CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Child delivery is a critical and sensitive stage of pregnancy. The day of delivery is a day when the pregnant woman needs the help of someone to bring forth her child safely. As much as a personnel is needed to help her in delivering safely, place of delivery is also important; Child birth and its process are one of the most significant life events to a woman (Yibeltal T., Yohana J.M & Thupayagale – Tshweneage G. 2015).During pregnancy women have intention of delivering their babies in different places of birth, which is personal to them. These pregnant women may register in public health facilities with skilled birth attendants, but some also register with places like Traditional Birth Attendants (TBAs), Faith-Based Organization like Mission Birth Attendants (MBA) belonging to religious groups such as churches and Muslims for different purposes, personal to them. Some women do not register with Public Health Facilities at all, so they do not attend Ante-Natal Clinics(ANC) until the day of delivery.
The Encarta dictionary defines intention as something that somebody plans to do, or the quality or state of having a purpose in mind. During pregnancy, women may decide to deliver their babies in different places which can be in urban or rural area, and these pregnant women could be literates or illiterates without considering the consequences of their decision on themselves and the unborn babies.
According to WHO (2017), United Nations through Millennium Development goals have galvanized efforts to improve child survival (MDG 4) and maternal health (MDG 5). The goal of MDG 4 is to reduce child mortality by two thirds which is under 5 mortality rate, while that of MDG 5 is to improve maternal health by 2015 in which the target is to reduce by three-quarter both between 1990 and 2015 (BMC Med. 2013). The global maternal mortality rate declined by 44% during the MDG era equating to annual average of 2.3% between 1990 and 2015. To achieve the Sustainable Development Goal (SDG) by 2030, accelerated progress is now needed in achieving the SDG 3.1 will require a global annual reduction of at least 7.3 per cent (World Health Statistic 2016). United Nations Secretary General opined that to achieve the ambitious target is reducing maternal death to fewer than 70 per 100,000 live births globally (UNDP 2015).
According to UNICEF, (n. d.) having babies in developing nations may be life threatening. Literally in every minute, a woman dies from avoidable complications caused by pregnancy, this adds up to approximately half a million fatalities per year. In Nigeria alone, maternal mortality rate reaches up to 3,200 women (number of women per thousand births, 42 days after child birth). WHO (2015) opined that every day in 2015, 16,000 children under 5 continue to die mostly from preventable causes. Child survival must remain a focus of the new sustainable development agenda (WHO 2017).
The major problem of high infant and maternal mortality rate in Nigeria is lack of access to health care; and prevalence of child marriage. Women in urban areas have more opportunity to receive health care in public and private health facilities. Most of the women in the rural area cannot afford the transport to the health facilities due to far distance from their communities especially at night so, they have to settle for individuals, quack doctors and nurses, TBAs, MBAs or no help at all during delivery. Many of the TBAs do not have skills and training necessary for delivering a baby. For example, they are not able to treat complications that occur during child birth nor can they perform Cesarean section. Nigeria has a high poverty rate, according to UNICEF (2010), Nigeria has a high poverty rate with 64.4% of the population lived in extreme poverty and 83.9% of the population lived in moderate to extreme poverty. The fact that many people cannot afford the health care needed by them contributes to Nigerians high maternal mortality rate. Poverty can be a reason why pregnant women may decide not to deliver at the health facilities where they do their ANC.
The major cause of neonatal death in 2010 were preterm birth complication, intrapartum complications and pneumonia/sepsis while the major causes of maternal death in 2010 were haemorrhage, hypertensive disorder, abortion, sepsis and other direct or indirect causes (BMC 2013).However, to prevent intra partum complication such as obstructed labour and haemorrhage, the two leading causes of maternal death, managing babies that are born very early and treating neonatal sepsis, all require good practices at the time of labour and delivery, preferably access.
