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Published by Merwynmae Pobletin

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Published by: Merwynmae Pobletin on Nov 26, 2012
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W. A. Gazali,
Falmata Muktar and
Mahamoud Mohammed Gana
Department of Sociology & Anthropology, University of Maiduguri,
Department of Nursing Sciences,
Department of Obstetrics and Gynaecology, College of Medical Sciences, University of Maiduguri, Maiduguri,NigeriaABSTRACTWomen’s utilization of maternal health care facility is an important health issue with regard to thewellbeing and survival of both the mother and her child during childbirth which has implications on thematernal and child mortality rate in human society. However, in most third world countries and Nigeriain particular there are certain factors that inhibit pregnant and women in patronizing maternal healthfacilities during childbirth. It is these factors that this paper investigated among pregnant women in thetwo Local Government Areas of Borno State. The methods of data collection adopted in the study werethe survey methods: Seventy eight (78) questionnaires were administered; six (6) in-depth interviewsand four sessions of focus-group discussion (three sessions in each of the 2 LG Areas) were conducted.KEY CONCEPTS: Barriers, Utilization, Maternal Health Care ClinicINTRODUCTIONThe demand for and utilization of maternal health services depends on numerous factors, many beyond awoman’s direct control, including the physical accessibility of facilities to her home; direct and indirect costs of obtaining services including not only fees for medication, transportation, feeding and accommodation chargesbut also the convenience of opening hours and average waiting times, the extent to which staff are competent,providing quality care and demonstrating cultural sensitivity to her needs, and the availability of other neededkey health care inputs including essential drugs and food supplements (Lashman, 2006).In addition to these service quality factors and access to the facility has been adversely affected by theintroduction of cost recovery schemes, including user fees for antenatal and delivery services in most states of the country. The impact of these fees on service utilization is particularly severe among the poor and vulnerablegroups, who have resorted to the use of traditional medical practitioners and spiritual healers as alternativeproviders of health care (El-Sefly, 2001 and Mairiga (2003)). Utilization is the way and manner in which peopleuse or utilize a particular thing(s), product(s) or service(s) because of the belief that it is important or serves avery vital functional and significant role in their well being, society at large, and the very survival of the humanrace. In this study, it means the way and manner in which married women of child bearing age - pregnantwomen and nursing mothers patronize Maternal Health Care clinic due to the belief and acceptance of theadvantages and importance associated with the use of the facility. Some of the issues considered in determiningor measuring utilization of the MHC facility in this study include; use of antenatal care, rate of attendance-(frequency or rate of visits) delivery assisted by a trained medical personnel (doctor or nurse/nurse-midwife),and use of postnatal care services. Another issues taken into considerations are reason(s) for not attendingantenatal and postnatal care (distance, convenience, opportunity cost (economic reason), and socio-culturalbarriers). There is some evidence that these barriers are at least as important in determining access to services asthe quality, volume, and price of services delivered by health care providers.Maternal Health Care clinic is defined in functional term, as a comprehensive maternal health care facility thatcovers the promotional, preventive and treatment services required by families in order that mothers (during andbetween maternal cycles) and their children may be kept well or if acutely or chronically ill or handicapped or
W. A. Gazali
et al
.,: Continental J. Tropical Medicine 6 (1): 12 - 21, 2012crippled by social, emotional, physical, or mental condition, may be restored to the greatest possible extent of good health. In view of the above definition, in this study Maternal Health Care clinic refers to the facility thatprovides all necessary services required by pregnant women, nursing mothers and their infants, particularlyservices rendered during prenatal, antenatal, childbirth and postnatal periods.Scope and limitations of the studyThe scope of the research is Maiduguri Metropolitan Council and Jere Local Government Areas. Therespondents are pregnant and women of child bearing age, and officials of MHC Clinics - nurses, midwives. InBorno State there are 147 Maternal Health Care facilities out of these 78 them, about 53.1% of the total facilitiesof the state are all located in area the researcher designated as Maiduguri Metropolitan Area, that comprise of MMC and Jere LGAs and the remaining 69 facilities are spread among the remaining 25 Local GovernmentArea. The limitations of the study are the fact that the research is focused on married pregnant women andnursing mothers who are one the beneficiaries of maternal health care service, and not young unmarried girls orwomen who are not pregnant. Furthermore, the study covered only nine (9) health facilities and wards(localities) within the study areas, few nurses and midwives and other health officials. In addition, the samplesize used in the in-depth interview and focus group discussion is small, as is the case usually with qualitativeresearch. Consequently, the data gathered through the two methods is reflecting the experience of only 6interviewees and 4 focus group discussions (FGDs).In view of the above the findings of this study can not be generalized beyond the groups identified for the studyand the areas of the study, Maiduguri the State capital, Khardamari the Headquarters of Jere LGA.DISCUSSIONSSocio-Cultural Factors These are factors associated with the traditions, norms and values of people that affectthe way and manner in which they seek medical help on health related problems. Culture incorporates belief-system that underlies the perception and interpretation of diseases and illness in societies. Igun (1977) andErinosho (1998), argued that, unlike in the western societies where the concept of disease is largely based on thegerm theory, hence patents perceive disease in terms of organic malfunction, which can be effectively,diagnosed using scientific and clinical techniques and the acceptance of a scientific notion of disease thereforeoblige patients to use modern orthodox or western-style health care service. In Africa and most developingcountries that is not the case.However, this notion of disease or illness contrasts with the dominant belief-system in most non-westernsocieties where diseases and sickness are attributed to witchcraft, sorcery and mystical forces; hence illness anddiseases are perceived, evaluated and acted upon in line with these beliefs that is why they seek medical helpfrom assorted traditional healers.Patients are wont to use traditional medicines or the services of traditional healers at the onset of ill health, andmore importantly due to the attitude of relating diseases and sickness to magico-religious factors the people insuch communities or societies appear to have greater confidence in the therapeutic skills of traditional healers(Lambo 1962, Erinosho 1977 and Igun 1988).These are some of the prevailing traditional beliefs and practices among most of the communities in the studyareas that hinder the full utilization of modern health facility in general and maternal health care services inparticular. This fact was clearly revealed by Jibo (2004), who studied women in Shekar Maidaki village in Kanostate where he found that the two main reasons for non-utilization of maternity care services amongst thewomen are spousal inhibition and access to experience traditional birth.According to Odebiyi, (1989) and Raju (2000) some of the socio-cultural practices and superstitious beliefs andpractices relating to the concept of causality in which illness and other misfortunes are attributed to evil spiritsare wide spread among many ethnic groups in Nigeria. Traditional perception of events may tie followers to theuse of traditional medicine and encourage use of formal system only when the traditional option fails. As aresult women in many communities in Nigeria seek medical treatment only as a last resort, after first attemptingto appease these evil spirits. The traditional beliefs obviously have negative effects on the use of modern healthcare delivery. Also
W. A. Gazali
et al
.,: Continental J. Tropical Medicine 6 (1): 12 - 21, 2012women under utilize maternal health care services due to their poverty, illiteracy, general backwardness andadherence to superstitious belief concerning illness and diseases.i, Early marriage and pregnancyEarly marriage is an act of giving young girls below maturity age in marriage. This practice is more common inthe northern part of the country where girls are married off before they are physically and psychologicallymature to manage motherhood. The age at which childbearing begins influences the number of children awoman bears throughout her reproductive life. Similarly, early childbearing, particularly among teenagers (thoseunder 20 years of age) has negative demographic, socio-economic, and socio-cultural consequences. Teenagemothers are more likely to suffer from severe complications during delivery, which result in higher morbidityand mortality for both themselves and their children. (NDHS 2003)Iman (1969), Cohen (1967), Gazali, (1996), and Waziri (2004), all revealed that, Kanuri girls are married off attender age because it is culturally believed that girls ‘decay’ (
 fero nyibcin)
, and unpleasant remarks may bemade about the parents in the community. A girl who does not have a marriage proposal at an early age is called
, meaning she has no intrinsic value for suitors. In some extreme cases she may be mocked, abused orgenerally looked down upon by the members of her family and the locality in general.Though it exposes women to many health problems like cephalopelvic disproportion, obstructed labour, vesicovaginal fistulae (VVF), etc, the number of children that a woman bears is an important aspect of most the of people in the study areas. Meaning high birth rate and large family size is a cherished cultural practice.Similarly, the traditional view (cultural value) that a girl should be married off as soon as she reaches pubertyremains strongly entrenched among majority of the people of the state at large and the areas of study inparticular (Gazali 2004 and 2005, Waziri 2004 and 2008).ii Polygyny:This is one of the cultural practices underlying various facets of reproductive health, with implications for safemotherhood. Polygyny is a common cultural practice among the Muslims of Northern Nigeria, and according toNDHS 2008, 46% of married women are in polygynous unions. Some of its implications are frequency of exposure to sexual activity and fertility. Other consequences of polygyny are intense competition among co-wives to fulfil the reproductive expectations of their husbands and his family. The number of children to whichthey give birth (in particular male children) affects the esteem and value placed on the woman in the householdand may also directly determine the size of her monthly allowance. Hence, large numbers of children and thecompetition among co-wives for a share of limited resources and emotional support from the husband haveserious implications on safe motherhood.iii, Large Family Size:This relates to the perception of women’s fundamental role, which is childbearing and child-rearing. Thesecultural values are shared by both men and women, although it is interesting to note that among westerneducated/ working class women they desire fewer children than their male partners, doubtless because they haveother aspirations and are more conscious of the burden of reproduction and child care. Recent studies inNorthern Nigeria suggest that it is often men rather than women who make the decision to have more children,that is, men’s views are more influential than women’s views in making family decisions (WHO1996, and SafeMotherhood).Similar findings were revealed by studies among some of the major ethnic groups in Borno State by Gazali,(1996), Waziri, (2004) and among the Hausa of Kano state by Adamu (2001) in Kano. In their studies theyindicated that men, because of their position in a patriarchal society, make it difficult for the women to regulateand control birth rate or in short adopt family planning without the consent of their husbands who usuallyoppose the idea. For instance, among some of the major ethnic groups in Borno state, particularly the Kanuri,Shuwa and Ba’aru, large family symbolise higher status for members of the family. Politically, it makes thefamily more relevant and religiously, it gives them the satisfaction of fulfilling an obligation – to marry andreproduce, so that the
(followers of Prophet Mohammed PBUH) will increase (Gazali, 1996 and Waziri2004).

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