Background to the Study
Maternal morbidity and mortality (MMM) is as old as the history of child bearing. It is a deceased state and death of a woman within 42 days after the termination of pregnancy, or within the pregnant period from any cause related to or aggravated by the pregnancy or its management (Sach 1987, Rowley 1987).
The rate at which pregnant women die due to pregnancy complications presently is quite alarming and it is a source of worry to the bereaved orphans, families, communities and the nation, World Health Organisation ( WHO, 2006). Due to the fact that child bearing is essentially a healthy and welcome process, traditional societies have managed, accept the risks as being unavoidable (Royston and Armstrong, 2006).
Indications are that maternal morbidity and mortality (MMM), globally every year, reaches over half a million (WHO; 2006). Most of the deaths from pregnancy related conditions are found in urban and rural areas of developing countries (Chiwuzie,Braimoh, Unuige 1985).
MMM rates in Nigeria are among the world highest, ranging from 800-1500 per 10,000 lives births. Despite the observation that traditional societies appear to have accepted the high MMM as unavoidable, researchers have shown that MMM and other pregnancy related problems are preventable (Royston and Armstrong 1989).
In the same vein, many researchers have analyzed the issue of MMM, and problems attributed to child bearing both in developed and developing countries. The conclusions are that they are preventable.
In a bid to find a lasting solution to increasing rate of MMM, governments, international agencies such as (WHO), United Nations Children’s Fund, (UNICF), and non- governmental organisations (NGOs) lunched the worldwide Safe Motherhood Initiative (SMI) at the International Conference in Nairobi in 1987(Onuzulike, 2006).
SMI is a global effort to reduce MMM in developing countries (Weston, 1986). The components of safe motherhood initiatives are prenatal care, ante-natal care, nutrition, family planning, personal hygiene during pregnancy, essential obstetric care, emergency care, postpartum care, post abortion care, prevention of sexually transmitted infections (STI’s), prevention of mother – to- child transmission (PMTCT) of HIV and AIDS and child care. The targets of safe motherhood initiatives are to reduce maternal mortality (deaths) to the lowest rate by the year 2015 in line with Millennium Development Goals (MDGs). However, for this present study the SMI in consideration are: prenatal/ante-natal care, nutritional care, personal hygiene while pregnant, essential obstetric care, child care and the pregnant women’s attitudes towards SMI based on level of education. The respondent’s educational level has link with attitude hence education brings changes in attitudes and enhances the quality of pregnant woman’s lives towards SMI.
Safe motherhood initiative aims at enhancing the quality and safety of pregnant women lives through the adaptation of a combination of health strategies. SMI means efforts to save pregnant women lives through a combination focused on three key areas; expanding and strengthening maternal health services, increasing access to family planning services; and improving the status of women through improving their cultural and legal status; and their access to educational and economic opportunities which are based on positive attitude (Maclaren, 1994).
There are three main health care delivery services enlisted by the safe motherhood initiative for the pregnant women to overcome maternal mortalities: pre natal care, Obstetric care and family Planning. It has been generally advocated that many maternal deaths in the developing world could be prevented if pregnant women are exposed to adequate health care attitudes during pregnancy (WHO, 1991). It has been claimed that most of the pregnancy complications and problems been experienced are deeply rooted in poor attitudes towards safe motherhood initiative components in urban and rural areas of the developing countries. This is caused by poor level of education towards SMI.
Hence studies are highly needed to ascertain the veracity of these claims based on their level of education. The researcher has therefore chosen to ascertain the application of these claims in Orlu Urban, Imo State Nigeria. To the best of the researcher’s knowledge, no such research had been conducted in Orlu urban.
Statement of the Problem
Nigeria, the most populous country in Africa, has the largest number of MMM in the world (Udeinya, 1995 and WHO, 1980). According to them, the death is responsible for a total of approximately 80,000 per year (Udeinya, 1995).These figures are of grave concern to a developing country like Nigeria. MMM result in deficient infant care, infant malnutrition and increased infant mortality.
Observations of pregnant women in Orlu urban revealed that they appear to patronize TBAs. Indeed, what is seen is that some aspects of the SMI are observed like prenatal/ante- natal attendants. Whereas, the actual delivery could be done any where ranging from the MCH, TBA’s, maternities and hospitals. What comes to mind therefore is whether the pregnant woman is differentiated in attendance to these facilities by any recognizable criteria. Again, if such criteria are based on any attitudinal inclinations. For instance could the preference to any facility of choice be based on education .Such that the more educated pregnant women are, the more the inclination to attend to facilities where SMI are prevalent.
These observations are indeed the motivation or problem of this study. Principally to investigate the disposition of pregnant women attitude towards some isolated components of SMI and the pregnant women’s attitude towards safe motherhood initiatives based on level of education. The high MMM rate indicates that pregnant women lack SMI positive attitude. Nigeria contributed about 10 per – cent to the world’s annual estimates of maternal death (NASPM, 2003). Earlier high MMM has been identified as a result from poor attitude towards the components of Safe Motherhood Initiative in both urban and rural areas of Nigeria (Onuzulike, 2006).