尼日利亚北部男性在女性卫生服务利用中的作用：基于女性、男性和提供者观点的定性研究。

Role of men in women's health service utilisation in northern Nigeria: a qualitative study of women, men and provider perspectives.

机构信息

Palladium, Washington, District of Columbia, USA

IHP Nigeria, Abuja, Nigeria.

出版信息

BMJ Open. 2024 Aug 6;14(8):e085758. doi: 10.1136/bmjopen-2024-085758.

DOI:10.1136/bmjopen-2024-085758

PMID:39107032

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11308895/

Abstract

BACKGROUND: The 2018 Nigeria Demographic and Health Survey shows poor maternal health in northern Nigeria. Contraceptive use remains low and maternal mortality high. Studies show that cultural norms related to men's decision-making role in the family significantly contribute to this phenomenon. OBJECTIVES: The assessment was designed to identify barriers to service delivery and utilisation of maternal-health and family-planning services in three northern Nigerian states, focusing on aspects of service delivery affected by husband involvement. DESIGN: Qualitative design included 16 focus group discussions and 12 in-depth interviews with facility clients, and 16 in-depth interviews with healthcare providers, in each of the three states. SETTING: Primary healthcare facilities in three northern Nigeria states: Bauchi, Kebbi and Sokoto. PARTICIPANTS: Women who came to the facility for family-planning services (n=233 in 24 focus groups); women who came for antenatal care (n=97 in 12 focus groups); men married to women who either received antenatal care or delivered in a facility (n=96 in 12 focus groups); mothers of newborns who delivered in a facility (n=36) and healthcare providers (n=48). RESULTS: We found gender barriers to contraceptive use and to obtaining maternal healthcare, with some women requiring their husband's permission to use services, even in emergencies. Several supply-side barriers exacerbate the situation. Many healthcare providers would not provide women with a family-planning method without their husbands' presence or approval; some male providers would not admit a woman to deliver in a facility if her husband objected to her being treated by a man and there was no female provider present and some facilities do not have the infrastructure to accommodate men. CONCLUSION: Despite years of programming, barriers to women's family-planning and maternal-health service utilisation persist. State governments in northern Nigeria should invest in additional provider training, improving infrastructure and hiring more female healthcare providers.

摘要

背景：2018 年尼日利亚人口与健康调查显示，尼日利亚北部的孕产妇健康状况不佳。避孕措施的使用率仍然很低，孕产妇死亡率很高。研究表明，与男性在家庭中的决策角色相关的文化规范对此现象有重大影响。

目的：本评估旨在确定在尼日利亚北部三个州提供孕产妇保健和计划生育服务以及利用这些服务方面的障碍，重点关注受丈夫参与度影响的服务提供方面。

设计：定性设计包括在三个州的每个州进行 16 次焦点小组讨论和 12 次深度访谈（共 36 次），以及对设施客户（233 人参加了 24 次焦点小组）、接受过产前护理的妇女（97 人参加了 12 次焦点小组）、与在设施中接受过产前护理或分娩的妇女结婚的男子（96 人参加了 12 次焦点小组）、在设施中分娩的新生儿母亲（36 人）和医疗保健提供者（48 人）进行 16 次深度访谈。

地点：尼日利亚北部三个州的初级保健设施：包奇州、凯比州和索科托州。

参与者：前来设施接受计划生育服务的妇女（24 次焦点小组中的 233 人）；前来接受产前护理的妇女（12 次焦点小组中的 97 人）；与在设施中接受过产前护理或分娩的妇女结婚的男子（12 次焦点小组中的 96 人）；在设施中分娩的新生儿母亲（36 人）和医疗保健提供者（48 人）。

结果：我们发现存在性别障碍，这影响了妇女对避孕措施和获得孕产妇保健的使用，一些妇女需要获得丈夫的许可才能使用服务，甚至在紧急情况下也是如此。一些供应方的障碍使情况恶化。许多医疗保健提供者不会在没有丈夫在场或同意的情况下向妇女提供计划生育方法；一些男提供者如果丈夫反对由男性治疗该妇女并且没有女提供者在场，他们不会允许该妇女在设施中分娩；一些设施没有基础设施来容纳男性。

结论：尽管多年来一直开展方案规划，但妇女利用计划生育和孕产妇保健服务的障碍仍然存在。尼日利亚北部各州政府应投资于更多的提供者培训、改善基础设施和招聘更多的女性医疗保健提供者。