Project – The Influence of Maternal Health Education on Antenatal Care Utilisation among Pregnant Women: A Study of Selected Primary Health Care Centres in Ado-Odo/Ota Local Government Area, Ogun State.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Maternal health remains an important component of public health because the health and wellbeing of women during pregnancy have significant implications for both maternal and newborn outcomes. Pregnancy is a period during which women require regular contact with skilled health professionals to monitor maternal and fetal wellbeing, identify complications early, provide preventive interventions and prepare women for childbirth and the postnatal period. Antenatal care (ANC) provides an important platform for these services and includes health promotion, disease prevention, screening, counselling, nutritional support and assessment of maternal and fetal conditions. The World Health Organization (WHO, 2016) recommends a minimum of eight antenatal contacts during pregnancy, beginning in the first trimester, because increased contact provides more opportunities for detecting and managing complications and for communicating essential health information to pregnant women. WHO (2025) continues to identify antenatal care as an important component of maternal health services and emphasizes interventions such as nutritional counselling, birth preparedness, complication readiness, screening and preventive care throughout pregnancy. Consequently, effective maternal health education within antenatal services has the potential to improve women’s knowledge, encourage appropriate health-seeking behaviours and support regular utilization of ANC services.

Maternal health education refers to the systematic provision of relevant information and counselling to women to improve their understanding of pregnancy, childbirth, maternal danger signs, nutrition, hygiene, medication, preventive care, birth preparedness, newborn care and appropriate use of health services. Education may be delivered through individual counselling, group health talks, demonstrations, printed materials, audiovisual resources and other communication approaches. The educational component of antenatal care is important because knowledge can influence a woman’s perception of pregnancy risks and her decisions concerning when and where to seek care. WHO (2016) identifies communication and counselling as integral components of quality antenatal care, including counselling on healthy nutrition, physical activity, preventive measures and preparation for childbirth. More recently, Oluranti et al. (2025) found that antenatal health education among pregnant women in Ibadan included topics such as nutrition, exercise, hygiene, immunization, prevention of malaria, emergency signs, labour expectations and referral, although the structure and delivery of education differed between facilities. This suggests that maternal health education is not simply the transmission of information but a potentially important mechanism through which pregnant women are supported to make informed decisions about pregnancy and healthcare utilisation.

Antenatal care utilisation is influenced by several individual, household, community and health-system factors, including maternal education, socioeconomic status, distance to health facilities, parity, household decision-making, availability of health services and perceptions of the quality of care. However, knowledge and awareness of the benefits of ANC are also important because a woman who understands the purpose of antenatal services may be more likely to initiate care early and maintain contact throughout pregnancy. Ekholuenetale et al. (2020), using nationally representative Nigerian Demographic and Health Survey data, found that only about 17.4% of women achieved eight or more ANC contacts and that women with at least secondary education were substantially more likely to achieve the recommended number of contacts than women with no formal education. Similarly, Adewuyi et al. (2024) found substantial disparities in antenatal care utilisation and receipt of ANC components between population groups in Nigeria. These findings indicate that improving women’s understanding and engagement with maternal health services is relevant to increasing appropriate utilisation, although health education must operate alongside efforts to address economic, geographical and health-system barriers.

Evidence from Nigeria further demonstrates that the number and timing of antenatal contacts remain important concerns. A national sub-national analysis by Aregbeyen et al. (2021) found that approximately one-quarter of women had no antenatal care contact, while only about one-fifth had eight or more contacts under the WHO-recommended standard. The study also found strong associations between women’s educational attainment, household wealth, community disadvantage and the number of ANC contacts. More recently, Setlhare et al. (2025) reported that only 40.5% of women in their Nigerian study achieved adequate antenatal care, with education, employment, age, parity and other socioeconomic factors influencing ANC adequacy. The findings demonstrate that simply making antenatal services available does not guarantee adequate utilisation. Pregnant women need to understand the importance of early booking, regular attendance, recommended investigations, preventive interventions and recognition of danger signs. Maternal health education can therefore serve as one component of a broader strategy for improving appropriate ANC utilisation.

The potential influence of health education on maternal healthcare utilisation has also been demonstrated in Southwestern Nigeria. Agbede (2015), in a quasi-experimental study conducted among pregnant women in Ikenne, Ogun State, exposed an intervention group to weekly clinic-based health education sessions addressing maternal health issues over five weeks. The study found that the intervention improved attitudes towards birth preparedness and complication readiness, and follow-up assessment showed higher utilisation of the primary health-care facility for delivery among women who received the health education intervention compared with the control group. Similarly, Sodeinde et al. (2020), in a study of pregnant women attending Primary Health Care Centres in Ikenne Local Government Area of Ogun State, examined women’s knowledge, utilisation and satisfaction with antenatal care services. The Ogun State evidence is particularly relevant because it demonstrates that maternal health education and women’s understanding of maternal services can be examined within the primary health-care context rather than only in tertiary hospitals. These findings provide a basis for investigating whether similar relationships exist among pregnant women attending selected primary health-care centres in Ado-Odo/Ota Local Government Area.

The quality and structure of antenatal health education may also determine whether women find the information sufficiently useful to influence their behaviour. Effective education requires appropriate content, competent delivery, understandable communication and opportunities for women to ask questions and clarify misconceptions. Oluranti et al. (2025), in a cross-sectional study of 240 pregnant women in selected health facilities in Ibadan, found that 77.5% of respondents perceived the structure of antenatal health education they received as good. The researchers also reported that women attending tertiary facilities were substantially more likely to perceive the structure of education as good than those attending secondary facilities, suggesting that differences in staffing, resources and delivery approaches may affect women’s educational experiences. WHO (2025) similarly recommends that antenatal contacts should include education and counselling concerning nutrition, birth preparedness, complication readiness, maternal and fetal monitoring and other preventive interventions. Therefore, the effectiveness of maternal health education may depend not only on whether health education is provided but also on the content, timing, method of delivery and responsiveness of the education to women’s individual needs.

The issue is particularly important in Ado-Odo/Ota Local Government Area of Ogun State because the area has experienced rapid urbanisation and population growth while containing communities with varying levels of socioeconomic development and access to health services. Earlier research conducted specifically in Ado-Odo/Ota by Azuh, Nwaubani and Ugwuanyi (2014) found that healthcare programme utilisation among women during pregnancy and childbirth was influenced by factors including educational attainment, distance to healthcare facilities, poverty and household power relations. More recent research by Azuh (2025) among pregnant women attending institutional clinics in Ota, within Ado-Odo/Ota Local Government Area, continued to identify access to health facilities during pregnancy and childbirth as an important issue. These local findings, together with evidence that education and awareness are associated with ANC utilisation in Nigeria, indicate the importance of examining maternal health education within the specific context of primary healthcare centres in Ado-Odo/Ota. The present study therefore seeks to determine the influence of maternal health education on antenatal care utilisation among pregnant women attending selected primary health-care centres in Ado-Odo/Ota Local Government Area, Ogun State.

1.2 Statement of the Problem

Antenatal care is an established component of safe motherhood, yet appropriate utilisation remains inadequate among many women in Nigeria. The WHO recommends a minimum of eight contacts during pregnancy, beginning in the first trimester, but national evidence indicates that a considerable proportion of Nigerian women either do not attend ANC or do not achieve the recommended number of contacts. Ekholuenetale et al. (2020) reported that only 17.4% of women in their national analysis had eight or more ANC contacts, while Aregbeyen et al. (2021) found substantial disparities in ANC contact across Nigerian states and socioeconomic groups. More recent evidence from the 2023/2024 Nigerian Demographic and Health Survey indicates that only 17.3% of women received the recommended level of ANC, with education, residence, wealth and distance to facilities remaining important determinants (Okediji et al., 2026). The persistence of inadequate ANC utilisation raises concerns about whether pregnant women have sufficient knowledge and understanding of the importance of early and regular antenatal care.

One of the problems associated with inadequate ANC utilisation is the possibility that pregnant women may not receive or adequately understand essential maternal health information. Antenatal health education is intended to equip women with knowledge concerning nutrition, preventive measures, maternal danger signs, birth preparedness, complication readiness, medication, immunisation and appropriate healthcare-seeking behaviour. However, the availability of education does not necessarily mean that the information is adequately delivered, understood or acted upon. Oluranti et al. (2025) found considerable variation in women’s perceptions of the structure of antenatal health education between health facilities in Ibadan, while WHO (2016) emphasises that communication and support should form an integral part of antenatal contacts. If health education is irregular, poorly structured, overly general or insufficiently adapted to women’s educational and cultural circumstances, its potential to influence ANC utilisation may be reduced.

There is also a contextual problem concerning access to evidence from primary healthcare settings in Ado-Odo/Ota Local Government Area. Existing research in Ogun State provides evidence that health education can influence pregnant women’s attitudes and utilisation of primary healthcare services. Agbede (2015) reported that clinic-based health education improved attitudes towards birth preparedness and increased subsequent utilisation of a primary health-care facility for delivery among women who received the intervention. At the same time, research specifically conducted in Ado-Odo/Ota has identified educational attainment, distance to health facilities, poverty and other socioeconomic factors as determinants of women’s use of healthcare programmes during pregnancy and childbirth (Azuh et al., 2014). These findings suggest that maternal health education may be relevant but should be examined within the broader context of local barriers to healthcare utilisation. There is therefore a need for current evidence from selected primary healthcare centres in Ado-Odo/Ota to determine whether the health education received by pregnant women is associated with their utilisation of antenatal care services.

The continued gap between recommended antenatal care and actual utilisation therefore constitutes an important maternal-health concern. Although national and regional studies have examined determinants of ANC utilisation, and previous research in Ogun State has demonstrated potential benefits of clinic-based health education, there remains a need for a focused study examining the influence of maternal health education on ANC utilisation among pregnant women attending selected primary health-care centres in Ado-Odo/Ota Local Government Area. Understanding whether health education relating to pregnancy care, danger signs, nutrition, birth preparedness and the importance of regular ANC attendance influences utilisation may provide useful evidence for strengthening health education programmes at the primary healthcare level. The study will therefore examine the influence of maternal health education on antenatal care utilisation among pregnant women in selected primary health-care centres in Ado-Odo/Ota Local Government Area, Ogun State, while recognising that utilisation may also be affected by socioeconomic, geographical and health-system factors (Adewuyi et al., 2024; Setlhare et al., 2025; Okediji et al., 2026).

1.3 Purpose of the Study

The general purpose of this study is to examine the influence of maternal health education on antenatal care utilisation among pregnant women attending selected primary health-care centres in Ado-Odo/Ota Local Government Area, Ogun State.

Specifically, the study seeks to:

1. Examine the influence of education on the importance and benefits of antenatal care on antenatal care utilisation among pregnant women in selected primary health-care centres in Ado-Odo/Ota Local Government Area.
2. Determine the influence of health education on maternal danger signs and complication readiness on antenatal care utilisation among pregnant women in selected primary health-care centres in Ado-Odo/Ota Local Government Area.
3. Examine the influence of health education on nutrition, preventive care and healthy practices during pregnancy on antenatal care utilisation among pregnant women in selected primary health-care centres in Ado-Odo/Ota Local Government Area.
4. Determine the overall influence of maternal health education on antenatal care utilisation among pregnant women in selected primary health-care centres in Ado-Odo/Ota Local Government Area.

1.4 Research Questions

The following research questions will guide the study:

1. What is the influence of education on the importance and benefits of antenatal care on antenatal care utilisation among pregnant women in selected primary health-care centres in Ado-Odo/Ota Local Government Area?
2. What is the influence of health education on maternal danger signs and complication readiness on antenatal care utilisation among pregnant women in selected primary health-care centres in Ado-Odo/Ota Local Government Area?
3. What is the influence of health education on nutrition, preventive care and healthy practices during pregnancy on antenatal care utilisation among pregnant women in selected primary health-care centres in Ado-Odo/Ota Local Government Area?
4. What is the overall influence of maternal health education on antenatal care utilisation among pregnant women in selected primary health-care centres in Ado-Odo/Ota Local Government Area?

1.5 Hypothesis

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

H₀: Maternal health education has no statistically significant influence on antenatal care utilisation among pregnant women in selected primary health-care centres in Ado-Odo/Ota Local Government Area, Ogun State.

1.6 Significance of the Study

The study will be significant to pregnant women because it will provide information on the importance of maternal health education in promoting appropriate utilisation of antenatal care services. The findings may help women understand the importance of early ANC initiation, regular attendance, compliance with recommended preventive interventions and prompt response to pregnancy-related danger signs.

The study will be useful to midwives, nurses, community health extension workers and other healthcare providers working in primary health-care centres. The findings may help healthcare workers identify areas of maternal health education that require greater emphasis and improve the way information is communicated to pregnant women.

The study will also be beneficial to primary healthcare administrators and programme managers in Ado-Odo/Ota Local Government Area. Evidence from the study may assist in planning antenatal health education sessions, selecting appropriate educational materials and developing approaches that encourage women to attend ANC regularly.

The study may be useful to the Ogun State Ministry of Health and other maternal-health policymakers. Findings from the study may provide local evidence for strengthening maternal health education as part of primary healthcare and maternal-health programmes.

The study will also be useful to community health workers and public-health educators by providing information that can support community sensitisation programmes. Such programmes may extend beyond health facilities to involve community leaders, women’s groups and other stakeholders who can encourage pregnant women to seek appropriate maternal healthcare.

Finally, the study will contribute to academic literature on maternal health education and antenatal care utilisation in Nigeria. It will provide evidence from selected primary healthcare centres in Ado-Odo/Ota Local Government Area and may serve as a reference for future studies in maternal and reproductive health.

1.7 Scope of the Study

The study focuses on the influence of maternal health education on antenatal care utilisation among pregnant women attending selected primary health-care centres in Ado-Odo/Ota Local Government Area, Ogun State.

The independent variable is maternal health education, which will be examined through education concerning the importance and benefits of ANC, maternal danger signs and complication readiness, nutrition, preventive care and healthy pregnancy practices.

The dependent variable is antenatal care utilisation, which will be examined in terms of early initiation of ANC, frequency of attendance, compliance with recommended ANC contacts and utilisation of recommended ANC services.

Geographically, the study is limited to selected primary health-care centres within Ado-Odo/Ota Local Government Area of Ogun State, Nigeria. The study will focus on pregnant women attending the selected facilities and will not cover women receiving care exclusively in secondary or tertiary healthcare facilities.

1.8 Operational Definition of Terms

Maternal Health Education: The structured provision of information, counselling and practical guidance to pregnant women concerning pregnancy, maternal health, fetal wellbeing, childbirth, danger signs, nutrition, preventive care and appropriate use of healthcare services.

Antenatal Care (ANC): Healthcare provided to a pregnant woman by skilled health professionals during pregnancy to monitor maternal and fetal wellbeing, prevent and identify complications, provide preventive interventions and prepare the woman for childbirth and parenthood.

Antenatal Care Utilisation: The extent to which a pregnant woman initiates, attends and continues to use recommended antenatal care services during pregnancy.

Pregnant Women: Women who are carrying a developing fetus and who are attending the selected primary health-care centres for pregnancy-related care.

Primary Health-Care Centre (PHC): A first-level healthcare facility that provides essential community-based preventive, promotive, curative and maternal and child health services.

Maternal Danger Signs: Signs or symptoms during pregnancy that may indicate a serious complication and require prompt medical assessment, such as severe bleeding, severe headache, convulsions, severe abdominal pain, difficulty breathing or loss of consciousness.

Birth Preparedness: The process by which a pregnant woman and her family plan for normal childbirth and prepare for possible complications, including identifying a place of delivery, arranging transportation and identifying financial and social support.

Complication Readiness: The ability of a pregnant woman and her family to recognise pregnancy-related danger signs and take appropriate and timely action to obtain skilled medical care.

Maternal Health: The health and wellbeing of women during pregnancy, childbirth and the postpartum period.

Selected Primary Health-Care Centres: The primary healthcare facilities within Ado-Odo/Ota Local Government Area that will be purposively selected as the locations for the study.

Project – The Influence of Maternal Health Education on Antenatal Care Utilisation among Pregnant Women: A Study of Selected Primary Health Care Centres in Ado-Odo/Ota Local Government Area, Ogun State.