Women's Health and Action Research Centre, Km 11 Benin-Lagos Expressway, Benin City, Edo State, Nigeria.
The Federal University, Oye-Ekiti, Ekiti State, Nigeria.
BMC Pregnancy Childbirth. 2019 Aug 5;19(1):277. doi: 10.1186/s12884-019-2433-1.
While Primary Health Care has been designed to provide universal access to skilled pregnancy care for the prevention of maternal deaths in Nigeria, available evidence suggests that pregnant women in rural communities often do not use Primary Health Care Centres for skilled care. The objective of this study was to investigate the reasons why women do not use PHC for skilled pregnancy care in rural Nigeria.
Qualitative data were obtained from twenty focus group discussions conducted with women and men in marital union to elicit their perceptions about utilisation of maternal and child health care services in PHC centres. Groups were constituted along the focus of sex and age. The group discussions were tape-recorded, transcribed verbatim and analyzed thematically.
The four broad categories of reasons for non-use identified in the study were: 1) accessibility factors - poor roads, difficulty with transportation, long distances, and facility not always open; 2) perceptions relating to poor quality of care, including inadequate drugs and consumables, abusive care by health providers, providers not in sufficient numbers and not always available in the facilities, long waiting times, and inappropriate referrals; 3) high costs of services, which include the inability to pay for services even when costs are not excessive, and the introduction of informal payments by staff; and 4) Other comprising partner support and misinterpretation of signs of pregnancy complications.
Addressing these factors through adequate budgetary provisions, programs to reduce out-of-pocket expenses for maternal health, adequate staffing and training, innovative methods of transportation and male involvement are critical in efforts to improve rural women's access to skilled pregnancy care in primary health care centres in the country.
初级卫生保健旨在为尼日利亚的产妇提供普遍获得熟练妊娠护理的机会，以预防产妇死亡，但现有证据表明，农村社区的孕妇通常不会到初级卫生保健中心寻求熟练护理。本研究旨在调查农村尼日利亚妇女不利用初级保健中心获得熟练妊娠护理的原因。
采用定性研究方法，通过 20 次焦点小组讨论，从已婚男女中收集他们对利用初级卫生保健中心的孕产妇和儿童保健服务的看法。根据性别和年龄构成小组。小组讨论进行了录音，逐字转录，并进行了主题分析。
本研究确定了四个不利用初级保健中心的主要原因：1）可及性因素-道路条件差、交通困难、距离远、设施不总是开放；2）对护理质量的看法，包括药物和耗材不足、卫生提供者虐待、提供者数量不足且设施中不总是有提供者、长时间等待和不适当的转诊；3）服务费用高，包括即使费用不高，也无法支付服务费用，以及工作人员引入非正式支付；4）其他因素包括伴侣支持和对妊娠并发症迹象的误解。
通过充足的预算拨款、减少孕产妇保健自付费用的方案、充足的人员配备和培训、创新的交通方式以及男性参与，解决这些因素对于改善农村妇女在该国初级卫生保健中心获得熟练妊娠护理至关重要。
