Project – Evaluation of Maternal Health Care Services Utilization Among Women of Reproductive Age. A study of Primary Health Centres in Ibadan North Local Government Area

CHAPTER ONE
INTRODUCTION

1.1 Background to the Study

Maternal health is a critical indicator of the overall effectiveness of a country’s health system and a cornerstone for achieving sustainable development goals (World Health Organization [WHO], 2022). Maternal health care services encompass the full range of interventions designed to ensure that women experience safe pregnancies, childbirth, and postpartum periods (United Nations Population Fund [UNFPA], 2021). These include antenatal care (ANC), skilled attendance during delivery, and postnatal care (PNC), all of which are essential for reducing maternal and neonatal morbidity and mortality (Adebayo & Yusuf, 2020).

Despite global progress, maternal mortality remains unacceptably high in many developing countries, including Nigeria. According to the World Bank (2022), Nigeria accounts for nearly 20% of global maternal deaths, with a maternal mortality ratio estimated at 512 deaths per 100,000 live births. Several factors contribute to this high rate, including limited access to quality maternal health services, poor infrastructure, socio-cultural beliefs, poverty, and inadequate health education (Okeke & Oladimeji, 2021). Utilization of maternal health services—particularly antenatal and postnatal care—has been identified as a vital determinant of maternal survival (Fagbamigbe et al., 2020).

In many Nigerian communities, especially in rural and peri-urban areas, women face multiple barriers to accessing maternal health services. Accessibility, affordability, and awareness are among the most significant determinants (Ogunjimi et al., 2019). For instance, long distances to health facilities, inadequate transportation, and poor road networks discourage regular visits to antenatal and postnatal clinics (Olaoye et al., 2021). Moreover, the cost of services and drugs often limits access, particularly among low-income households.

Cultural and religious beliefs also play a crucial role in shaping women’s health-seeking behaviors. In some communities, traditional birth attendants (TBAs) are preferred to skilled medical personnel due to cultural trust or perceptions of affordability and convenience (Ezeh et al., 2020). Similarly, some women avoid hospital-based care because of gender norms, fear of mistreatment by healthcare providers, or lack of spousal support (Ogunjimi et al., 2019).

Given this context, evaluating maternal health care utilization is essential to understanding the barriers that hinder effective service delivery and use. This study, therefore, focuses on the utilization of maternal health care services among women of reproductive age in Primary Health Centres (PHCs) in Ibadan North Local Government Area (LGA) of Oyo State, Nigeria. The study investigates how accessibility, affordability, awareness, and cultural beliefs influence women’s use of antenatal and postnatal care services.

1.2 Statement of the Problem

Maternal health indicators in Nigeria have remained poor despite the government’s numerous health interventions and international support. In Ibadan North LGA, several PHCs exist to provide maternal health services, yet many women of reproductive age do not fully utilize these services. Studies have shown that while awareness of antenatal care may be high, consistent attendance and postnatal follow-ups remain low (Olaoye et al., 2021).

Barriers such as financial constraints, distance to facilities, lack of awareness, and cultural or religious beliefs often discourage women from seeking medical care during and after pregnancy (Ezeh et al., 2020). Additionally, healthcare system inefficiencies such as inadequate staffing, poor facility conditions, and lack of essential drugs further reduce women’s confidence in public health facilities (Adebayo & Yusuf, 2020).

The persistence of these challenges contributes to high rates of maternal and neonatal complications, preventable deaths, and poor reproductive health outcomes. Despite efforts by the Oyo State Ministry of Health and local governments to improve maternal health service delivery, utilization rates remain below expectations. This study seeks to evaluate the extent of maternal health care service utilization among women of reproductive age in Ibadan North LGA and to identify the key barriers preventing optimal access and use of antenatal and postnatal services.

1.3 Objectives of the Study

The main objective of this study is to evaluate maternal health care services utilization among women of reproductive age in Ibadan North Local Government Area, Oyo State.

The specific objectives are to:

1. Assess the level of utilization of antenatal and postnatal care services among women of reproductive age in Ibadan North LGA.

2. Examine how accessibility influences the utilization of maternal health care services.

3. Determine the effect of affordability on the use of antenatal and postnatal care services.

4. Investigate the impact of awareness and health education on women’s utilization of maternal health services.

5. Explore the influence of cultural beliefs on maternal health care-seeking behavior.

1.4 Research Questions

The following research questions will guide the study:

1. What is the level of utilization of antenatal and postnatal care services among women of reproductive age in Ibadan North LGA?

2. How does accessibility affect maternal health care services utilization in the study area?

3. To what extent does affordability influence women’s use of maternal health services?

4. What role does awareness play in influencing maternal health care utilization?

5. How do cultural beliefs affect women’s decisions to seek antenatal and postnatal care?

1.5 Research Hypothesis

H₀: There is no significant relationship between accessibility, affordability, awareness, and cultural beliefs, and the utilization of maternal health care services among women of reproductive age in Ibadan North Local Government Area.

1.6 Significance of the Study

This study is significant for several reasons. First, it contributes to the growing body of knowledge on maternal health care utilization in Nigeria, particularly in urban and peri-urban communities. By identifying the barriers that hinder effective utilization, the findings can inform evidence-based policy interventions aimed at improving maternal health outcomes (Adebayo & Yusuf, 2020).

Second, the results will be valuable to the Oyo State Ministry of Health, Primary Health Care Development Agency, and Local Government Health Departments in developing targeted strategies that address socio-economic and cultural barriers to service use. Health professionals and non-governmental organizations (NGOs) can also leverage these insights to strengthen maternal health education and community outreach programs.

Third, the study will help in improving the delivery and quality of services at PHCs by highlighting factors such as accessibility, affordability, and staff attitudes that affect women’s confidence in the healthcare system. Finally, the study will serve as a reference material for future researchers and students interested in maternal health and reproductive health behavior studies in Nigeria.

1.7 Scope of the Study

The study will be conducted in Ibadan North Local Government Area of Oyo State, which has a mix of urban and peri-urban communities and a considerable number of Primary Health Centres providing maternal and child health services. The focus will be on women of reproductive age (15–49 years) who have accessed or are eligible to access antenatal and postnatal services within the past two years. The study will examine key variables including accessibility, affordability, awareness, and cultural beliefs as determinants of maternal health care utilization. The temporal scope covers data collected in the year 2025.

1.8 Operational Definition of Terms

• Maternal Health Care Services: Health services provided to women during pregnancy, childbirth, and the postpartum period, including antenatal, delivery, and postnatal care.

• Antenatal Care (ANC): Preventive health care provided to pregnant women to ensure safe pregnancy and delivery outcomes.

• Postnatal Care (PNC): Health care services provided to mothers and newborns immediately after childbirth and during the postpartum period.

• Accessibility: The ease with which women can physically reach and obtain maternal health care services.

• Affordability: The financial capacity of women to pay for maternal health care services, including transportation, drugs, and consultation fees.

• Awareness: The level of knowledge women have about the importance and availability of maternal health services.

• Cultural Beliefs: Social norms, traditions, and values that influence women’s attitudes and decisions regarding the use of modern maternal health services.

1.9 Organization of the Study

This study is divided into five chapters. Chapter One presents the introduction, background, statement of the problem, objectives, research questions, hypothesis, and significance of the study. Chapter Two reviews relevant literature on maternal health care utilization, focusing on conceptual, theoretical, and empirical frameworks. Chapter Three describes the research methodology, including design, population, sampling, instruments, and data analysis techniques. Chapter Four presents the data, analysis, and interpretation of findings. Chapter Five summarizes the study, draws conclusions, and makes recommendations.

Project – Evaluation of Maternal Health Care Services Utilization Among Women of Reproductive Age. A study of Primary Health Centres in Ibadan North Local Government Area