres in Makurdi. Local investigation is therefore necessary to identify the factors most closely associated with service utilisation in the selected facilities. This study seeks to examine these factors to generate evidence that may assist healthcare workers, facility administrators, and maternal health planners in developing locally appropriate measures to improve antenatal care attendance and continuity.

1.2 Statement of the Problem

Antenatal care is widely recognised as an important intervention for promoting maternal and fetal wellbeing, yet the benefits of these services depend on whether pregnant women access them early and continue attending throughout pregnancy. Routine antenatal care provides opportunities for healthcare professionals to identify pregnancy-related complications, monitor fetal development, administer preventive interventions, and educate women on healthy pregnancy practices. The WHO (2016) recommends a minimum of eight antenatal care contacts to improve pregnancy outcomes and women’s experience of care. However, evidence from Nigeria indicates that the utilisation of the recommended number of contacts remains limited. Ekholuenetale, Benebo, and Idebolo (2020), using data from the 2018 Nigeria Demographic and Health Survey, reported that approximately 17.4% of the women included in their analysis had eight or more antenatal care contacts. This evidence raises concern about the factors that prevent pregnant women from obtaining the full benefits of antenatal care and highlights the need to investigate these factors in specific local settings.

One major problem is that pregnant women’s ability to utilise antenatal care services may be affected by economic and personal circumstances. Transportation costs, consultation-related expenses, the cost of prescribed medicines, household financial pressures, educational attainment, employment responsibilities, and the availability of family support may influence the decision to attend antenatal appointments. Women with limited financial resources may postpone registration, miss scheduled contacts, or discontinue attendance when the cost of reaching a facility becomes difficult to manage. Similarly, women who lack adequate information about the importance of early and regular antenatal care may not appreciate the benefits of attending before complications arise. Ekholuenetale et al. (2020) found that educational attainment, use of mass media, timing of antenatal care initiation, and place of residence were associated with the likelihood of completing eight or more contacts in Nigeria. These findings demonstrate that underutilisation may reflect several interacting barriers rather than a single cause.

The accessibility and quality of healthcare services may also influence pregnant women’s decisions to attend primary healthcare centres. Long distances, inadequate transportation, prolonged waiting times, shortages of healthcare personnel, unfavourable staff attitudes, and concerns about the quality of care may discourage women from initiating or continuing antenatal attendance. Evidence from Makurdi also indicates that service delivery and healthcare workers’ interactions with pregnant women deserve attention. A study of antenatal care service delivery at the Federal Medical Centre, Makurdi, reported that some respondents experienced concerns including inadequate attention, delays, and unfavourable staff behaviour, which could discourage continued utilisation (Abogonye & Wegh, 2025). Although a federal medical centre differs from a primary healthcare centre, the findings highlight the importance of examining women’s experiences of care alongside financial, social, and geographical factors. It is therefore necessary to investigate whether similar or different barriers affect pregnant women attending the selected primary healthcare centres in Makurdi Local Government Area.

Furthermore, existing national and facility-based evidence cannot fully establish the particular factors associated with antenatal care utilisation among pregnant women attending the selected primary healthcare centres in Makurdi. Women in this setting may have different experiences relating to educational background, income, transport, family influence, cultural beliefs, pregnancy history, knowledge of antenatal care, and satisfaction with healthcare services. Without locally generated evidence, healthcare providers and maternal health programme planners may find it difficult to determine which barriers should receive priority when developing interventions to improve attendance and continuity of care. The WHO (2016) emphasises the importance of accessible, high-quality, person-centred antenatal care, while Ekholuenetale et al. (2020) demonstrate the relevance of individual, household, and community factors in Nigeria. Consequently, this study seeks to identify the factors associated with the utilisation of antenatal care services among pregnant women attending selected primary healthcare centres in Makurdi Local Government Area, Benue State.

1.3 Objectives of the Study

The main objective of this study is to examine the factors associated with the utilisation of antenatal care services among pregnant women attending selected primary healthcare centres in Makurdi Local Government Area, Benue State.

The specific objectives are to:

1. Assess the level of utilisation of antenatal care services among pregnant women attending selected primary healthcare centres in Makurdi Local Government Area.

2. Examine the relationship between the sociodemographic characteristics of pregnant women and their utilisation of antenatal care services.

3. Identify the economic, cultural, and family-related factors associated with the utilisation of antenatal care services among pregnant women.

4. Determine the relationship between healthcare service-related factors and antenatal care utilisation among pregnant women attending the selected primary healthcare centres.

1.4 Research Questions

The following research questions will guide the study:

1. What is the level of utilisation of antenatal care services among pregnant women attending selected primary healthcare centres in Makurdi Local Government Area?

2. What relationship exists between the sociodemographic characteristics of pregnant women and their utilisation of antenatal care services?

3. What economic, cultural, and family-related factors are associated with the utilisation of antenatal care services among pregnant women?

4. What relationship exists between healthcare service-related factors and antenatal care utilisation among pregnant women attending the selected primary healthcare centres?

1.5 Research Hypothesis

The following null hypothesis will be tested at the 0.05 level of significance:

H₀: There is no statistically significant relationship between selected sociodemographic, economic, cultural, family-related, and healthcare service-related factors and the utilisation of antenatal care services among pregnant women attending selected primary healthcare centres in Makurdi Local Government Area, Benue State.

1.6 Significance of the Study

The findings of this study may be beneficial to pregnant women, healthcare workers, primary healthcare administrators, government agencies, community leaders, researchers, and future students.

Pregnant women: The findings may help identify barriers that prevent women from accessing antenatal care early and attending regularly. The study may also increase awareness of the importance of antenatal care for monitoring pregnancy, identifying complications, receiving preventive interventions, and preparing for childbirth.

Healthcare workers: Nurses, midwives, community health extension workers, and other maternal healthcare personnel may benefit from evidence concerning the factors that influence women’s attendance. The findings may help them improve antenatal counselling, communication, appointment scheduling, and patient-centred care.

Primary healthcare administrators: The study may provide information useful for improving service delivery at the selected facilities. By identifying accessibility challenges, waiting-time concerns, staff-related issues, and other barriers, administrators may be better positioned to improve the organisation and quality of antenatal care.

Government and health policymakers: The findings may provide local evidence for planning maternal healthcare interventions in Makurdi Local Government Area and Benue State. The results may assist policymakers in identifying areas where improvements in service accessibility, health education, transport support, or resource allocation may be needed.

Community leaders and families: The study may help community leaders, partners, and family members understand how social support and household decisions can affect antenatal care utilisation. This understanding may encourage supportive attitudes towards early registration and regular attendance.

Researchers and students: The study may contribute to literature on maternal healthcare utilisation in Nigeria and serve as a reference for future research on antenatal care, health service accessibility, and maternal health outcomes.

1.7 Scope of the Study

The study focuses on factors associated with the utilisation of antenatal care services among pregnant women attending selected primary healthcare centres in Makurdi Local Government Area, Benue State.

The content scope covers the level and pattern of antenatal care utilisation, including the timing of initial registration and attendance during pregnancy. It also examines selected sociodemographic characteristics, economic circumstances, cultural beliefs, family support, geographical accessibility, and healthcare service-related factors that may influence attendance.

The geographical scope is limited to the selected primary healthcare centres within Makurdi Local Government Area. The study population comprises pregnant women attending these facilities during the period of data collection. Findings will be interpreted within the context of the selected facilities and should not automatically be generalised to every pregnant woman in Benue State.

1.8 Limitations of the Study

The study may encounter limitations relating to time, financial resources, access to respondents, and the availability of complete information. Some respondents may have difficulty recalling the number or timing of previous antenatal contacts, while others may be reluctant to discuss financial difficulties, cultural beliefs, or negative experiences with healthcare workers. Such circumstances may affect the accuracy of self-reported information.

The study’s restriction to selected primary healthcare centres may also limit the extent to which its findings represent women attending private hospitals, secondary or tertiary facilities, or women who do not access formal antenatal care. Furthermore, if a cross-sectional design is adopted, the findings may identify associations between selected factors and antenatal care utilisation but will not establish causation conclusively. To minimise these limitations, the researcher will use clear questionnaire items, protect respondents’ confidentiality, explain the voluntary nature of participation, and follow relevant ethical requirements.

1.9 Operational Definition of Terms

Antenatal care (ANC): Healthcare provided to a pregnant woman during pregnancy to monitor maternal and fetal health, prevent or identify complications, provide health education, and prepare for childbirth.

Antenatal care utilisation: The extent to which pregnant women access and use antenatal care services, including the timing of initial registration and the number or regularity of subsequent contacts.

Pregnant women: Women who are currently pregnant and attend the selected primary healthcare centres in Makurdi Local Government Area during the study period.

Primary healthcare centres: First-contact healthcare facilities that provide basic health services, including antenatal care, maternal health education, preventive interventions, and referrals where necessary.

Sociodemographic factors: Personal and social characteristics of pregnant women, such as age, marital status, educational attainment, occupation, and place of residence, that may be associated with antenatal care utilisation.

Economic factors: Financial circumstances that may influence antenatal care attendance, including household income, transport expenses, healthcare-related costs, and financial support.

Cultural factors: Beliefs, norms, practices, and community expectations that may influence decisions about pregnancy and the use of formal healthcare services.

Family-related factors: The influence of partners, relatives, household responsibilities, and family support on a pregnant woman’s ability or willingness to attend antenatal care.

Healthcare service-related factors: Characteristics of healthcare delivery that may influence utilisation, including distance, waiting time, staff attitudes, availability of personnel, perceived quality of care, and accessibility of services.

Selected primary healthcare centres: The primary healthcare facilities chosen for data collection within Makurdi Local Government Area, Benue State.

Project – Factors Associated with the Utilisation of Antenatal Care Services Among Pregnant Women: A Study of Selected Primary Healthcare Centres in Makurdi Local Government Area, Benue State.