Sexual, Reproductive, Maternal, New-born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya.
School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
Int Health. 2023 Jul 4;15(4):435-444. doi: 10.1093/inthealth/ihac064.
Ending maternal mortality has been a significant global health priority for decades. Many sub-Saharan African countries introduced user fee removal policies to attain this goal and ensure universal access to health facility delivery. However, many women in Nigeria continue to deliver at home. We examined the reasons for home birth in settings with free maternal healthcare in Southwestern and North Central Nigeria.
We adopted a fully mixed, sequential, equal-status design. For the quantitative study, we drew data from 211 women who reported giving birth at home from a survey of 1227 women of reproductive age who gave birth in the 5 y before the survey. The qualitative study involved six focus group discussions and 68 in-depth interviews. Data generated through the interviews were coded and subjected to inductive thematic analysis, while descriptive statistics were used to analyse the quantitative data.
Women faced several barriers that limited their use of skilled birth attendants. These barriers operate at multiple levels and could be grouped as economic, sociocultural and health facility-related factors. Despite the user fee removal policy, lack of transportation, birth unpreparedness and lack of money pushed women to give birth at home. Also, sociocultural reasons such as hospital delivery not being deemed necessary in the community, women not wanting to be seen by male health workers, husbands not motivated and husbands' disapproval hindered the use of health facilities for childbirth.
This study has demonstrated that free healthcare does not guarantee universal access to healthcare. Interventions, especially in the Nasarawa state of Nigeria, should focus on the education of mothers on the importance of health facility-based delivery and birth preparedness.
几十年来，降低孕产妇死亡率一直是全球卫生的一个重要优先事项。许多撒哈拉以南非洲国家推出了取消用户付费政策，以实现这一目标，并确保所有人都能获得医疗设施分娩服务。然而，尼日利亚仍有许多妇女在家中分娩。我们研究了在尼日利亚西南部和中北部的免费产妇保健环境中，在家中分娩的原因。
我们采用了完全混合、顺序、同等地位的设计。在定量研究中，我们从 1227 名生育年龄妇女的调查中抽取了 211 名报告在家中分娩的妇女的数据。定性研究涉及六次焦点小组讨论和 68 次深入访谈。通过访谈产生的数据被编码并进行了归纳主题分析，而描述性统计数据则用于分析定量数据。
妇女面临着几个限制其使用熟练接生员的障碍。这些障碍在多个层面上运作，可以分为经济、社会文化和与卫生机构相关的因素。尽管取消了用户付费政策，但缺乏交通工具、生育准备不足和缺乏资金迫使妇女在家中分娩。此外，一些社会文化因素也阻碍了妇女到医疗机构分娩，例如社区不认为医院分娩是必要的，妇女不想让男卫生工作者看到自己，丈夫没有动力，丈夫不赞成等。
本研究表明，免费医疗并不能保证普遍获得医疗服务。干预措施，特别是在尼日利亚的纳萨拉瓦州，应侧重于教育母亲认识到在医疗机构分娩和生育准备的重要性。
