School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada.
Women's Health and Action Research Centre, KM 11 Lagos-Benin Expressway, Igue-Iyeha, Benin City, Edo State, Nigeria.
BMC Pregnancy Childbirth. 2021 Jan 6;21(1):20. doi: 10.1186/s12884-020-03493-8.
The uptake of skilled pregnancy care in rural areas of Nigeria remains a challenge amid the various strategies aimed at improving access to skilled care. The low use of skilled health care during pregnancy, childbirth and postpartum indicates that Nigerian women are paying a heavy price as seen in the country's very high maternal mortality rates. The perceptions of key stakeholders on the use of skilled care will provide a broad understanding of factors that need to be addressed to increase women's access to skilled pregnancy care. The objective of this study was therefore, to explore the perspectives of policymakers and health workers, two major stakeholders in the health system, on facilitators and barriers to women's use of skilled pregnancy care in rural Edo State, Nigeria.
This paper draws on qualitative data collected in Edo State through key informant interviews with 13 key stakeholders (policy makers and healthcare providers) from a range of institutions. Data was analyzed using an iterative process of inductive and deductive approaches.
Stakeholders identified barriers to pregnant women's use of skilled pregnancy care and they include; financial constraints, women's lack of decision-making power, ignorance, poor understanding of health, competitive services offered by traditional birth attendants, previous negative experience with skilled healthcare, shortage of health workforce, and poor financing and governance of the health system. Study participants suggested health insurance schemes, community support for skilled pregnancy care, favourable financial and governance policies, as necessary to facilitate women's use of skilled pregnancy care.
This study adds to the literature, a rich description of views from policymakers and health providers on the deterrents and enablers to skilled pregnancy care. The views and recommendations of policymakers and health workers have highlighted the importance of multi-level factors in initiatives to improve pregnant women's health behaviour. Therefore, initiatives seeking to improve pregnant women's use of skilled pregnancy care should ensure that important factors at each distinct level of the social and physical environment are identified and addressed.
在尼日利亚农村地区，尽管采取了各种旨在改善获得熟练护理机会的策略，但熟练妊娠护理的利用率仍然是一个挑战。在怀孕期间、分娩期间和产后期间熟练卫生保健的低利用率表明，尼日利亚妇女正在为此付出沉重的代价，这反映在该国非常高的孕产妇死亡率上。主要利益攸关方对熟练护理的看法将广泛了解需要解决的因素，以增加妇女获得熟练妊娠护理的机会。因此，本研究的目的是探讨政策制定者和卫生工作者的观点，他们是卫生系统中的两个主要利益攸关方，了解在尼日利亚埃多州农村地区促进和阻碍妇女使用熟练妊娠护理的因素。
本文利用在埃多州收集的定性数据，通过对来自一系列机构的 13 名主要利益攸关方（政策制定者和医疗保健提供者）的关键知情人访谈进行分析。数据采用归纳和演绎方法的迭代过程进行分析。
利益攸关方确定了孕妇使用熟练妊娠护理的障碍，包括经济限制、妇女缺乏决策权、无知、对健康的理解不足、传统助产妇提供的竞争性服务、以前对熟练医疗保健的负面体验、卫生人力短缺以及卫生系统的融资和治理不善。研究参与者建议实施健康保险计划、社区支持熟练妊娠护理、制定有利的财务和治理政策，以促进妇女使用熟练妊娠护理。
本研究丰富了政策制定者和卫生提供者对熟练妊娠护理障碍和促进因素的看法文献。政策制定者和卫生工作者的观点和建议强调了在改善孕妇健康行为的倡议中多层面因素的重要性。因此，旨在改善孕妇熟练妊娠护理利用率的倡议应确保确定和解决社会和物理环境各个不同层面的重要因素。
