Project – Determinants of Skilled Birth Attendance Utilization Among Women at General Hospital, Akwanga, Nasarawa State, Nigeria

CHAPTER ONE

INTRODUCTION

Background of the Study

Skilled birth attendance (SBA) — the assistance of childbirth by trained health professionals such as doctors, nurses, or midwives — is recognized globally as one of the most effective interventions to reduce maternal and newborn mortality and morbidity (World Health Organization [WHO], 2016). SBA ensures competent management of labour, prompt identification and treatment of complications, and effective referral systems for advanced care when necessary (UNICEF, 2021). The presence of trained personnel during childbirth can substantially lower life-threatening outcomes such as postpartum hemorrhage, obstructed labour, and sepsis (Campbell & Graham, 2006).

Despite improvements in maternal health policies and increased global awareness, the utilization of SBA remains suboptimal in many low- and middle-income countries, particularly in sub-Saharan Africa where maternal mortality ratios remain high (National Population Commission [NPC] & ICF, 2019). In Nigeria, only about 30–49% of births are attended by skilled health personnel, which is below global averages and insufficient to significantly reduce maternal mortality (WHO, 2016; NPC & ICF, 2019). Determinants of SBA utilization identified in previous studies include maternal education, wealth status, antenatal care attendance, media exposure, urban–rural residence, and age at marriage (Tobin et al., 2020; Akinyemi et al., 2017).

Nasarawa State, located in central Nigeria, reflects similar maternal health challenges. General Hospital, Akwanga serves as a critical referral center for maternal and child health services in the region. However, many women still deliver at home or with unskilled attendants due to barriers such as cost, cultural beliefs, distance to health facilities, and limited health system responsiveness (Okonofua et al., 2019). Understanding the determinants of SBA utilization among women attending General Hospital, Akwanga — particularly those relating to socio-demographic factors, health service accessibility, and community influences — is crucial to inform targeted interventions and improve maternal health outcomes in Nasarawa State and similar settings (Tobin et al., 2020).

Statement of the Problem

Maternal mortality remains a pressing public health concern in Nigeria. Although global maternal deaths have declined over time, Nigeria’s maternal mortality ratio remains among the highest worldwide, largely due to complications during pregnancy and childbirth (UNICEF, 2021). Skilled birth attendance has been shown to substantially reduce maternal and neonatal deaths by providing competent intrapartum care and emergency management. However, utilization of SBA in many parts of Nigeria, including Nasarawa State, remains inadequate.

In Akwanga, anecdotal reports from health workers at General Hospital indicate that while antenatal care attendance may be moderate, a sizable proportion of women still opt to give birth at home or with traditional birth attendants rather than skilled professionals (Okonofua et al., 2019). These choices may be influenced by socio-economic status, level of education, cultural norms, distance to facilities, partner support, and perceived quality of care (Akinyemi et al., 2017). Despite the importance of SBA, empirical data on the determinants of its utilization in Akwanga remains limited, making it difficult for policymakers and health managers to design effective strategies. This study therefore seeks to fill this knowledge gap by systematically assessing factors influencing SBA utilization among women delivering at General Hospital, Akwanga.

Research Questions

1. What are the socio-demographic characteristics of women attending General Hospital, Akwanga for delivery?

2. What proportion of women utilize skilled birth attendance during delivery at General Hospital, Akwanga?

3. What socio-economic and health-system factors influence the utilization of skilled birth attendance among these women?

4. What barriers do women face in accessing skilled birth attendance at General Hospital, Akwanga?

Objectives of the Study

General Objective:
To assess the determinants of skilled birth attendance utilization among women at General Hospital, Akwanga, Nasarawa State, Nigeria.

Specific Objectives:

1. To describe the socio-demographic profile of women attending General Hospital, Akwanga for childbirth.

2. To determine the proportion of women who utilize skilled birth attendance.

3. To examine the influence of socio-economic and health-system factors on the utilization of skilled birth attendance.

4. To identify barriers to SBA utilization among women in the study area.

Hypothesis

Null Hypothesis (H₀):
There is no significant association between socio-economic status and the utilization of skilled birth attendance among women delivering at General Hospital, Akwanga.

Significance of the Study

This study will provide valuable insights into the specific determinants influencing SBA utilization in Akwanga, Nasarawa State. The evidence will be useful to:

• Policy Makers and Health Planners: to design context-specific interventions that improve uptake of SBA and strengthen maternal health systems (WHO, 2016).

• Health Facility Managers and Providers: to adjust service delivery models to address barriers identified among women seeking skilled care (Okonofua et al., 2019).

• Researchers and Academics: to contribute to literature on maternal health service utilization in Nigeria, particularly at facility and sub-national levels (Tobin et al., 2020).

• Community Leaders and Women’s Groups: to facilitate targeted community engagement and education strategies promoting skilled care during childbirth (Akinyemi et al., 2017).

Scope of the Study

The study is restricted to women of reproductive age who delivered at or were referred to General Hospital, Akwanga within the study period. It will focus on utilization patterns of skilled birth attendance and associated determinants including socio-demographic characteristics, health-seeking behaviours, accessibility factors, and barriers to SBA. The study will not include home deliveries not linked to the hospital.

Project – Determinants of Skilled Birth Attendance Utilization Among Women at General Hospital, Akwanga, Nasarawa State, Nigeria