TABLE OF CONTENTS
Title Page – – – – – – – – – – i
Approval Page – – – – – – – – – – ii
Certification Page – – – – – – – – – iii
Dedication – – – – – – – – – – iv
Acknowledgements – – – – – – – – – v
Table of Contents – – – – – – – – – vi
List of Tables – – – – – – – – – – ix
List of Figures – – – – – – – – – – x
Abstract – – – – – – – – – – xi
CHAPTER ONE: INTRODUCTION
Background to the Study – – – – – – – – 1
Statement of Problem – – – – – – – – – 3
Purpose of Study – – – – – – – – – 4
Objectives of the Study – – – – – – – – 4
Research Questions – – – – – – – – – 5
Significance of the Study – – – – – – – – 5
Scope of Study – – – – – – – – – 6
Operational Definition of Terms – – – – – – – 6
CHAPTER TWO: LITERATURE REVIEW
Maternal Health Services – – – – – – – – 8
Antenatal care Services – – – – – – – – 8
Intranatal Care – – – – – – – – – – 9
Postpartum Care – – – – – – – – – 10
Women Status – – – – – – – – – – 11
Women Decision Making Autonomy and Maternal use of PHC Facility – 12
Women Employment Status and Maternal use of PHC Facility – – – 13
Education and Maternal use of PHC Facility – – – – – – 14
Wealth Index and Maternal use of PHC Facility – – – – – 15
Theoretical Review – – – – – – – – – 16
Anderson’s Health Behavioural Model – – – – – – 16
Review of Empirical Study – – – – – – – – 18
Summary of Literature Review – – – – – – – 24
CHAPTER THREE: RESEARCH METHOD
Research Design – – – – – – – – – 25
Area of Study – – – – – – – – – – 25
Population of Study – – – – – – – – – 26
Sample – – – – – – – – – – 26
Inclusion Criteria – – – – – – – – – 26
Sampling Procedure – – – – – – – – – 27
Instrument for Data Collection – – – – – – – 28
Validity of Instrument – – – – – – – – – 28
Reliability of Instrument Ethical Consideration – – – – – 28
Ethical Consideration – – – – – – – – – 29
Procedure for Data Collection – – – – – – – 29
Method of Data Analysis – – – – – – – – 29
CHAPTER FOUR: PRESENTATION OF RESULTS – – – – 31
CHAPTER FIVE: DISCUSSION OF FINDINGS
Proportion of women who utilise Maternal Health Care Services – – – 45
Association between Women Decision Making Autonomy and use of Maternal
Health Care Service – – – – – – – – 45
Association between Women Education and use of Maternal Healthcare Services – 45
Association between Women Occupation and use of Maternal Health
Care Services – – – – – – – – – 46
Association between Women Economic Status and use Maternal Health
Care Services – – – – – – – – – – 47
Implication of the Findings to Nursing – – – – – 48
Conclusion – – – – – – – – – 48
Recommendation – – – – – – – – – 49
Limitations – – – – – – – – – – 49
Suggestions for Further Studies – – – – – – 50
Summary – – – – – – – – – – 50
References – – – – – – – – – – 51
Appendix 1 – – – – – – – – – – 56
Appendix 2 – – – – – – – – – – 57
Appendix 3 – – – – – – – – – – 59
Questionnaire – – – – – – – – – – 60
LIST OF TABLES
Table 1a: Demographic characteristics of respondents – – – 27
Table1b: Socio demographic variables of the respondents – – – 31
Table 2a: Economic status (wealth index) of the respondents – – 33
Table 2b: Economic status (wealth index) of the respondents contd- – – 34
Table 3a: Utilisation of maternal health services (ANC) – – – 35
Table 3b: Utilisation of ANC contd – – – – – – 36
Table 3c: Partner’s perception of ANC – – – – – – 37
Table 4: Utilisation of maternal health care services for delivery care (n=482) 38
Table 5: Cross tabulation between decision making autonomy and utilization of
antenatal services – – – – – – – 40
Table 6: Association between Educational status of women and use of maternal health
care services – – – – – – – – 41
Table 7: Association between women occupation and use of maternal health care
Services – – — – – – – – 42
Table 8: Association between women economic status and use maternal health care
Services – – – – – – – – 43
LIST OF FIGURES
Figure1: Anderson’s behavioural model of health services utilization – 18
Figure 2: Conceptual model of the study – – – – – – 18
ABSTRACT
The study examined the association between women’s status and utilisation of maternal health care services of primary health care centres in Nando, in Nando, Anambra east L.G.A of Anambra State. Five objectives were developed. A cross sectional descriptive research design was used. The study population consisted of women of child bearing age (15-49years) who had given birth in the last five years. A sample size of 500 participants was used after using the formula for estimating sample size from a finite population. However, only 482 copies of the questionnaire were returned, giving a response rate of 96.4%. The instrument for data collection was a questionnaire developed by the researcher based on literature review. Data were analysed using the statistical package for the social sciences (SPSS version 18). The major findings showed that 71.5% utilised ANC while 44.4% utilised delivery healthcare services; 40.2% of the women took decisions jointly with their husbands while 32.4% took decisions alone on utilisation of ANC. As regards utilisation of delivery care services, 39% took decisions alone while 36.5% took decisions jointly with their husbands on where to have their baby. There is a statistical significant association between women decision making autonomy and utilisation, women educational and utilisation, and women economic status and maternal health care service utilisation. However, the study showed no statistical significant association between occupational status and utilisation of maternal health care services. The study concluded that the factors that influence the utilisation of maternal health care services are women decision making autonomy, educational status and their economic status.
CHAPTER ONE
INTRODUCTION
Background to the Study
Giving birth is a positive and fulfilling experience that sometimes comes with risks (WHO, 2008). The health risk associated with reproduction affect virtually all women of reproductive age at some point in their lives (WHO, 2008). These risks are more marked in developing countries where a majority of the women are poor and have a low economic status (WHO, 2008). This low status deprives them of the decision-making power necessary to take prompt decisions on health care. In developed countries where women are educated and earn a reasonable income, they have the power to make decisions concerning their health and have access to basic maternal health care services (WHO, 2008).
Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period (WHO 2008). It has been estimated by the Safe Motherhood Initiative (SMI) that 30 to 50 morbidities occur for each maternal death (SMI, 2009). The tragedy of not preventing these avoidable deaths resulted in 536,000 maternal deaths worldwide in 2009 (WHO 2010). Developing regions accounted for 99 percent (533,000) of these deaths, with sub-Saharan Africa and Southern Asia accounting for 86 percent of them (UN 2008,). For such women, pregnancy and childbirth led to illness and disability. Improving maternal health and reducing maternal mortality have been the main concerns of several international summits and conferences. The Millennium Summit in 2000 calls for a 75 percent reduction by 2015 in the maternal mortality ratio (UN, 2008,). However as the deadline approaches, these hopes have not been met, many countries are nowhere near achieving this objective, and there is no sure evidence that global maternal mortality levels has declined in the past decade by any significant degree (Rajesh, Prashant, Chandan & sing, 2013, WHO,2013). The utilization of maternal health care services, especially at the primary level, is one of the important factors that will help reduce the incidence of maternal mortality (SMI, 2008).