Where Women Deliver: Maternal Care-Seeking Behaviors in Nigeria

Abstract

BACKGROUND Maternal mortality is one of the most intractable health challenges confronting the developing world. In Nigeria, the situation is particularly dire. Despite efforts to improve maternal health, the maternal mortality rate stayed the same between 2008 and 2013. Even with comparatively high numbers of births registered at skilled health facilities, most Nigerian women eventually deliver outside of hospitals. Yet little is known about the diversity of care options that women frequent and the role religion may play in care-seeking behaviors. METHODS This is a qualitative study that relies on participant-observation, and in-depth interviews with pregnant women recruited using purposive and convenience sampling at three government health centers across Ondo state. After obtaining verbal informed consent, participants were interviewed once at the beginning of the study and once after childbirth. Participants were also observed at their encounters with care and informally interviewed over the phone when visits were missed. Data was coded and analyzed using dedoose qualitative data software. Data was collected between 2015 to 2016 as part of a larger research project on maternal health in Nigeria. RESULTS Eighteen in-person interviews, fifty-three observation sessions, and eighty-four phone conversations were conducted with the nine participants of the study. Religious belief played an important role in reproductive health decision making for many participants especially concerning abortion and use of contraception. Pregnancy care-seeking behaviors were influenced by the perceived knowledge and expertise of the care provider, access to transportation at night, and information gathered from family and friends. Input from husbands and the costs of care were less of an influence. CONCLUSIONS Maternal mortality remains a major problem in Nigeria. This study offers insights on the health-seeking behaviors of women and experiences of maternal health care in Nigeria. More research is needed on the non-biomedical settings of pregnancy care and family planning interventions should be designed with religion in mind.