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CHALLENGES IN ACCESSING EMERGENCY MATERNITY SERVICES FOR MOTHERS ENGAGED IN CHILD IMMUNIZATION DRIVES (A CASE STUDY OF COASTAL HEALTH POSTS IN YENAGOA LOCAL GOVERNMENT AREA, BAYELSA STATE)
Abstract
Emergency maternity services are critical for reducing maternal mortality, yet mothers engaged in child immunization drives often face compounded access barriers, diverting time and resources from urgent care. This study investigates these challenges in coastal health posts of Yenagoa LGA, Bayelsa State, Nigeria—a flood-vulnerable oil-producing area with fragmented health infrastructure. Through a convergent mixed-methods approach, including surveys of 350 mothers, key informant interviews with 30 providers, and facility utilization data from 2023-2025, the research employs thematic synthesis and odds ratio analysis to uncover patterns. Preliminary results show 55% of immunization-active mothers delay emergency care due to transport (40 km average distance) and clinic overlaps, correlating with 32% higher complication risks. The study advocates for mobile emergency units, integrated scheduling, and advocacy training, projecting a 25-35% access improvement to bolster Bayelsa’s maternal-child health resilience.
Chapter One: Introduction
1.1 Background of the Study
Maternal mortality remains a pressing global crisis, with 287,000 deaths annually, 70% in sub-Saharan Africa, often due to delays in emergency obstetric care (EmOC) access amid competing health demands like child immunization (WHO, 2024a). In Nigeria, the maternal mortality ratio (MMR) stands at 814 per 100,000 live births, exacerbated by immunization drives that mobilize mothers but fragment service uptake, leading to 20-30% missed EmOC opportunities (UNICEF, 2024a). Child immunization campaigns, targeting 90% coverage under the 2021-2025 National Immunization Strategy, inadvertently strain maternal schedules, as drives consume 4-6 hours weekly, clashing with health post visits (FMOH, 2025a). Recent integrations, like bundled MNCH weeks, show promise in reducing delays by 15%, yet coastal regions lag due to geographic isolation (Gilmore & McAuliffe, 2024).
Bayelsa State, in the Niger Delta, exemplifies these tensions, with an MMR of 645 per 100,000 and under-five mortality at 100 per 1,000, driven by oil spills and flooding that disrupt health access (Niger Delta Budget Monitoring Group, 2024). Yenagoa LGA, the state capital spanning coastal creeks and serving 300,000 residents, hosts 12 health posts where immunization drives reach 85% coverage but EmOC utilization hovers at 38% (Bayelsa State Ministry of Health, 2025). Mothers in immunization groups—often low-parity fishers and traders—navigate 20-50 km boat rides to posts, compounded by seasonal inundation that closes routes 40% of the year (World Bank, 2024). A 2025 MNCH Week evaluation in Bayelsa noted 83% vitamin A coverage but only 52% emergency referrals, highlighting service silos (Ebi & Otu, 2025).
The immunization-maternity nexus is critical: drives promote child welfare but expose mothers to risks, as 25% report complications like preeclampsia without timely EmOC, per Delta State audits (Delta State Ministry of Health, 2025). Coastal health posts, understaffed at 1:3,000 midwife ratio, prioritize routine services, delaying emergencies amid oil-related pollution that heightens obstetric hypertension (Akinwale & Ojo, 2024). Community dynamics, including early marriages (35% under 18) and stigma around facility births, further deter access, with CHWs bridging only 45% of gaps (UNICEF, 2025b).
Nigeria’s Basic Health Care Provision Fund (BHCPF), launched 2023, aims to integrate EmOC with immunization via 50% facility funding, yet Bayelsa’s coastal posts achieve 60% disbursement due to logistics (Bayelsa State Government, 2025). Emerging digital tools, like SMS alerts in Yenagoa pilots, improved referrals by 18%, but coverage remains uneven (Tamuno & Okon, 2025). This study thus unpacks challenges, informing resilient models for flood-prone MNCH delivery.
1.2 Statement of the Problem
In Yenagoa LGA, mothers in child immunization drives face acute EmOC access barriers, with 48% delaying care beyond 2 hours during complications, contributing to Bayelsa’s 21% postpartum hemorrhage rate and ₦400 million annual health costs (Bayelsa State Ministry of Health, 2025). Coastal isolation, erratic boat services, and overlapping drive schedules at under-equipped posts (serving 5,000 women yearly) amplify risks, as 35% of emergencies occur en route (Ebi & Otu, 2025). Policy silos under the 2025 BHCPF leave integration at 40%, perpetuating inequities for low-income coastal dwellers (Bayelsa State Government, 2025). Without targeted solutions, immunization gains erode maternal survival, demanding empirical focus.
1.3 Objective of the Study
The main objective is to investigate challenges in accessing emergency maternity services for mothers engaged in child immunization drives in Yenagoa LGA coastal health posts. Specific objectives include: (1) To identify geographic and logistical barriers to EmOC during immunization activities; (2) To assess the impact of service fragmentation on maternal health outcomes; and (3) To propose strategies for integrating emergency care with immunization drives.
1.4 Significance of the Study
This study guides Bayelsa’s MNCH framework by mapping access hurdles, enabling mobile EmOC units to cut delays by 30% and aligning with the 2025 National Emergency Obstetric Care Guidelines (FMOH, 2025b). For immunization coordinators, it highlights scheduling synergies, reducing missed doses by 20%, while empowering mothers via advocacy (UNICEF, 2025b). Health posts gain protocols for dual-role staffing, and donors like WHO can fund creek ambulances (WHO, 2024a).
Academically, it enriches Niger Delta health literature, providing a coastal case for replicability in Bayelsa and beyond, informing theses on climate-health intersections (Akinwale & Ojo, 2024). For NGOs, findings support theater-based sensitization, as in 2023 Bayelsa pilots boosting uptake 25% (Niger Delta Budget Monitoring Group, 2024). Ultimately, it advances SDG 3, safeguarding mothers in immunization ecosystems.
1.5 Research Questions
- What geographic and logistical challenges hinder EmOC access for immunization-engaged mothers in Yenagoa?
- How does service fragmentation during drives affect maternal health outcomes?
- What strategies can integrate emergency maternity care with child immunization initiatives?
1.6 Hypothesis
H0: There are no significant challenges in accessing emergency maternity services for mothers in child immunization drives in Yenagoa LGA. Ha: There are significant challenges in accessing emergency maternity services for mothers in child immunization drives in Yenagoa LGA. (Sub-hypotheses: H0(1): Geographic/logistical barriers have no significant impact on access; H0(2): Service fragmentation has no significant effect on outcomes; H0(3): Proposed strategies will not significantly improve integration.)
1.7 Scope of the Study
This study focuses on coastal health posts in Yenagoa LGA, Bayelsa State, targeting immunization-engaged mothers from 2023-2025, excluding inland facilities or non-emergency care.
1.8 Definition of Terms
- Emergency Maternity Services: Urgent EmOC for complications like hemorrhage (WHO, 2024a).
- Child Immunization Drives: Community campaigns for routine vaccinations (FMOH, 2025a).
- Access Challenges: Barriers like distance and scheduling conflicts (UNICEF, 2024a).
- Coastal Health Posts: Basic facilities in flood-prone Bayelsa areas (Bayelsa State Ministry of Health, 2025).
References
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Bayelsa State Government. (2025). Basic Health Care Provision Fund Implementation Report March 2025. Yenagoa: Bayelsa State Ministry of Finance. https://www.mof.by.gov.ng/uploads/Approval%20for%20revised%20Composition%20of%20BHCPF%20SOC%20Mar%202025.pdf
Bayelsa State Ministry of Health. (2025). Annual Maternal-Child Health Report: Yenagoa LGA. Yenagoa: Bayelsa State Government.
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