ABSTRACT
The study was aimed at assessing the extent to which the safe motherhood practices are provided in Nsukka Local Government Area of Enugu State, Nigeria. To guide the study, five research questions were formulated with the intention of assessing the various causes of maternal mortality among child-bearing mothers, the extent to which safe motherhood practices are provided during the ante-natal, natal and post-natal periods and the extent to which strategies are employed for improving the provision of safe motherhood practices in Nsukka Local Government Area of Enugu State. Also, five null hypotheses were tested at .05 level of significance and used to guide the study. Descriptive survey research design was used. Stratified random sampling technique was employed to compose a sample of 437 respondents from a population of 664 members of the registered expectant mothers that attended ante-natal, natal and post-natal care services in public hospitals and health centres in both rural and urban areas of Nsukka Local Government Area. The instrument used for the study was a 44-item structured questionnaire titled Assessment of the Provision of Safe Motherhood Practices Questionnaire (APSMPQ). The instrument was face validated by three experts; one in measurement and evaluation and two in community development, all from University of Nigeria, Nsukka. Its reliability was ensured using Cronbach alpha estimate. Reliability co-efficient of .84 was obtained. Frequencies and percentages, weighted mean and standard deviation were used in analyzing the collected data. Administration of the instrument to the respondents was through direct delivery technique. Findings of the study revealed that the safe motherhood practices were provided to a moderate extent during the ante-natal, natal and post-natal periods. All the five null hypotheses were accepted showing that there were no significant differences between the mean ratings of expectant mothers in the rural areas and their counterparts in the urban areas on the extent to which safe motherhood practices were provided during the ante-natal, natal and post-natal periods in Nsukka Local Government Area of Enugu State. Based on the findings of the study, recommendations were proffered which included that skilled health attendants should educate the child-bearing mothers and the community about their rights as clients, and that the state ministry of health should deploy trained nurses to provide maternal and child health care services by sensitizing communities about availability of daily maternal and child health care services.
TABLE OF CONTENTS
Page
Title Page i
Approval Page ii
Dedication iii
Acknowledgments iv
Table of Contents vi
List of Tables viii
Abstract ix
CHAPTER ONE: INTRODUCTION 1
Background to the Study 1
Statement of the Problem 10
Purpose of the Study 12
Significance of the Study 12
Research Questions 14
Hypotheses 14
Scope of the Study 16
CHAPTER TWO: LITERATURE REVIEW 17
Conceptual Framework 17
Concept of maternal health care services 17
Concept of safe motherhood practices 23
Theoretical Framework 45
Theory of reasoned action 45
Expectancy theory 49
Review of Related Empirical Studies 51
Causes of maternal mortality among child-bearing mothers 51
Provision of safe motherhood practices during the ante-natal period 52
Provision of safe motherhood practices during the natal period 53
Provision of safe motherhood practices during the post-natal period 54
Strategies for improving on the provision of safe motherhood practices 56
Summary of Literature Review 59
CHAPTER THREE: RESEARCH METHOD 62
Design of the Study 62
Area of the Study 63
Population of the Study 64
Sample and Sampling Technique 64
Instrument for Data Collection 65
Validation of the Instrument 66
Reliability of the Instrument 67
Procedure for Data Collection 67
Method of Data Analysis 68
CHAPTER FOUR: RESULTS 69
Research Question One 69
Research Question Two 72
Research Question Three 75
Research Question Four 78
Research Question Five 81
Summary of the Major Findings 84
CHAPTER FIVE: SUMMARY OF FINDINGS, DISCUSSIONS
AND RECOMMENDATIONS 87
Discussion of the Study 87
Educational Implications of the Study 100
Conclusion 102
Recommendations 104
Limitations of the Study 106
Suggestions for Further Research 106
REFERENCES 107
APPENDICES 110
Appendix A: Questionnaire 110
Appendix B: Population and Sample Distribution 115
Appendix C: Questionnaire Return Rate 116
Appendix D: Reliability Analysis 117
Appendix E: Mean Analysis 126
Appendix F: T-Test Analysis 129
CHAPTER ONE
INTRODUCTION
Background to the Study
Safe motherhood practices are seen as a major mile stone in the race to reduce the burden of maternal mortality and morbidity throughout the world particularly in developing countries. This is because child bearing has become a trauma and a nightmare for most women instead of a joyful experience it ought to be. Moreover, apart from a small number of privileged and conscientious countries that have succeeded in reducing maternal mortality, each pregnancy and childbirth remains a risky experience for hundreds of millions of women world wide.
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Safe motherhood has been conceptualized as a means of ensuring women’s accessibility needed during antenatal programme in order to facilitate their safety and optimal health throughout pregnancy and childbirth (Price, 2002). It is a means of saving lives of women and improving the health of millions of others (Jatau, 2000). Safe motherhood is aimed at preventing maternal and prenatal mortality and morbidity. It also enhances the quality and safety of women’s lives through the adaptation of combination of health and non-health strategies (Igbokwe, 2011). According to Ara and Ariful (2009), safe motherhood means that no woman or baby should die or be harmed by pregnancy or death. Safe motherhood aims at reducing maternal and new born mortality and morbidity. It is a critical part of saving lives in community. This approach seeks to ensure that women receive appropriate attention throughout their pregnancy and childbirth, providing pre- and postnatal care including care of the baby and breastfeeding support and delivery care with referral for women with obstetric complications. Ara and Ariful further stated that it is estimated that 529,000 women die yearly worldwide, from complications of pregnancy and childbirth—about one woman every minute. Some 99 per cent of these deaths occur in developing countries, where a woman’s lifetime risk of dying from pregnancy-related complications is 45 times higher than that of her counterparts in developed countries. The risk of dying from pregnancy-related complications is highest in sub-Saharan Africa and in South-Central Asia, where in some countries the maternal mortality ratios are more than 1,000 deaths per 100,000 live births. 60 to 80 per cent of maternal deaths are due to obstetric hemorrhage, obstructed labor, obstetric sepsis, hypertensive disorders of pregnancy, and complications of unsafe abortion. These direct complications are unpredictable and most occur within hours or days after delivery.
Maternal death and disability are the leading cause of healthy life years lost for developing country women of reproductive age, accounting for more than 28 million disability-adjusted life years (DALYs) lost and at least 18 per cent of the burden of disease in these women. For each woman who dies, an estimated 100 women survive childbearing but suffer from serious disease, disability, or physical damage caused by pregnancy-related complications. Long-term consequences of pregnancy-related complications include uterine prolapse, pelvic inflammatory disease, fistula, incontinence, infertility, and pain during sexual intercourse. A mother’s death carries profound consequences not only for her family, especially her surviving children, but also for her community and country. In some developing countries, if the mother dies, the risk of death for her children under age 5 is doubled or tripled. In addition, because a woman dies during her most productive years, her death has a strong social and economic impact—her family and community lose a productive worker and a primary care giver.
Women in developing countries lose more disability-adjusted life years (28 million) to maternal causes than to any other. The cost in human, social and economic terms is enormous. Garg, Chhabra and Zothanzami (2006) observed that pregnancy is not a disease but a means by which the human race is propagated. The hazards of childbirth cannot be avoided by simply preventing pregnancy. Society depends on future generations, and women should not be required to give their lives or health in undertaking this social and physiological duty. Safe motherhood is not only a health issue—it is also a moral issue. Investment in safe motherhood reduces household poverty, saves families and governments the costs of treatment and other services, and strengthens the health system. An investment in safe motherhood is an investment in the emotional, social, and economic well-being of millions of women, children, families and communities. This has important consequences for all nations of the world. Safe motherhood is an important social and economic investment. It is a matter of social justice and human rights.
Throughout the world women face poverty, discrimination, and gender inequalities. These factors contribute to poor reproductive health and unsafe motherhood even before a pregnancy occurs, and they make it worse once pregnancy and childbearing have begun. High levels of maternal mortality are a symptom of neglect of women’s most fundamental human rights. Such neglect affects the poor, the disadvantaged and the powerless most acutely. Protecting and promoting women’s rights, empowering women to make informed choices, and reducing social and economic inequalities are all keys to safe motherhood.
Safe motherhood is achieved through a programme of inter-linked steps which strive to provide family planning services to prevent unwanted pregnancies, safe abortions (where abortion is legalized couple with efficient management and treatment of complication of unsafe abortions are accessible), Pre-natal and delivery care at the community level with quick access to first-referral services for complications and post partum services, Promotion of breastfeeding, immunization and nutrition services. Safe motherhood services must be integrated into the health delivery system and necessary inputs such as drugs, equipment, facilities and proper training of staff workers (Daly, Azefor & Nasah, 1993).
The contents of safe motherhood practices according to Mahmond (2001) include health education (consisting of healthful or healthy practices such as hygiene on pregnancy), the importance of fresh air and exercise during pregnancy, rest and sleep relaxation, suitable clothing and diet during pregnancy development among others. Baizely (2002) pointed out the preparation for childbearing which also include the components of safe motherhood practices in which women are taught simple anatomy, physiology and psychology of pregnancy, labour and delivery. Exercises are good for women to prepare their muscles that will be used during labour and delivery.
Coeli (2006) revealed that the cornerstone of effective safe motherhood practices is antenatal care which is the early utilization of health services offered by the health team. It is essential therefore that every mother is aware of and has the knowledge of relevant contents of ante-natal care so as to benefit from the services. Maternal and child health care services are aspects of modern health care specifically designed for the health promotion of the mothers and children. According to Alakija (2000), safe motherhood practice is referred to the preventive, curative, rehabilitative health care for mothers and children. It includes maternal health, child health, family planning, school health, handicapped children and adolescent health. Safe motherhood practices aim at promoting the health of mothers of child-bearing age and their children so that children will have the opportunity for normal growth and development. It will also help to make the reproductive life of women not to constitute too much risk to their health and well-being (Akinsola, 2006). Many factors can affect the health or well-being of mothers and children; hence programmes related to them must be multifaceted and should be carefully coordinated from many disciplines, organizations and agencies where mother and child health activities are given specific attention by public health agencies.
Safe motherhood practices deal with problems that cover a broad spectrum. Their solution requires a great deal of interdependent action on the part of various disciplines, such as obstetric and gynaecology, paediatrics, nutrition, health education, mental health and environmental sanitation for the promotion, prevention, curative and rehabilitative aspect of these disciplines. Samuel (2010) observed that some areas of importance that can influence the health and welfare of mothers and children include sanitation of water, milk and food, promotion of satisfactory facilities for the disposal of human waste, vital statistics provision of public health laboratory and health education. Samuel further indicated that the safe motherhood practices provided under National Child Health Scheme (NCHS) include pre-conceptional, ante-natal and post-natal care.
Pre-conceptional care is the care provided for a woman to ensure that she is in optimal health before conception (Namboze, 1985). According to Samuel (2010), pre-conception is a period proceeding conception. It includes the period before the expectant mother reaches physiological maturity and hence marriage. This includes care throughout infancy, childhood, school age and adolescence. The services provided for pre-conceptional care are growth monitoring, nutrition education in schools, pre-marital medical examination, marriage counselling, genetic counselling and taking of family medical or health history.
Ante-natal care comprises the complete health supervision of the pregnant mother in order to maintain, protect and promote her health and well-being and that of the foetus and the new-born infant. Ante-natal care, according to Akinsola (2006), is referred to as care given to pregnant women immediately after the pregnancy has been confirmed, i.e., at about the third month. Okereke (2010) stated that ante-natal care is the care given to a pregnant mother starting from the onset of pregnancy or from the time her pregnancy was confirmed, until the onset of labour. Most complications in pregnancy are best treated if they are identified early. Ante-natal care are usually organized monthly in ante-natal clinics for expectant mothers with pregnancy less than 24 weeks, while those between 24 to 36 weeks will have their ante-natal every two weeks, and every week for those between 36 weeks till the onset of labour. The main purpose of ante-natal care is to prevent complications of pregnancy such as pains, bleeding, discomfort, accident anaemia, infection, malaria. In the ante-natal clinics, many activities are carried out such as individual and group health education, history taking and examination, identification of the high-risk patients, treatment, immunization and prophylaxis.
Natal care is very crucial for the survival of mothers and the infant during labour, delivery and the immediate post-natal period. Arkuta (1995) stressed that natal care known as intra-natal or intra-partum or parturient service is regarded as the health care provided to the mother at the onset of labour. Okereke (2000) stated that intra-partum care is the care of a pregnant woman from the start of labour to the end of the third stage of labour with the release of the placenta. Intra-partum care consists of constant supervision and encouragement and relief of pains as well as the establishment of respiration in the baby immediately after birth. The aim of intra-natal care is to make sure that both the mother and the new-born receive minimum injury, maintain antiseptic and aseptic conditions and prepare obstetric team for any complication such as prolonged labour. Other aims are to give good care to the baby at delivery, for example, resuscitation, care of the cord and the eyes (Alakija, 2000). Intra-partum services include history taking for unbooked cases, palpation of the abdomen for normalcy and checking of the foetal heart rate; inspection of the vulva and examination of the vagina, close monitoring of the maternal vital signs and proper recording, relief of pains, encouraging appropriate exercise like brisk walking are other activities during intra-partum. Proper care is needed during labour and during delivery, till the end of natal stage. It is very essential for post-natal care.
Post-natal care takes off from the first 6 – 8 weeks following delivery and it is known as puerperium. It is the period during which the uterus and other organs and structures of the mother are returning to the pre-pregnancy state. This period as the care given to a mother from the time she delivers of her baby to six weeks after (Lucas and Gills, 2000). According to Meeks and Philips (2001), post-natal care is a period after the first several weeks of delivery. Therefore, it is the health care provided following childbirth to both mother and her baby. Alakija (2000) enumerated the objectives of post-natal service such as prevention of complications which may occur during post-natal period, making sure that mother establishes breast feeding, giving health education to the mother and the family. During post-natal period, health workers provide a lot of services such as advice on personal and environmental hygiene, rest, nutrition and breast feeding, assessing size of uterus, education on the care of the baby, treatment of ailments, immunization to the baby, and counselling for family planning (Azuonwu, 2004). Knowing the components of maternal and child health care services so far discussed is of no value without their availability and utilization.
In a similar vein, Adewumi (2002) stressed that the importance of effective safe motherhood practices by women cannot be overemphasized as a means of satisfactory and satisfying care in the entire child bearing years from conception to the postnatal visit. Ojo and Briggs (2003) found out that safe motherhood practices were neglected by pregnant mothers in rural communities in Enugu State especially in Nsukka Local Government Area. In Nsukka Local Government Area, there are 16 autonomous communities. Only few of them are found in the urban areas. Others are in the rural areas of the local government area. Therefore, the safe motherhood practices have implications for both the rural and urban areas. It is important that none of these two facets of communities (urban and rural) should be neglected in the provision of safe motherhood practices as the health development of both mother and child is paramount to the development of Nsukka Local Government Area.
However, since the 1976 Local Government Reforms, Nsukka Local Government Council has also facilitated the provision of safe motherhood practices and making them close to the grassroots level by encouraging and initiating the availability and utilization of safe motherhood practices through several national and international conferences, workshops, and seminars. World Health Organization, WHO (2000) reported that at the community level, the extent of utilization of safe motherhood practices may depend on community factors such as cultures, values, beliefs, norms, ecology and geography, among others. Other factors include availability of the services, accessibility and quality of other health services (private and public) around, food, energy, water supply and sanitation. It is in the light of the above, that the study sought to assess the various safe motherhood practices as perceived by women in Nsukka Local Government Area of Enugu State.
Statement of the Problem
Safe motherhood practices have been recommended as basis for formulation, implementation and monitoring of health programmes directed at reducing maternal and child morbidity and mortality all over the world. For example, the fifth millennium development goal (MDG) calls for improving maternal and child health through professional care during pregnancy and childbirth. In 1983, expanded programme on immunization was launched in Nigeria to improve immunization coverage using new vaccine distribution system based on ice-packed (cold) boxes to preserve the potency of the vaccines and ensure efficacy. The expanded programme on immunization was launched by the National Health Insurance Scheme (NHIS) to improve health care services. It was also aimed at reducing maternal and child morbidity and mortality and enhancing the health of women and children through effective ante-natal, natal, and post-natal care practices. It improves access to emergency obstetric care. Health personnel are also trained through workshops to recognize key signs of ailment and to implement correct treatment and follow up actions.
In spite of all these efforts, available records in Nsukka Local Government Area have shown that no significant progress has been made in the reduction of mobility and mortality rates among mothers and children. A great number of them die due to complications related to pregnancy and childbirth which are preventable. Majority of them die due to preventable and/or curative diseases such as respiratory infections, malaria, measles, HIV/AIDS, pneumonia, diarrhoea. This situation is tragic especially when one discovers that mothers and children are dying as a result of preventable and curable diseases associated with pregnancy and child-birth. The high mortality and morbidity rates prompted the researcher to assess the extent to which safe motherhood practices are provided to mothers and children both in the rural and urban areas in Nsukka Local Government Area of Enugu State in terms of ante-natal, natal and post-natal periods.
Purpose of the Study
The purpose of this study is to assess the extent of the provision of safe motherhood practices in Nsukka Local Government Area of Enugu State. Specifically, the objectives of the study are:
- to determine the various causes of maternal mortality among child-bearing mothers in Nsukka Local Government Area.
- to ascertain the extent to which safe motherhood practices are provided during the ante-natal period in Nsukka Local Government Area.
- to find out the extent to which safe motherhood practices are provided during the natal period in Nsukka Local Government Area.
- to ascertain the extent to which safe motherhood practices are provided during the post-natal period in Nsukka Local Government Area.
- to find out the strategies for improving on the provision of safe motherhood practices in Nsukka Local Government Area.
Significance of the Study
The findings of the study will provide information on the extent of the provision of safe motherhood practices among health educators and workers, government, state ministries of health and donor agencies, nurses and midwives, child-bearing mothers and children, and generally women and parents.
The findings of the study will be beneficial to health educators who will utilize the result to educate women on the components of safe motherhood practices and their importance, respectively. The result of the findings will also be beneficial to health educators in identifying groups with high risks of pregnancy-related complications. Also, based on the findings, the health educators will organize an enlightenment campaign to educate mothers on the factors that hinder effective provision and utilization of safe motherhood practices such as cultural belief. The findings of the study will also be useful to health workers. It will help them to ensure that they make necessary provisions for all the required services and to improve in the quality of services rendered to mothers and children.
Government and donor agencies (such as WHO and UNICEF) that are concerned with the health promotion of mothers and children will find the findings of the study very useful. This is because the information obtained will help ensure regular supply of both mothers and children with health tools in the various local government areas. The study will generate information on the extent of promotion and provision of safe motherhood practices. The findings will be beneficial to nurses and midwives who will enlighten mothers on the causes of pregnancy and childbearing complications and the need to provide safe motherhood practices for its prevention and treatment.
It will generate data on the availability of safe motherhood practices in Nsukka Local Government Area of Enugu State. The findings will also be beneficial to mothers. It will enable them to know the required practices for them and their children. It will also enable them to compare the different kinds of practices (both orthodox and non-orthodox) obtained in the health centres and hospitals. From the findings of the study, mothers will be able to appreciate the need to have these practices provided. This will lead to effective improvement in the provision of the safe motherhood practices in Enugu State as a whole.
Research Questions
The following research questions were posed to guide this study:
- What are the various causes of maternal mortality among child-bearing mothers in Nsukka Local Government Area?
- To what extent are the safe motherhood practices provided during the ante-natal period in Nsukka Local Government Area?
- To what extent are the safe motherhood practices provided during the natal period in Nsukka Local Government Area?
- To what extent are the safe motherhood practices provided during the post-natal period in Nsukka Local Government Area?
- What are the strategies for improving on the provision of safe motherhood practices in Nsukka Local Government Area?
Hypotheses
The following null hypotheses were formulated and tested at 0.05 level of significance:
- There is no significant difference between the mean ratings of the expectant mothers in the rural areas and their counterparts in the urban areas on the various causes of maternal mortality among child-bearing mothers in Nsukka Local Government Area.
- There is no significant difference between the mean ratings of the expectant mothers in the rural areas and their counterparts in the urban areas on the extent to which safe motherhood practices are provided during the ante-natal period in Nsukka Local Government Area.
- There is no significant difference between the mean ratings of the expectant mothers in the rural areas and their counterparts in the urban areas on the extent to which safe motherhood practices are provided during the natal period in Nsukka Local Government Area.
- There is no significant difference between the mean ratings of the expectant mothers in the rural areas and their counterparts in the urban areas on the extent to which safe motherhood practices are provided during the post-natal period in Nsukka Local Government Area.
- There is no significant difference between the mean ratings of the expectant mothers in the rural areas and their counterparts in the urban areas on the strategies for improving on the provision of safe motherhood practices in Nsukka Local Government Area.
Scope of the Study
The study focused on the assessment of the provision of safe motherhood practices in Nsukka Local Government Area of Enugu State. The study is restricted to the registered expectant mothers that attend ante-natal, natal and post-natal care services in hospitals and health centres in both rural and urban areas of Nsukka Local Government Area. The study is further restricted to the assessment of the extent to which safe motherhood practices are provided during the ante-natal, natal and post-natal periods in hospitals and health centres in Nsukka Local Government Area. Finally, the study focused on the assessment of the strategies for improving on the provision of safe motherhood practices in Nsukka Local Government Area of Enugu State.
INTRODUCTION
Background to the Study
Safe motherhood practices are seen as a major mile stone in the race to reduce the burden of maternal mortality and morbidity throughout the world particularly in developing countries. This is because child bearing has become a trauma and a nightmare for most women instead of a joyful experience it ought to be. Moreover, apart from a small number of privileged and conscientious countries that have succeeded in reducing maternal mortality, each pregnancy and childbirth remains a risky experience for hundreds of millions of women world wide.
|
Safe motherhood has been conceptualized as a means of ensuring women’s accessibility needed during antenatal programme in order to facilitate their safety and optimal health throughout pregnancy and childbirth (Price, 2002). It is a means of saving lives of women and improving the health of millions of others (Jatau, 2000). Safe motherhood is aimed at preventing maternal and prenatal mortality and morbidity. It also enhances the quality and safety of women’s lives through the adaptation of combination of health and non-health strategies (Igbokwe, 2011). According to Ara and Ariful (2009), safe motherhood means that no woman or baby should die or be harmed by pregnancy or death. Safe motherhood aims at reducing maternal and new born mortality and morbidity. It is a critical part of saving lives in community. This approach seeks to ensure that women receive appropriate attention throughout their pregnancy and childbirth, providing pre- and postnatal care including care of the baby and breastfeeding support and delivery care with referral for women with obstetric complications. Ara and Ariful further stated that it is estimated that 529,000 women die yearly worldwide, from complications of pregnancy and childbirth—about one woman every minute. Some 99 per cent of these deaths occur in developing countries, where a woman’s lifetime risk of dying from pregnancy-related complications is 45 times higher than that of her counterparts in developed countries. The risk of dying from pregnancy-related complications is highest in sub-Saharan Africa and in South-Central Asia, where in some countries the maternal mortality ratios are more than 1,000 deaths per 100,000 live births. 60 to 80 per cent of maternal deaths are due to obstetric hemorrhage, obstructed labor, obstetric sepsis, hypertensive disorders of pregnancy, and complications of unsafe abortion. These direct complications are unpredictable and most occur within hours or days after delivery.
Maternal death and disability are the leading cause of healthy life years lost for developing country women of reproductive age, accounting for more than 28 million disability-adjusted life years (DALYs) lost and at least 18 per cent of the burden of disease in these women. For each woman who dies, an estimated 100 women survive childbearing but suffer from serious disease, disability, or physical damage caused by pregnancy-related complications. Long-term consequences of pregnancy-related complications include uterine prolapse, pelvic inflammatory disease, fistula, incontinence, infertility, and pain during sexual intercourse. A mother’s death carries profound consequences not only for her family, especially her surviving children, but also for her community and country. In some developing countries, if the mother dies, the risk of death for her children under age 5 is doubled or tripled. In addition, because a woman dies during her most productive years, her death has a strong social and economic impact—her family and community lose a productive worker and a primary care giver.
Women in developing countries lose more disability-adjusted life years (28 million) to maternal causes than to any other. The cost in human, social and economic terms is enormous. Garg, Chhabra and Zothanzami (2006) observed that pregnancy is not a disease but a means by which the human race is propagated. The hazards of childbirth cannot be avoided by simply preventing pregnancy. Society depends on future generations, and women should not be required to give their lives or health in undertaking this social and physiological duty. Safe motherhood is not only a health issue—it is also a moral issue. Investment in safe motherhood reduces household poverty, saves families and governments the costs of treatment and other services, and strengthens the health system. An investment in safe motherhood is an investment in the emotional, social, and economic well-being of millions of women, children, families and communities. This has important consequences for all nations of the world. Safe motherhood is an important social and economic investment. It is a matter of social justice and human rights.
Throughout the world women face poverty, discrimination, and gender inequalities. These factors contribute to poor reproductive health and unsafe motherhood even before a pregnancy occurs, and they make it worse once pregnancy and childbearing have begun. High levels of maternal mortality are a symptom of neglect of women’s most fundamental human rights. Such neglect affects the poor, the disadvantaged and the powerless most acutely. Protecting and promoting women’s rights, empowering women to make informed choices, and reducing social and economic inequalities are all keys to safe motherhood.
Safe motherhood is achieved through a programme of inter-linked steps which strive to provide family planning services to prevent unwanted pregnancies, safe abortions (where abortion is legalized couple with efficient management and treatment of complication of unsafe abortions are accessible), Pre-natal and delivery care at the community level with quick access to first-referral services for complications and post partum services, Promotion of breastfeeding, immunization and nutrition services. Safe motherhood services must be integrated into the health delivery system and necessary inputs such as drugs, equipment, facilities and proper training of staff workers (Daly, Azefor & Nasah, 1993).
The contents of safe motherhood practices according to Mahmond (2001) include health education (consisting of healthful or healthy practices such as hygiene on pregnancy), the importance of fresh air and exercise during pregnancy, rest and sleep relaxation, suitable clothing and diet during pregnancy development among others. Baizely (2002) pointed out the preparation for childbearing which also include the components of safe motherhood practices in which women are taught simple anatomy, physiology and psychology of pregnancy, labour and delivery. Exercises are good for women to prepare their muscles that will be used during labour and delivery.
Coeli (2006) revealed that the cornerstone of effective safe motherhood practices is antenatal care which is the early utilization of health services offered by the health team. It is essential therefore that every mother is aware of and has the knowledge of relevant contents of ante-natal care so as to benefit from the services. Maternal and child health care services are aspects of modern health care specifically designed for the health promotion of the mothers and children. According to Alakija (2000), safe motherhood practice is referred to the preventive, curative, rehabilitative health care for mothers and children. It includes maternal health, child health, family planning, school health, handicapped children and adolescent health. Safe motherhood practices aim at promoting the health of mothers of child-bearing age and their children so that children will have the opportunity for normal growth and development. It will also help to make the reproductive life of women not to constitute too much risk to their health and well-being (Akinsola, 2006). Many factors can affect the health or well-being of mothers and children; hence programmes related to them must be multifaceted and should be carefully coordinated from many disciplines, organizations and agencies where mother and child health activities are given specific attention by public health agencies.
Safe motherhood practices deal with problems that cover a broad spectrum. Their solution requires a great deal of interdependent action on the part of various disciplines, such as obstetric and gynaecology, paediatrics, nutrition, health education, mental health and environmental sanitation for the promotion, prevention, curative and rehabilitative aspect of these disciplines. Samuel (2010) observed that some areas of importance that can influence the health and welfare of mothers and children include sanitation of water, milk and food, promotion of satisfactory facilities for the disposal of human waste, vital statistics provision of public health laboratory and health education. Samuel further indicated that the safe motherhood practices provided under National Child Health Scheme (NCHS) include pre-conceptional, ante-natal and post-natal care.
Pre-conceptional care is the care provided for a woman to ensure that she is in optimal health before conception (Namboze, 1985). According to Samuel (2010), pre-conception is a period proceeding conception. It includes the period before the expectant mother reaches physiological maturity and hence marriage. This includes care throughout infancy, childhood, school age and adolescence. The services provided for pre-conceptional care are growth monitoring, nutrition education in schools, pre-marital medical examination, marriage counselling, genetic counselling and taking of family medical or health history.
Ante-natal care comprises the complete health supervision of the pregnant mother in order to maintain, protect and promote her health and well-being and that of the foetus and the new-born infant. Ante-natal care, according to Akinsola (2006), is referred to as care given to pregnant women immediately after the pregnancy has been confirmed, i.e., at about the third month. Okereke (2010) stated that ante-natal care is the care given to a pregnant mother starting from the onset of pregnancy or from the time her pregnancy was confirmed, until the onset of labour. Most complications in pregnancy are best treated if they are identified early. Ante-natal care are usually organized monthly in ante-natal clinics for expectant mothers with pregnancy less than 24 weeks, while those between 24 to 36 weeks will have their ante-natal every two weeks, and every week for those between 36 weeks till the onset of labour. The main purpose of ante-natal care is to prevent complications of pregnancy such as pains, bleeding, discomfort, accident anaemia, infection, malaria. In the ante-natal clinics, many activities are carried out such as individual and group health education, history taking and examination, identification of the high-risk patients, treatment, immunization and prophylaxis.
Natal care is very crucial for the survival of mothers and the infant during labour, delivery and the immediate post-natal period. Arkuta (1995) stressed that natal care known as intra-natal or intra-partum or parturient service is regarded as the health care provided to the mother at the onset of labour. Okereke (2000) stated that intra-partum care is the care of a pregnant woman from the start of labour to the end of the third stage of labour with the release of the placenta. Intra-partum care consists of constant supervision and encouragement and relief of pains as well as the establishment of respiration in the baby immediately after birth. The aim of intra-natal care is to make sure that both the mother and the new-born receive minimum injury, maintain antiseptic and aseptic conditions and prepare obstetric team for any complication such as prolonged labour. Other aims are to give good care to the baby at delivery, for example, resuscitation, care of the cord and the eyes (Alakija, 2000). Intra-partum services include history taking for unbooked cases, palpation of the abdomen for normalcy and checking of the foetal heart rate; inspection of the vulva and examination of the vagina, close monitoring of the maternal vital signs and proper recording, relief of pains, encouraging appropriate exercise like brisk walking are other activities during intra-partum. Proper care is needed during labour and during delivery, till the end of natal stage. It is very essential for post-natal care.
Post-natal care takes off from the first 6 – 8 weeks following delivery and it is known as puerperium. It is the period during which the uterus and other organs and structures of the mother are returning to the pre-pregnancy state. This period as the care given to a mother from the time she delivers of her baby to six weeks after (Lucas and Gills, 2000). According to Meeks and Philips (2001), post-natal care is a period after the first several weeks of delivery. Therefore, it is the health care provided following childbirth to both mother and her baby. Alakija (2000) enumerated the objectives of post-natal service such as prevention of complications which may occur during post-natal period, making sure that mother establishes breast feeding, giving health education to the mother and the family. During post-natal period, health workers provide a lot of services such as advice on personal and environmental hygiene, rest, nutrition and breast feeding, assessing size of uterus, education on the care of the baby, treatment of ailments, immunization to the baby, and counselling for family planning (Azuonwu, 2004). Knowing the components of maternal and child health care services so far discussed is of no value without their availability and utilization.
In a similar vein, Adewumi (2002) stressed that the importance of effective safe motherhood practices by women cannot be overemphasized as a means of satisfactory and satisfying care in the entire child bearing years from conception to the postnatal visit. Ojo and Briggs (2003) found out that safe motherhood practices were neglected by pregnant mothers in rural communities in Enugu State especially in Nsukka Local Government Area. In Nsukka Local Government Area, there are 16 autonomous communities. Only few of them are found in the urban areas. Others are in the rural areas of the local government area. Therefore, the safe motherhood practices have implications for both the rural and urban areas. It is important that none of these two facets of communities (urban and rural) should be neglected in the provision of safe motherhood practices as the health development of both mother and child is paramount to the development of Nsukka Local Government Area.
However, since the 1976 Local Government Reforms, Nsukka Local Government Council has also facilitated the provision of safe motherhood practices and making them close to the grassroots level by encouraging and initiating the availability and utilization of safe motherhood practices through several national and international conferences, workshops, and seminars. World Health Organization, WHO (2000) reported that at the community level, the extent of utilization of safe motherhood practices may depend on community factors such as cultures, values, beliefs, norms, ecology and geography, among others. Other factors include availability of the services, accessibility and quality of other health services (private and public) around, food, energy, water supply and sanitation. It is in the light of the above, that the study sought to assess the various safe motherhood practices as perceived by women in Nsukka Local Government Area of Enugu State.
Statement of the Problem
Safe motherhood practices have been recommended as basis for formulation, implementation and monitoring of health programmes directed at reducing maternal and child morbidity and mortality all over the world. For example, the fifth millennium development goal (MDG) calls for improving maternal and child health through professional care during pregnancy and childbirth. In 1983, expanded programme on immunization was launched in Nigeria to improve immunization coverage using new vaccine distribution system based on ice-packed (cold) boxes to preserve the potency of the vaccines and ensure efficacy. The expanded programme on immunization was launched by the National Health Insurance Scheme (NHIS) to improve health care services. It was also aimed at reducing maternal and child morbidity and mortality and enhancing the health of women and children through effective ante-natal, natal, and post-natal care practices. It improves access to emergency obstetric care. Health personnel are also trained through workshops to recognize key signs of ailment and to implement correct treatment and follow up actions.
In spite of all these efforts, available records in Nsukka Local Government Area have shown that no significant progress has been made in the reduction of mobility and mortality rates among mothers and children. A great number of them die due to complications related to pregnancy and childbirth which are preventable. Majority of them die due to preventable and/or curative diseases such as respiratory infections, malaria, measles, HIV/AIDS, pneumonia, diarrhoea. This situation is tragic especially when one discovers that mothers and children are dying as a result of preventable and curable diseases associated with pregnancy and child-birth. The high mortality and morbidity rates prompted the researcher to assess the extent to which safe motherhood practices are provided to mothers and children both in the rural and urban areas in Nsukka Local Government Area of Enugu State in terms of ante-natal, natal and post-natal periods.
Purpose of the Study
The purpose of this study is to assess the extent of the provision of safe motherhood practices in Nsukka Local Government Area of Enugu State. Specifically, the objectives of the study are:
- to determine the various causes of maternal mortality among child-bearing mothers in Nsukka Local Government Area.
- to ascertain the extent to which safe motherhood practices are provided during the ante-natal period in Nsukka Local Government Area.
- to find out the extent to which safe motherhood practices are provided during the natal period in Nsukka Local Government Area.
- to ascertain the extent to which safe motherhood practices are provided during the post-natal period in Nsukka Local Government Area.
- to find out the strategies for improving on the provision of safe motherhood practices in Nsukka Local Government Area.
Significance of the Study
The findings of the study will provide information on the extent of the provision of safe motherhood practices among health educators and workers, government, state ministries of health and donor agencies, nurses and midwives, child-bearing mothers and children, and generally women and parents.
The findings of the study will be beneficial to health educators who will utilize the result to educate women on the components of safe motherhood practices and their importance, respectively. The result of the findings will also be beneficial to health educators in identifying groups with high risks of pregnancy-related complications. Also, based on the findings, the health educators will organize an enlightenment campaign to educate mothers on the factors that hinder effective provision and utilization of safe motherhood practices such as cultural belief. The findings of the study will also be useful to health workers. It will help them to ensure that they make necessary provisions for all the required services and to improve in the quality of services rendered to mothers and children.
Government and donor agencies (such as WHO and UNICEF) that are concerned with the health promotion of mothers and children will find the findings of the study very useful. This is because the information obtained will help ensure regular supply of both mothers and children with health tools in the various local government areas. The study will generate information on the extent of promotion and provision of safe motherhood practices. The findings will be beneficial to nurses and midwives who will enlighten mothers on the causes of pregnancy and childbearing complications and the need to provide safe motherhood practices for its prevention and treatment.
It will generate data on the availability of safe motherhood practices in Nsukka Local Government Area of Enugu State. The findings will also be beneficial to mothers. It will enable them to know the required practices for them and their children. It will also enable them to compare the different kinds of practices (both orthodox and non-orthodox) obtained in the health centres and hospitals. From the findings of the study, mothers will be able to appreciate the need to have these practices provided. This will lead to effective improvement in the provision of the safe motherhood practices in Enugu State as a whole.
Research Questions
The following research questions were posed to guide this study:
- What are the various causes of maternal mortality among child-bearing mothers in Nsukka Local Government Area?
- To what extent are the safe motherhood practices provided during the ante-natal period in Nsukka Local Government Area?
- To what extent are the safe motherhood practices provided during the natal period in Nsukka Local Government Area?
- To what extent are the safe motherhood practices provided during the post-natal period in Nsukka Local Government Area?
- What are the strategies for improving on the provision of safe motherhood practices in Nsukka Local Government Area?
Hypotheses
The following null hypotheses were formulated and tested at 0.05 level of significance:
- There is no significant difference between the mean ratings of the expectant mothers in the rural areas and their counterparts in the urban areas on the various causes of maternal mortality among child-bearing mothers in Nsukka Local Government Area.
- There is no significant difference between the mean ratings of the expectant mothers in the rural areas and their counterparts in the urban areas on the extent to which safe motherhood practices are provided during the ante-natal period in Nsukka Local Government Area.
- There is no significant difference between the mean ratings of the expectant mothers in the rural areas and their counterparts in the urban areas on the extent to which safe motherhood practices are provided during the natal period in Nsukka Local Government Area.
- There is no significant difference between the mean ratings of the expectant mothers in the rural areas and their counterparts in the urban areas on the extent to which safe motherhood practices are provided during the post-natal period in Nsukka Local Government Area.
- There is no significant difference between the mean ratings of the expectant mothers in the rural areas and their counterparts in the urban areas on the strategies for improving on the provision of safe motherhood practices in Nsukka Local Government Area.
Scope of the Study
The study focused on the assessment of the provision of safe motherhood practices in Nsukka Local Government Area of Enugu State. The study is restricted to the registered expectant mothers that attend ante-natal, natal and post-natal care services in hospitals and health centres in both rural and urban areas of Nsukka Local Government Area. The study is further restricted to the assessment of the extent to which safe motherhood practices are provided during the ante-natal, natal and post-natal periods in hospitals and health centres in Nsukka Local Government Area. Finally, the study focused on the assessment of the strategies for improving on the provision of safe motherhood practices in Nsukka Local Government Area of Enugu State.
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