Project – Barriers to Maternal Healthcare Utilisation among Pregnant Women in Urban Communities: A Case Study of Alimosho Local Government Area, Lagos State.

CHAPTER ONE

INTRODUCTION

Title: Barriers to Maternal Healthcare Utilisation among Pregnant Women in Urban Communities: A Case Study of Alimosho Local Government Area, Lagos State

1.1 Background to the Study

Maternal healthcare is an essential component of public health because it focuses on protecting the health and well-being of women throughout pregnancy, childbirth and the period following delivery. It includes antenatal care, skilled attendance during childbirth, emergency obstetric services and postnatal care. These services are designed to prevent pregnancy-related complications, identify health risks early, provide appropriate treatment and reduce maternal and newborn deaths. Maternal healthcare utilisation refers to the extent to which pregnant women access and use these services when needed. Adequate utilisation is important because complications such as severe bleeding, infections, hypertensive disorders, obstructed labour and complications arising from unsafe abortion can result in maternal disability or death if not properly managed. The World Health Organization (2016) recommends a minimum of eight antenatal care contacts during pregnancy to improve maternal and newborn outcomes, while emphasising that antenatal care should provide effective clinical interventions, health promotion and support for pregnant women. Similarly, the World Health Organization, United Nations Children’s Fund, United Nations Population Fund, World Bank Group, and United Nations Department of Economic and Social Affairs (2025) highlight the continuing global burden of preventable maternal deaths and the importance of accessible, quality maternal healthcare. These considerations demonstrate that maternal healthcare utilisation is not simply a matter of attending a hospital but involves receiving timely, appropriate and continuous care throughout pregnancy and after childbirth.

The importance of maternal healthcare is particularly evident in developing countries, where preventable maternal deaths remain a major public health concern. Although improvements have been recorded in some regions, many women still experience difficulties accessing skilled antenatal, delivery and postnatal services. The World Health Organization (2025) reported that more than 700 women died every day in 2023 from preventable causes related to pregnancy and childbirth, with the greatest burden occurring in low-resource settings. In Nigeria, the situation remains serious because maternal health outcomes are influenced by poverty, unequal access to healthcare, inadequate health infrastructure, shortages of skilled personnel and delays in seeking or receiving appropriate treatment. According to the National Population Commission (NPC) and ICF (2025), findings from the 2024 Nigeria Demographic and Health Survey showed that 63% of women aged 15–49 with a live birth in the preceding two years received antenatal care from a skilled provider, while 26% received no antenatal care. The report also indicated that 43% of live births occurred in health facilities and only 46% were assisted by skilled providers. These figures demonstrate that a substantial proportion of Nigerian women still do not receive the full range of maternal healthcare services required for safer pregnancy and childbirth.

Maternal healthcare utilisation is influenced by several interrelated barriers, which can broadly be classified as financial, geographical, institutional, informational, psychological and sociocultural. Financial barriers include consultation fees, laboratory charges, medication costs, transportation expenses and other indirect costs associated with attending healthcare facilities. Even where public healthcare facilities provide subsidised services, pregnant women may still face expenses that make regular attendance difficult, particularly when household income is limited or irregular. Geographical barriers include long distances to health facilities, poor road conditions, traffic congestion and inadequate transportation, especially when women need urgent medical attention. Institutional barriers may involve long waiting times, inadequate medical equipment, shortages of healthcare workers, poor staff attitudes, lack of essential medicines and insufficient emergency referral arrangements. Adedokun, Uthman, and Bisiriyu (2023), using data from the 2018 Nigeria Demographic and Health Survey, found that maternal healthcare utilisation was associated with household wealth, education, employment, residence, distance to health facilities, access to permission and the ability to reach healthcare facilities. Their findings indicate that maternal healthcare decisions are influenced by both the personal circumstances of pregnant women and the conditions under which health services are provided.

In addition to economic and institutional challenges, cultural beliefs, religious practices, family influence and women’s decision-making autonomy can affect maternal healthcare utilisation. In some communities, pregnancy and childbirth may be regarded as natural processes that do not require regular medical attention unless complications arise. Some women may prefer traditional birth attendants, religious or spiritual centres, or home delivery because of personal beliefs, previous experiences or the influence of family members. Others may be required to obtain permission or financial support from their husbands or relatives before attending health facilities. These circumstances can delay antenatal registration, reduce the number of antenatal visits and discourage facility-based delivery. Matsuoka et al. (2020), in a study of the underlying causes of underutilisation of maternal, neonatal and child health services in Lagos State, identified five broad categories of barriers: financial, physical, cognitive, organisational, and psychological or sociocultural barriers. Their findings demonstrate that underutilisation is not caused by a single factor but by the interaction of several conditions affecting women’s ability and willingness to seek care. Consequently, understanding maternal healthcare utilisation requires attention to the social and cultural environment in which pregnant women make healthcare decisions.

Urban communities are often assumed to have better access to healthcare services than rural areas because they generally have more hospitals, primary healthcare centres, private clinics, pharmacies and qualified healthcare professionals. However, urban residence does not automatically guarantee adequate maternal healthcare utilisation. Rapid population growth, overcrowding, unequal distribution of health facilities, high living costs, traffic congestion and socioeconomic inequality can create serious obstacles for pregnant women living in urban communities. Women in low-income urban settlements may live relatively close to healthcare facilities but still be unable to afford consultation fees, diagnostic tests, medicines or transportation. They may also experience overcrowded facilities, long waiting periods and inadequate attention from health workers. The National Population Commission and ICF (2025) reported differences in maternal healthcare utilisation according to household wealth and educational attainment, indicating that socioeconomic inequality remains an important determinant of access to maternal services. Similarly, Adedokun et al. (2023) found that women from wealthier households and those with higher levels of education were more likely to utilise maternal healthcare services adequately. These findings suggest that the availability of health facilities in urban areas must be considered alongside affordability, service quality and the living conditions of pregnant women.

In Lagos State, maternal healthcare utilisation remains an important public health concern because of the state’s large population, rapid urbanisation and wide differences in household socioeconomic conditions. Although Lagos has public and private healthcare facilities across its local government areas, pregnant women may experience barriers relating to service costs, distance, transportation, health worker behaviour, availability of equipment and drugs, and the quality of care received. Matsuoka et al. (2020), in their investigation of maternal, neonatal and child healthcare underutilisation in Lagos State, identified financial, physical, cognitive, organisational and psychological or sociocultural barriers. The researchers recommended stronger community outreach, health promotion and improved deployment of health personnel to address these challenges. More recent research by Oladapo and colleagues on maternal healthcare utilisation in low-income communities in Lagos State also identified distance to health facilities, health worker behaviour, inadequate equipment and drugs, affordability, spousal decisions, transportation difficulties and spiritual beliefs as factors influencing the choice of antenatal and delivery services. These findings show that living in an urban state such as Lagos does not eliminate the obstacles that prevent women from obtaining appropriate maternal healthcare.

Alimosho Local Government Area provides a relevant setting for examining the barriers to maternal healthcare utilisation among pregnant women in urban communities. As a major local government area in Lagos State, Alimosho contains communities with different socioeconomic conditions and varying access to public and private healthcare facilities. The presence of healthcare facilities does not necessarily mean that all pregnant women can afford or consistently access antenatal, delivery and postnatal services. A study by Okafor and Yewande (2020), conducted in two health institutions in Alimosho, examined the effect of antenatal education on pregnant women’s knowledge and utilisation of facility-based delivery services. The researchers reported low pre-intervention utilisation scores and found that antenatal education significantly improved knowledge and the utilisation of facility-based delivery services. This suggests that inadequate information and awareness may contribute to poor utilisation, while appropriate health education can improve women’s use of available services. Nevertheless, antenatal education alone may not resolve financial difficulties, transportation problems, inadequate facility resources, negative staff attitudes and sociocultural restrictions. It is therefore necessary to examine the various barriers confronting pregnant women in the area and determine how these barriers affect their utilisation of maternal healthcare services. Against this background, this study investigates barriers to maternal healthcare utilisation among pregnant women in urban communities, using Alimosho Local Government Area, Lagos State, as a case study.

1.2 Statement of the Problem

Maternal healthcare services are designed to protect pregnant women and their babies through early detection of complications, appropriate medical interventions, skilled delivery and postnatal monitoring. Despite the availability of public and private healthcare facilities in many Nigerian urban centres, adequate utilisation of these services remains a challenge. The 2024 Nigeria Demographic and Health Survey reported that 63% of women with a recent live birth received antenatal care from a skilled provider, while 26% received no antenatal care. It also reported that only 43% of live births occurred in health facilities and 46% were assisted by skilled providers (National Population Commission & ICF, 2025). These figures reveal gaps in the use of essential maternal healthcare services and raise concerns about the number of women who may experience pregnancy and childbirth without adequate professional support. The problem is particularly important because the failure to obtain timely maternal care can increase the risk of preventable complications, maternal deaths and poor newborn outcomes. Consequently, the presence of healthcare facilities alone cannot be regarded as sufficient evidence of effective maternal healthcare access and utilisation.

One major problem affecting maternal healthcare utilisation is the financial burden associated with accessing services. Pregnant women may be required to pay for registration, consultation, laboratory investigations, ultrasound scans, prescribed drugs, delivery services and transportation. For women from low-income households, these expenses can make regular antenatal attendance and facility-based delivery difficult. Some women may delay their first antenatal visit, miss scheduled appointments or depend on traditional birth attendants and other informal providers because they perceive formal healthcare services as unaffordable. Adedokun et al. (2023) found that household wealth was significantly associated with the utilisation of maternal healthcare services in Nigeria, while Matsuoka et al. (2020) identified financial barriers as one of the major causes of underutilisation of maternal, neonatal and child healthcare services in Lagos State. This suggests that financial constraints may continue to prevent pregnant women from obtaining the full range of maternal healthcare services, even when health facilities are located within their urban communities.

Another problem concerns the physical, institutional and sociocultural conditions that influence women’s ability and willingness to use maternal healthcare services. Traffic congestion, transportation difficulties, distance to facilities, long waiting times, inadequate medical equipment, shortages of essential drugs and poor attitudes of some healthcare workers may discourage pregnant women from attending health facilities consistently. In addition, cultural beliefs, religious practices, family pressure and limited decision-making autonomy may influence the choice of where and when women seek maternal care. Matsuoka et al. (2020) identified physical, organisational, cognitive and psychological or sociocultural barriers to maternal healthcare utilisation in Lagos State. Similarly, research on low-income communities in Lagos found that women’s choices of antenatal and delivery facilities were influenced by health worker behaviour, equipment and drug availability, affordability, spousal decisions, transportation and spiritual beliefs. These challenges suggest that maternal healthcare utilisation is shaped by the combined effects of women’s personal circumstances and the quality, accessibility and acceptability of available services.

The central problem addressed by this study is that, despite the availability of maternal healthcare facilities and health education programmes in Alimosho Local Government Area, some pregnant women may still experience difficulties accessing and consistently using antenatal, skilled delivery and postnatal services. Although Okafor and Yewande (2020) examined the effect of antenatal education on facility-based delivery utilisation in two health institutions in Alimosho, there is a need for a broader examination of the financial, geographical, institutional, informational and sociocultural barriers affecting pregnant women across selected urban communities in the local government area. Without adequate knowledge of these barriers, interventions designed to improve maternal healthcare utilisation may fail to address the actual circumstances preventing women from obtaining appropriate care. This study therefore seeks to identify the major barriers to maternal healthcare utilisation, examine their influence on the use of maternal healthcare services and suggest measures for improving access and utilisation among pregnant women in selected urban communities in Alimosho Local Government Area, Lagos State.

1.3 Objectives of the Study

The main objective of this study is to examine the barriers to maternal healthcare utilisation among pregnant women in urban communities in Alimosho Local Government Area, Lagos State.

The specific objectives are to:

1. Examine the extent to which pregnant women utilise antenatal, skilled delivery and postnatal healthcare services in selected communities in Alimosho Local Government Area.

2. Identify the financial and socioeconomic barriers affecting maternal healthcare utilisation among pregnant women in the study area.

3. Examine the influence of geographical, institutional and healthcare-service-related factors on maternal healthcare utilisation among pregnant women in the study area.

4. Assess the influence of cultural beliefs, family decision-making and awareness of maternal healthcare services on utilisation among pregnant women in the study area.

1.4 Research Questions

The following research questions will guide the study:

1. To what extent do pregnant women utilise antenatal, skilled delivery and postnatal healthcare services in selected communities in Alimosho Local Government Area?

2. What financial and socioeconomic barriers affect maternal healthcare utilisation among pregnant women in the study area?

3. How do geographical, institutional and healthcare-service-related factors influence maternal healthcare utilisation among pregnant women in the study area?

4. How do cultural beliefs, family decision-making and awareness of maternal healthcare services influence utilisation among pregnant women in the study area?

1.5 Research Hypothesis

The following null hypothesis will be tested:

H₀: There is no significant relationship between barriers to healthcare access and maternal healthcare utilisation among pregnant women in selected urban communities in Alimosho Local Government Area, Lagos State.

1.6 Significance of the Study

The findings of this study will be significant to the following groups:

Pregnant Women: The study will help pregnant women understand the importance of consistent antenatal attendance, skilled delivery and postnatal care. It will also create awareness of the different barriers that may prevent them from accessing maternal healthcare services and encourage them to seek appropriate assistance when necessary.

Healthcare Professionals: The study will provide useful information to doctors, nurses, midwives, community health workers and other maternal healthcare professionals on the challenges pregnant women experience when accessing healthcare services. It may encourage healthcare workers to improve communication, patient education, professional conduct and the quality of maternal healthcare delivery.

Government and Health Policymakers: The findings will assist government authorities and policymakers in identifying the major financial, geographical, institutional and sociocultural barriers affecting maternal healthcare utilisation. The study may provide evidence for developing policies and programmes that improve affordability, accessibility and quality of maternal healthcare services.

Alimosho Local Government Authority: The study will provide useful information to the local government authority on the maternal healthcare needs of pregnant women in its communities. The findings may encourage improved community health outreach, maternal health education, support for primary healthcare facilities and collaboration with relevant health agencies.

Healthcare Institutions: Public and private healthcare facilities may benefit from the findings by identifying areas where maternal healthcare services require improvement. The study may encourage better patient relations, reduced waiting times, improved availability of essential medicines and equipment, and more effective referral arrangements for pregnant women.

Non-Governmental Organisations and Development Agencies: Organisations involved in maternal health, reproductive health and community development may use the findings to design interventions that address the specific challenges facing pregnant women in urban communities. The study may also assist them in developing programmes that promote maternal health education, financial support and access to skilled healthcare.

Researchers and Students: The study will contribute to academic literature on maternal healthcare utilisation, maternal health management and public health service delivery. It will serve as reference material for students and researchers interested in maternal health challenges, particularly in urban communities in Lagos State and other parts of Nigeria.

1.7 Scope of the Study

The study focuses on barriers to maternal healthcare utilisation among pregnant women in urban communities in Alimosho Local Government Area, Lagos State.

Geographical Scope: The study will be conducted in selected urban communities within Alimosho Local Government Area, Lagos State. The specific communities will be identified and stated during the research methodology based on the sampling procedure.

Content Scope: The study examines the utilisation of antenatal care, skilled delivery services and postnatal care. It also investigates financial and socioeconomic barriers, geographical accessibility, institutional challenges, healthcare workers’ attitudes, cultural beliefs, family influence and awareness of maternal healthcare services.

Population Scope: The study will focus on pregnant women residing in the selected communities in Alimosho Local Government Area. Where necessary, women who recently gave birth may also be included if the research design requires information about their recent experiences of maternal healthcare utilisation.

Temporal Scope: The study will focus on the maternal healthcare experiences of respondents during their current pregnancies or most recent pregnancies, depending on the eligibility criteria established for data collection.

1.8 Operational Definition of Terms

Maternal Healthcare: Healthcare services provided to women during pregnancy, childbirth and the postnatal period to protect their health and reduce the risks of maternal and newborn complications.

Maternal Healthcare Utilisation: The extent to which pregnant women access and use available maternal healthcare services, including antenatal care, skilled delivery and postnatal care.

Barriers: Conditions or circumstances that prevent, discourage or make it difficult for pregnant women to access and use appropriate maternal healthcare services.

Pregnant Women: Women who are currently carrying a pregnancy and reside in the selected communities within Alimosho Local Government Area.

Antenatal Care: Healthcare services provided to pregnant women during pregnancy to monitor maternal and foetal health, identify complications, provide preventive interventions and prepare women for childbirth.

Skilled Birth Attendance: Assistance provided during childbirth by qualified and trained healthcare professionals, such as doctors, nurses and midwives, who possess the necessary competencies to manage normal deliveries and identify or respond to complications.

Postnatal Care: Healthcare services provided to mothers and newborn babies after childbirth to monitor recovery, identify complications and promote the health and well-being of both mother and child.

Financial Barriers: Economic difficulties that prevent pregnant women from accessing maternal healthcare services, including consultation fees, medication costs, laboratory charges and transportation expenses.

Geographical Barriers: Physical difficulties associated with reaching healthcare facilities, including distance, poor roads, transportation problems and traffic congestion.

Institutional Barriers: Challenges within healthcare facilities that discourage utilisation, such as inadequate equipment, shortages of healthcare workers, long waiting times, poor staff attitudes and lack of essential medicines.

Sociocultural Barriers: Cultural beliefs, religious practices, family expectations and social norms that influence pregnant women’s decisions about seeking and using maternal healthcare services.

Urban Communities: Densely populated residential areas within Alimosho Local Government Area where people live and engage in different economic and social activities.

Maternal Health Education: Information and guidance provided to pregnant women to improve their knowledge of pregnancy, childbirth, danger signs, birth preparedness and appropriate healthcare practices.

Project – Barriers to Maternal Healthcare Utilisation among Pregnant Women in Urban Communities: A Case Study of Alimosho Local Government Area, Lagos State.