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PREFERENCE FOR TRADITIONAL BIRTH ATTENDANT SERVICES AMONG PREGNANT WOMEN ATTENDING ANTENATAL CLINIC IN RUMUOMASI COMMUNITY , RIVERS STATE
Abstract
This study examined the preference for Traditional Birth Attendant (TBA) services among pregnant women attending antenatal clinics in Rumuomasi Community, Rivers State. A cross-sectional survey research design was adopted to explore the extent of patronage, factors influencing preference, and measures that could promote the utilization of standardized healthcare facilities for antenatal care. A structured questionnaire was designed to collect data from a sample of 133 respondents, ensuring that relevant information was obtained regarding their healthcare choices during pregnancy. The collected data were analyzed using SPSS version 27, with descriptive and inferential statistical tools employed to present the findings. A one-sample t-test was used to test the hypotheses formulated for the study. The results revealed that a significant number of pregnant women in Rumuomasi preferred TBA services due to factors such as accessibility, affordability, personalized care, and cultural beliefs. Many respondents reported frequent visits to TBAs for antenatal care and delivery, citing financial constraints and negative experiences with hospital staff as major reasons for their preference. The study further found that cultural beliefs played a significant role in shaping women’s healthcare decisions, with many participants expressing trust in traditional birth attendants due to long-standing practices within their communities. Additionally, the findings indicated that despite the availability of standardized healthcare facilities, the demand for TBA services remained high, suggesting gaps in the healthcare system that discourage women from utilizing hospital services. The hypotheses tested provided statistical evidence to support these findings. The first hypothesis, which stated that there was no significant relationship between accessibility and preference for TBA services, was rejected as the results indicated a strong correlation between ease of access and the choice of traditional birth attendants. Similarly, the second hypothesis, which posited that cultural beliefs did not significantly influence the preference for TBAs, was also rejected, confirming that cultural factors played a vital role in women’s healthcare decisions. The third hypothesis, which suggested that the level of awareness of standardized healthcare facilities did not significantly affect antenatal care utilization, was also rejected, as the findings showed that a lack of awareness and perceived barriers contributed to low hospital attendance. Based on these findings, the study concluded that while TBAs play a crucial role in maternal healthcare in Rumuomasi, there is a need to enhance the accessibility, affordability, and quality of standardized healthcare facilities to encourage more women to utilize formal antenatal and delivery services. Negative perceptions about hospital care, particularly concerning the attitudes of healthcare workers and the cost of services, need to be addressed to improve maternal health outcomes. The study recommended that healthcare authorities implement targeted interventions, such as community sensitization programs, financial subsidies, and improved healthcare worker-patient relationships, to promote hospital-based maternity services. Additionally, integrating TBAs into the formal healthcare system through training and collaboration could help bridge the gap between traditional and modern maternal healthcare services.
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Maternal healthcare is a critical aspect of public health, particularly in developing countries where maternal and infant mortality rates remain high. In Nigeria, despite the availability of modern healthcare facilities, a significant number of pregnant women continue to patronize Traditional Birth Attendants (TBAs) for antenatal care and delivery services. Traditional Birth Attendants play an essential role in maternal health, especially in rural and semi-urban areas where access to formal healthcare services is limited.
Rumuomasi, a community in Rivers State, Nigeria, is an urban settlement with diverse healthcare options, including hospitals, clinics, and TBAs. However, despite the availability of standardized healthcare facilities, some pregnant women prefer to receive antenatal care and delivery assistance from TBAs. This preference raises questions regarding accessibility, affordability, cultural beliefs, and perceived quality of care between TBAs and modern healthcare practitioners.
Understanding the factors influencing the preference for TBA services is crucial for improving maternal health outcomes in Rumuomasi. By examining the level of patronage, the underlying reasons for preference, and potential measures to promote standardized healthcare utilization, this study seeks to contribute to efforts aimed at enhancing maternal and child healthcare services in Rivers State.
1.2 Statement of the Problem
Despite significant advancements in maternal healthcare, Nigeria continues to experience high maternal and infant mortality rates, with many pregnant women still relying on Traditional Birth Attendants (TBAs) for antenatal care and delivery services (Itina, 2021). While several studies have examined the role of TBAs in maternal health, there remains a gap in understanding why women in urban communities, where modern healthcare facilities are readily available, still prefer TBAs over hospitals and clinics (Jerve, Krantz, & San, 2021). Much of the existing literature has focused on rural areas, where TBAs are often the only available option, leaving a research gap regarding urban communities such as Rumuomasi, where both formal and informal maternal healthcare services coexist (Labiran, Mafe, Onajole, & Lambo, 2022).
One of the key gaps in previous studies is the limited exploration of the socio-economic and cultural factors that continue to drive the preference for TBAs in urban settings. Many studies have documented financial constraints as a primary reason for the reliance on TBAs in rural areas (Mills, Brugha, Hanson, & McPake, 2022), but there is insufficient data on whether this factor remains as significant in urban settings where government hospitals and private clinics are accessible. Additionally, while affordability has been a widely cited reason for choosing TBAs (Jokhio, Winter, Cheng, & Engl, 2023), few studies have investigated whether perceptions of quality, trust, and personalized care contribute equally or even more significantly to this preference in urban areas.
Another gap in research is the effectiveness of previous integration efforts between TBAs and modern healthcare practitioners. While studies have suggested that training TBAs could improve maternal health outcomes (Mhame, Busia, & Kasilo, 2021), there is limited empirical evidence on how such training programs have impacted maternal healthcare decisions in Nigeria. Some research has indicated mixed results in countries that attempted to formalize TBA training programs, with some successes in reducing perinatal mortality and other cases showing continued maternal health risks due to the TBAs’ reluctance to fully adopt modern medical practices (Jokhio, Winter, Cheng, & Engl, 2023). However, specific studies on how these programs have fared in Nigeria, particularly in urban areas like Rumuomasi, are scarce.
Additionally, while government policies have sought to improve maternal healthcare access through initiatives such as the Ward Minimum Health Care Package (National Primary Health Care Development Agency, 2021), there is limited research on the extent to which these policies have influenced the choice between TBAs and modern healthcare services. Understanding the gaps in policy implementation and their impact on maternal healthcare preferences is crucial for developing more effective strategies to reduce maternal and infant mortality.
This study aims to fill these research gaps by examining the reasons behind the continued preference for TBAs in Rumuomasi, an urban setting with diverse healthcare options. By exploring socio-economic, cultural, and policy-related factors influencing maternal healthcare choices, this research seeks to provide insights that could inform future maternal health interventions in Nigeria.
1.3 Objectives of the Study
The objectives of this study are to:
- Assess the level of patronage for TBA services in Rumuomasi.
- Identify factors influencing pregnant women’s preference for TBA services in Rumuomasi.
- Discuss measures promoting the utilization of standardized healthcare facilities for antenatal care among pregnant women in Rumuomasi.
1.4 Research Questions
This study seeks to answer the following questions:
- What is the level of patronage for TBA services among pregnant women in Rumuomasi?
- What factors influence pregnant women’s preference for TBA services in Rumuomasi?
- What measures can be implemented to promote the utilization of standardized healthcare facilities for antenatal care in Rumuomasi?
1.5 Research Hypotheses
The study will test the following hypotheses:
- There is no significant relationship between accessibility and the preference for TBA services among pregnant women in Rumuomasi.
- Cultural beliefs do not significantly influence the preference for TBA services among pregnant women in Rumuomasi.
- The level of awareness of standardized healthcare facilities does not significantly affect the utilization of antenatal care services in Rumuomasi.
1.6 Significance of the Study
This study is significant in several ways, particularly in advancing knowledge on maternal healthcare preferences in Nigeria. It seeks to provide a deeper understanding of why pregnant women in Rumuomasi, an urban community with access to modern healthcare facilities, continue to prefer Traditional Birth Attendants (TBAs) for antenatal care and delivery services. While previous studies have largely focused on rural settings, this research will fill a critical gap by exploring the socio-economic, cultural, and personal factors that influence maternal healthcare choices in an urban environment. By doing so, it will contribute to existing literature on maternal health and inform discussions on improving healthcare accessibility and utilization.
The findings of this study will be valuable to healthcare policymakers, government agencies, and maternal health practitioners. With high maternal and infant mortality rates still a challenge in Nigeria, understanding the factors driving the preference for TBAs can guide the development of targeted interventions that integrate traditional and modern healthcare practices. Policymakers can use the insights from this research to design strategies that enhance collaboration between TBAs and formal healthcare providers, ensuring that pregnant women receive quality and safe maternal care. Additionally, the study will highlight areas where improvements in the healthcare system are necessary, such as affordability, accessibility, and culturally sensitive care approaches.
Beyond policy implications, the study will also contribute to public health awareness efforts. By identifying the reasons behind the continued reliance on TBAs, healthcare providers and advocacy groups can develop more effective campaigns to educate pregnant women about the benefits of standardized antenatal care. Increased awareness can encourage more women to utilize modern healthcare services, leading to improved maternal and child health outcomes. If properly addressed, this shift in preference can help reduce maternal and infant mortality rates, aligning with national and global maternal health improvement goals.
Furthermore, the study’s significance extends to bridging gaps between traditional and modern maternal healthcare services. TBAs have long been an integral part of maternal care in Nigeria, and rather than eliminating their role, this study can inform strategies for their better integration into the formal healthcare system. By promoting collaboration and training initiatives, TBAs can be equipped with essential medical knowledge to enhance maternal health outcomes. Ultimately, the study will provide a holistic understanding of maternal healthcare choices in Rumuomasi and serve as a foundation for future research and policy improvements in Nigeria’s maternal health sector.
1.7 Scope of the Study
The study is limited to pregnant women attending antenatal clinics in Rumuomasi, Rivers State. It will focus on their preference for TBA services, the factors influencing this preference, and potential measures to promote modern healthcare utilization. The study will exclude other aspects of maternal healthcare, such as postnatal care, except where relevant to the research objectives.
1.8 Operational Definition of Terms
Traditional Birth Attendant (TBA): A person, usually without formal medical training, who assists pregnant women during childbirth and provides antenatal and postnatal care based on traditional knowledge and practices.
Antenatal Care: Healthcare services provided to pregnant women to ensure the health of both the mother and baby before childbirth.
Maternal Healthcare: Medical services aimed at ensuring the well-being of women during pregnancy, childbirth, and the postnatal period.
Standardized Healthcare Facility: A formally recognized medical center such as a hospital or clinic, staffed with trained healthcare professionals offering evidence-based maternal care services.
Patronage: The frequency and extent to which pregnant women seek services from TBAs.
Cultural Beliefs: Traditional values and practices that influence healthcare decisions among pregnant women.
Healthcare Utilization: The extent to which pregnant women make use of modern healthcare facilities for antenatal and delivery services.
Perceived Quality of Care: Pregnant women’s opinions about the effectiveness, safety, and reliability of services provided by TBAs compared to modern healthcare facilities.