ASSESSMENT OF THE FACTORS AFFECTING ACCESS AND UTILISATION OF SELECTED MATERNAL HEALTH CARE SERVICES IN KADUNA STATE, NIGERIA
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ABSTRACT
The official policy which exempts women and their babies from out-of-pocket payment for their health care in Kaduna State is only in written paper because the study found that women are usually asked to pay some token whenever they go to hospital to utilise health care services. The study examined the challenges of maternal health among women of reproductive age (15-49 years) in Kaduna State. The main aim of the study is to assess the factors affecting access and utilisation of selected maternal health care services in Kaduna Sate. The specific objectives are: to assess women’s awareness of selected maternal health care services in the study area, to determine the extent of utilisation of selected maternal health care services among women in the study area, to identify factors affecting access to the selected maternal health care services among women in the study area, to determine strategies put in place by women to over-come barriers to utilisation of the selected maternal health care services in the study area. Literature was reviewed in line with the study objectives. The study utilised Anderson health behavioural model as the theoretical framework. The study was carried out in the three senatorial zones in Kaduna State. A total of three hundred and seventy-nine questionnaires were administered to women of reproductive age in selected Local Government Areas of Kaduna State using multistage sampling technique. In-depth interviews were also conducted among nineteen (19) key informants comprising orthodox health practitioners and traditional birth attendants. Twelve (12) Focus Group Discussions were conducted on both women and men in the study areas. Hospital records were also collected using documentary review. The mean age of the respondents was 32 years; they had an average of 5 children. Majority of the respondents were married and had formal education. The level of awareness of the selected maternal health care services was very high, utilisation of the services was however lower than awareness. For family planning 26.5% gave a history of ever using modern contraceptives while only 16.7% are currently using. Similarly 99.7% use antenatal care only very few deliver in health facility. While injectable method of family planning is the most preferred by the respondents husband not agreeing to it and love for many children were reasons for not using family planning. Also, ability to pay for maternal health care services significantly influenced utilisation of the services as women who earn above N30,000 monthly utilised delivery services than women who earn less. The findings revealed that there is a significant relationship between religion and use of family planning as majority of the Muslims has never used family planning whereas; some of the Christians have ever used family planning. The result shows that while about average of the respondents delivered their babies in government hospital, below average had home delivery. Majority of the women that delivered in private clinics have tertiary education. While majority of the respondents that earn N30,000 above delivered in private clinics, some of respondents that earn between N11,000 - N20,000 had home delivery. Majority of the respondents agreed that the staff reception at the maternal health care centers is either friendly or somewhat friendly. Documentary records from the hospitals shows that majority of the women do come for antenatal care across the zones but women from Kaduna north do not come for delivery in the hospital. The documentary also shows that antenatal is the most used maternal health care services while xv family planning is the least used across the zones. Regression results show that place of delivery is significant with educational level and age and has positive relationship with educational level, monthly income and age. Also ever used family planning is significant with religion, marital status, monthly income and age whereas it has positive relationship with only marital status. Access to antenatal care has no significant relationship with any of the socio-economic variable but has positive association with age, religion and monthly income. Also utilisation of antenatal care is significant with marital status, monthly income and age and has positive relationship with religion, marital status, educational level and age. The regression results also shows that utilisation of delivery service is significant with age and educational level and has positive association with marital status and monthly income. Utilisation of postnatal care is significant with religion, marital status, and monthly income and has positive association with marital status and monthly income. Factors found to be associated with use of maternal health care services were financial capability, education and male dominance. It is therefore recommended that there should be sensitization programmes to increase the awareness of all other services rendered in maternal health care centers. There should be adequate information about utilisation of family planning methods in other to dispel any misconceptions about family planning. Also, public enlightenment programme on maternal health service utilisation and male responsibilities should be effectively carried out in all communities especially among women in Kaduna North who hardly utilise delivery care, and family planning services. Government should make accessibility to maternal health care centers easy so as to encourage women to utilise the services.
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