Non-Utilization of antenatal care services among women of reproductive age in the Niger delta region of Nigeria: Findings from 2595 women

The United Nations’ Sustainable Development Goals and the World Health Organization (WHO) outline targets for the reduction of maternal mortality by 2030. Quality antenatal care is one of the three essential maternal health services which ensure good feto-maternal outcomes. The antenatal period provides ample opportunity for health workers to educate women, offer screening, diagnosis and treatment services for pregnancy-related conditions, and refer women for specialized interventions. This descriptive cross-sectional community-based household survey using multistage sampling technique describes the pattern of utilization of antenatal care services, the perception of respondents toward antenatal care and the determinants of utilization of antenatal care among a cohort of 2595 women of reproductive age in Rivers State. Data was collected using interviewer-administered questionnaires built on the Open Data Kit (ODK) application for android phones and analyzed using the Statistical Package for Social Sciences (SPSS) version 23.0 statistical software. Antenatal care was poorly utilized. There was no association between level of education and utilization of antenatal care services. Women residing in urban locations (Adj O.R = 1.46; 95% C.I = 1.16 to 1.84) and women who were comfortable with the government health facility closest to their residence (Adj O.R = 1.72; 95% C.I = 1.36 to 2.17) had increased odds of utilizing antenatal care services. Married women had an increased odds of utilizing antenatal care services compared to unmarried woman Adj O.R=1.66; 95% C.I =1.30 to 2.11 The implications of these findings underscore the need for fit-for-purpose interventions that address the barriers and modifiable determinants identified and should be considered when policymakers or international agencies plan the prevention of maternal morbidity and mortality in developing countries. Models of care that involve continuous health promotion activities within the communities, health systems strengthening, community-based insurance schemes and a patient-centered approach to care have the potential to improve utilization of antenatal care services. *Correspondence to: Rosemary Ogu, Department of Obstetrics and Gynecology, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria; E-mail: rosemary.ogu@uniport.edu. ng Received: June 15, 2018; Accepted: June 22, 2018; Published: June 25, 2018 Introduction The United Nations’ Sustainable Development Goals and the World Health Organization (WHO) outline targets for the reduction of maternal mortality by 2030 [1-3]. The WHO’s Ending Preventive Maternal Mortality (EPPM) strategies seek to reduce the global maternal mortality ratio (MMR) to fewer than 70 maternal deaths per 100,000 live births and reduce by two-thirds country specific MMRs [4]. This EPPM target translates to a reduction in the Nigerian MMR figures from 867 per 100,000 live births in 2010 to 289 per 100,000 live births in 2030 [5,6]. Quality antenatal care is one of the three essential maternal health services which ensure good feto-maternal outcomes [7]. The antenatal period provides ample opportunity for health workers to educate women, offer screening, diagnosis and treatment services for pregnancy-related conditions, and refer women for specialized interventions. It is therefore imperative that pregnant women take full advantage of antenatal care services [8-12]. Unfortunately, utilization rates for antenatal care in Nigeria has been below expectations with the proportions of pregnant women who utilized antenatal services in their last pregnancy ranging between 12% to 60.3% [13-15]. The reasons for these poor utilization rates have been attributed to factors which can be classified into individual and household factors, facility-based factors and community-based factors. Some examples of individual and household-based factors include socio-demographic and socio-economic and parity, attitudes and personal preferences. Facility-based factors may include, health worker attitude, waiting time, perceived staff competence, and cost of services. Community-based factors may include type of community (urban or rural), and community beliefs and practices [13-17]. Although the determinants of utilization of antenatal care in the West and Northern parts of Nigeria are documented [18,19], there isn’t much evidence in the literature about the determinants among women living in the Niger-Delta. Cultural and social beliefs and practices differ widely across the regions of the country. It is therefore vital to understand the determinants of utilization of antenatal care in the Niger Maduka O (2018) Non-Utilization of antenatal care services among women of reproductive age in the Niger delta region of Nigeria: Findings from 2595 women Clin Obstet Gynecol Reprod Med, 2018 doi: 10.15761/COGRM.1000220 Volume 4(3): 2-5 Delta region of Nigeria, with a view to proffering viable demand and supply-side interventions to improve feto-maternal outcomes. The aim of this community-based household survey was to describe the pattern of utilization of antenatal care services, the perception of respondents toward antenatal care and the determinants of utilization of antenatal care among a large cohort of women of reproductive age in Rivers State. The results of the quantitative survey are presented in this manuscript.