DEMOGRAPHIC PROFILE OF MOTHERS AND UTILIZATION OF HEALTH CARE SERVICES IN IKPA IKONO 2 COMMUNITY IN MKPAT ENIN LOCAL GOVERNMENT AREA
Abstract
This study examined the Demographic profile of mothers and their utilization of Healthcare services in Ikpa Ikono 2 community in Mkpat Enin Local Government Area. Six research questions were raised to guide the study. The population of the study comprised all women of child bearing age in the community totaling 15,720. Purposive sampling technique was used to gather the profile of mothers attending the two health facilities using a record checking proforma. The sample stood at 147. Simple percentage was used to answer the research questions. The findings of the study revealed that women in the age group between 15-25 years utilized healthcare services more than other age groups. It was also revealed that women who attended secondary school utilizes health services most. Married women utilized health services more than the singles or the widowed. Findings also revealed that women who were pregnant with their second babies utilized healthcare more. Another finding indicated that civil servants had higher rate of healthcare utilization. It was recommended that education of the community members on the need for utilization of healthcare services be carried out women and girls should be encouraged to go to school and more incentives should be provided to encourage more patronage by the women among others.
CHAPTER ONE
INTRODUCTION
Background of the Study
Maternal health has emerged as global priority. The World Health Organization (WHO) (2008) referred to maternal health as the health of the women during pregnancy, childbirth and the postpartum period. Maternal and child healthcare services is one of the components of primary Health Care which is concerned with early ante natal clinic, health education, delivery and postnatal care which also include care of the new born as well (Federal Ministry of Health (FMOH, 1996). The purpose of health services is to improve the health status of the populations through treatment of diseases, prevention of illness and promotion of health.
In rich nations where women have access to basic health care, giving birth is a positive and fulfilling experience, while on the other hand, for many women in poor countries, it is associated with suffering ill health and even death. Most poor health outcomes among reproductive women concerns with the non-use of modern maternal health care services such as antenatal care, delivery care and post natal care. WHO (2001) noted that lack of access and utilization of these essential obstetric services contribute to high maternal death rate. Therefore utilization of health care services can be seen as the quantity of services that is consumed when a patient demand is translated into health seeking behaviour.
WHO (1981) stated that utilization of services or actual coverage is expressed as the proportion of people in need of a service who actually receive it in a given period, usually a year. Utilization give some indication of the care needed by a population and therefore the health status of the population. In other words, a relationship exists between utilization of healthcare services and health need and status. This can be viewed as a type of individual behaviour which is a function of characteristics of the environment in which he lives and or some interactions of these individuals and societal factors (Moor, 1969).
Ahanobi and Ewuzie (2000) saw health care service utilization behaviour as that of someone in the use or non use of provided healthcare services to become and remain free of disease and illness. Thus utilization of maternal health service is one of the important factors to reduce the incidence of maternal mortality.
In many countries utilization of health care services by women differ greatly. In the developed nations of the world, women have been found to make effective use of health care services provided by the government, agencies and individuals. However, in developing nations, the situation is different. Evidence abound that there is under utilization of available services by women in the developing countries inpite of the effort by government and other agencies in providing these services (Ondimu, 2001; Ndifon & Asuquo, 2004). In Nigeria, studies conducted around the country revealed under utilization of maternal health services (Essien, 2002; Izugbara & Ukwaji, 2003; and Nwakoby, 2004).
Poor health outcomes among reproductive women concerns with the non use of modern maternal health care services such as ante-natal care delivery care are post natal care. According to Abou Zahr and Wardlaw (2004), antenatal care provides the opportunity for complications to be detected and gives women advice on the management of complications. It is an essential safety net for healthy motherhood and childbirth where the well being of both the prospective mother and her offspring can be monitored (2004).
In the area of maternity care, many women who received antenatal care are relatively high, but utilization of delivery services at modern health care facility is still low. Vas-Lerberghe and De-Brouware (2001) noted that a professional delivery care, such as assistance by a skilled health worker (doctor, nurse or midwife) at delivery is key to reduce maternal mortality. Use of health facility for delivery is still very low. It is reported that only 47% of deliveries occur in the health facilities and the remaining more than half deliver at home assisted by unskilled attendants (National Bureau of Statistics, 2005).
WHO (2005) reported that most maternal deaths occur because the deliveries were not assisted by skilled health personnel. Thus, traditional birth attendance (TBAs) continue to have a significant role in assisting deliveries.
Adolescent pregnancy is one of the factors contributing to maternal deaths. Very early motherhood increases the risk of dying in childbirth and make the well being of surviving mothers difficult (WHO, 2004). Reducing adolescent fertility would contribute directly or indirectly in improving maternal health. Winikoff and Sullivan (1987) opined that access to contraception is important to save women’s life. Family planning can prevent the serious health consequencies of women’s health by helping women prevent unwanted pregnancies and high risk pregnancies. Joyce, Kaestner and Korenman (2000) noted that non use of contraceptives increase the risk of maternal death, because unwanted pregnancies can lead to unsafe abortion and late prenatal care. The WHO (2005) noted that an estimated 100,000 maternal death could be prevented each year if women who did not want children used effective contraception.
Maternal healthcare also include the post natal care which comprised care of the mother and that of the newborn. According to WHO (1978) the aim of post natal care are to prevent complications, provide care for the rapid restoration of the woman’s health, check adequacy of breastfeeding and provide family planning services. In addition, postnatal care also provide basic health education to mothers and check adequate growth of the baby including immunization.
The postnatal period is the time immediately after the birth of the baby and up to six weeks (42 days) after birth, and is critical for the newborn and the mother. During this period bleeding and infection pose the greatest risk to the mother’s life, while preterm birth as phyxia and severe infections pose greatest risks to the newborn (WHO, 2010). These problems could be reduced if women receive appropriate postnatal care. Early studies have shown that about 5% of the maternal deaths and 40% of neonatal deaths occur within 24 hours after birth and this is known as immediate post natal period (Nabukera, Witte, Muchunguzi, Bajunirwe, Batwala, Mulogo, Far, Barry, & Salihu 2006). In a study conducted in 2006 Dhakal, Chapman, Simkhada, Van-Feijlinyen, Stephen & Raja (2007) reported that only 34% of women utilized postnatal care services within the 42 days after birth. The same study reported that occupation ethnicity, household economic status and educating of spouse were significantly associated with the utilization of post natal care.
It must be noted that utilization requires voluntary participation. It is expected that all women will avail themselves of the health care services provided in their locality, but numerous factors exert restrictions on the extent of utilization. Such factors like education, cultural, primary and secondary socialization may influence health care seeking behaviour. Andersen and Newman (2005) also stated that demographic variables are important bases for distributing health services under a system of equitable distribution because of well established relationships of age, sex and marital status to physical needs, disease patterns health maintenance and subsequent use of services.
Mkpat Enin government is a rural area and studies indicate that rural women are bound by poverty in their choice of services (Ukwayi, 2003). Umakantha and Yuvara (2005) opined that lack of knowledge about the benefits of healthcare services will also hinder its utilization. This study will look at six demographic variables in the determinants of maternal health care utilization. These are maternal age, marital status, educational level, religion, painting and occupation status. It is a well recognized fact that a woman’s current age level plays an important role in the utilization of medical services Nwakoby (2004) stated that maternal age is seen as one of those factors found to be most consistently associated with the use of health care services, Mekonnen, (2003) observed that the younger age group tend to utilized antenatal care services more than their older counterpart. Simkhada, Van-Teijlinge, Porter & Simkhada (2008) also observed that in the developing countries women of older age group have low utilization of health services. This they opined that it could be due to the greater confidence and experience of the older and greater responsibilities within the household. Elo (1992) stated that age indirectly influence utilization of maternal health care services as a result of perceived risk associated with first pregnancy. Thus a woman is likely to seek medical attention for the first pregnancy. Treffers (2003) also discovered in his research that teen mothers are less likely to receive prenatal care often seeking it at the 3rd trimester if at all. In the review of Guttmacher Reports Wind (2004) discovered that 1/3 of pregnancy teens received insufficient prenatal care and that their children are likely to suffer from health issues in childhood or be hospitalized than those born to elderly mothers. Venkatesh, Umakanth and Yuvaraj (2005) noted that the development of modern medicine and improvement in education opportunities for women in recent years, have made younger women to have enhanced knowledge of modern healthcare services and place more values upon them.
Education of mothers is an important social variable that has a positive effect on the utilization of maternal and child health services. Evidence from previous research suggests that maternal education has a positive effect on the use of healthcare services (Mbackz and Vande Wale, 1987). Furthermore, Caldwell (1990) have argued that educated mothers are more likely than uneducated women to take advantage of modern medicine and comply with recommended treatments because education changes the mother’s knowledge and perception of the importance of modern medicine in the care of her children.
According to Say and Raine (2007) women education is a major factor influencing maternal healthcare utilization. Dagne (2010) maintained that educated women are more likely than are uneducated women to use antenatal care to use it early and frequently, and to use trained providers and medical institutions, and that education is positively associated with safe delivery. Therefore the level of formal education attainment affects the health behaviour of women which in turn affects their education also empowers the women to demand more and better quality health.
Ondimu (2000) found out that reproductive health problems was higher for mothers who have low level of education and who do, not adequately utilize health care services. It is expected that educated women possess the decision making power within the household, awareness, knowledge and acceptance of modern medical treatment and health care institutions. Educated women also attached a higher value to their welfare and that of their health being more confident in handling health officials. It is argued that better educated women are more aware of their problems, have the knowledge of availability of care and utilize the information effectively to maintain or achieve good health status.
Another important determinants of maternal healthcare service utilization is marital status. WHO (1998) stated that in many parts of Africa, women’s decision-making power is extremely limited, particularly in matters of reproduction and sexuality. In most instances, decision about maternal care are often made by the husbands. Kaguna and Nuwaha (2000) established that influence from spouse affects utilization of health services by expectant women. When a woman is married some of his variables come into play in her life, therefore the husband’s income, education and may be religion becomes relevant to the women and these will influence her outlook and perception of health care services.
According to studies, husband’s decision greatly influence utilization of health care services by women. In most places husband’s decision is required for a woman to seek health services especially life saving care. Esima, Ojo and Fabula (2002) reported that husband’s consent was one of the factors that influence women health care utilization in Ile Ife. Venketash et al (2005) revealed that wives generally need their husbands permission to attend clinics and access reproductive health services. Adamu and Slihu (2002) discovered husband’s denial in a study in Kano which influences the use of antenatal services negatively. Similarly, Marie Stopes International (2004) found out that some pregnant women who attended an antenatal clinic without their husband’s knowledge would incure a real risk of physical violence.
Contrary to this view, Mekonnen and Mekonnen (2002) observed that in Ethiopia the unmarried expectant mothers residing in rural areas are more than twice as likely as married women to receive delivery assistant from a health professional than their married counterpart.
Religion is another variable which is seen to have a significant relationship with service utilization. Studies revealed that those individuals following orthodox or catholic, muslim and protestant tend to use health services more than those following traditional belief (Mekonnen and Mekonnen, 2002).
Utilization of health care services by the women of child bearing age is greatly influenced by religion. These belief affect their health behaviour and acceptance or response to treatment either negatively or positively. When religion forbids medication, it hinders the effective utilization of health services by believers of such faith (Marie Stopes International, 2004).
Some religious doctrines are against certain medical services and women of these faith in line with their beliefs are bound to shun such services. Women of such faith with clinical problems such as eclampsia, obstructed labour, post partum, haemorrhage and pueperal sepsis usually refuse maternal care in health centres. They believe in faith healing and miracles.
It is also seen that parity level of women do affect the utilization of health care services. Venkatesh, Umakenth and Yuvaraj (2005) agreed that utilization of care is higher among women with lower parity and in the 18-29 years of age. They stated that the percentage of utilization gradually declined with the rise of parity and age. In their opinion Bhatic and Cleland (1995) stated that women of lower age group and lower parity tend to give careful attention to seeking health care services due to their inexperience in reproductive matters. Navaneetham and Dharmalingam (2002) asserted that low utilization of maternal health care services among higher parity women could be due to time and resources constraint faced by their larger families. Women having children with birth order of five or more and are grand multipara have a lesser chance of delivering in health institutions than those with lesser number of children. A study in Turkey showed that women who delivered their first child were found to be significantly more likely to use prenatal care and trained assistance during the delivery than women in the higher parity order (Celik & Hotchkiss, 2000). Birmeta, Dibaba and Woldeyohannes (2013) indicated that some women with repeated experience of child birth did not want to go to health institution because of their previous experience which often led them to believe that they do not need assistance from the health professional.
A woman’s occupation level plays a significant role in the utilization of health care services. According to Chakraborty, Islam, Chouldhury, Dari & Akhter (2003) women’s involvement in gainful employment is one of the important factors positively affecting the use of health services and seeking quality medical care. This will also empowers them to take part in decision making process about health care for themselves and their family.
Simoes, Kunz, Munnich & Schmahl (2006) in their study in Germany found the difference in an individual’s use of antenatal services to be associated with occupational status. They noted that unskilled workers, trainees, students and housewives avail themselves less of antenatal care services when compared to the working class women.
According to Collins, Anwar, Igbal & Ronsmans (2007) there is a relatively increase in the antenatal services, utilization remained much lower among the poorest rural woman as compared to the richest urban woman.
However, in contrast in a study in Ghana by Addai (2007) there was no significant difference between occupation and income on antenatal services utilization. Similarly in a study done in Pakistan, it was observed that family income was not associated with utilization of health care services (Alam, Quereshi, Adil & Ali, 2004). Though Venkatesh et al (2008) noted a significant difference between house wives and working class women in the utilization of healthcare services, but contrary to expectation, housewives utilizes antenatal services more than the working class mothers. To their observation, it was due to the fear of loosing their job by the working class mothers as they spent valuable man hours to have access to health care providers.
DEMOGRAPHIC PROFILE OF MOTHERS AND UTILIZATION OF HEALTH CARE SERVICES IN IKPA IKONO 2 COMMUNITY IN MKPAT ENIN LOCAL GOVERNMENT AREA