CHAPTER ONE
Introduction
Background to the Study
The health of the mother determines to a large extent the health of her family. Ratzan, Filerman and Lesar (2000) noted that mothers are primary producers of health for their children. Park (2006) stated that a healthy mother brings forth a healthy baby with better chances of survival. United States Agency for International Development-USAID (2008) affirmed that a mother’s health profoundly affects the health and well being of her children. Davour, and Davour (2005) asserted that women’s ill-health impacts seriously on children and families, national productivity and household income and human life. They added that in children and family, women’s ill health can initiate a cycle of ill-health in the next generation.
World Health Organization – WHO (1980) pointed out that with growing recognition of the importance of the health of women in the development process, it has become increasingly obvious that the high mortality of women in developing countries in their middle years is a cause for grave concern. WHO (1998) noted that pregnancy and childbirth are special events in women’s lives and in the lives of their families, and that this can be a time of great hope and joyful anticipation. The WHO further stated that it can also be a time of fear, suffering and even death. Public Health Programme – PHP (2004) added that maternal mortality not only affects the family involved but it also has a great effect on the society as a whole.
Policy Project, Nigeria – PPN (2002) reported that Nigeria contributes ten per cent of the world’s maternal deaths with an average of seven for every 1, 000 births. They added that this indicator has a negative impact on child survival since children who lose their mothers experience an increased risk of death or other complications such as malnutrition. The tragedy is that these women die not from diseases but during the normal life enhancing process of procreation. Park (2006) declared that most maternal deaths are preventable. Lucas and Gilles (2006) pointed out that technologies for prevention of these deaths are available. The challenge, they added, is to achieve universal health care coverage.
Childinfo.org (2007) stated that vast disparities persist in maternal health coverage between the industrialized and developing countries, rich and poor, urban and rural, educated and uneducated. They added that all women should have access to basic maternity care through a continuum of services offering quality antenatal care, clean and safe delivery and post partum care for mother and infant with a functioning referral system linking the whole. Child info.org further stated that the simple most critical intervention for safe motherhood is to ensure that women receive care during delivery by skilled health personnel-a doctor, nurse and midwife with the necessary skills to handle normal deliveries safely, to recognize the onset of complications beyond their capacity and to refer the mother for emergency care as needed. WHO (2007a) asserted that in developing countries, interventions that are known to be effective in lowering maternal and prenatal mortality and morbidity are not universally provided. The WHO added that these interventions can be delivered by skilled personnel, providing care during pregnancy, childbirth and postnatal period.
Ezedum (2007) noted that the high maternal mortality ratio in Nigeria is suggestive of a not-so-functional maternal health service. He added that maternal health, an aspect of Maternal and Child Health (MCH) is part of reproductive health. WHO (2007b) defined maternal health as the health of women during pregnancy, childbirth and postpartum period. Delivery of maternal health services is through the health care.
Health care has been defined by William (2003) as the prevention, treatment and management of illness and preservation of mental well-being through the services offered by the medical, nursing and allied health professions. He added that a health care provider or health professional is an organization or person who delivers proper health care in a systematic way professionally to any individual in need of health care services. en.wikipedia.org/wiki/Health_care stated that health care embraces all the goods and services designed to promote health including preventive, curative and palliative interventions whether directed to individuals or to populations. When these goods and services are directed to the health of mothers, it is referred to as maternal health care.
Igwe (1999) defined maternal health care as services rendered by families, communities and health professionals to an expectant woman during the period between conception and birth so that her health and the health of her foetus can be observed and maintained. He further stated that the aim of maternal health care is to reduce the number of maternal deaths resulting from deliveries and complications of pregnancy, childbirth and puerperium. Alakija (2000) defined maternal and child health care as the promotive, preventive, curative and rehabilitative health care for mothers and children. Onuzulike (2004) described maternal health care as health and health-related care fashioned towards helping mothers to cope successfully with the physical and psychological strains under which they are exposed in the course of fulfilling their roles as wives and mothers. Following from the above, maternal health care is referred to in this study as the promotive, preventive, curative and rehabilitative health care for mothers.
Rundel (2005) defined service as a system provided by a government or official organization for the needs of the public. Health services that are provided for mothers are referred to as maternal health care services (MHCS). The concept of maternal health care services in the context of this study implies the promotive, preventive, curative and rehabilitative services rendered by government or private organizations to women in their fecund period to improve their health outcomes and those of their children.
Maternal health care is a component of MCH. Park (2006) noted that the ultimate objective of MCH is life-long health. The components of MHCS include antenatal care, delivery services and postnatal care (Lucas & Gilles, 2006). Deacon (1985) defined antenatal care as the health supervision of the pregnant mother throughout the gestation period, from inception of pregnancy to the onset of the first stage of labour. Bradley (1990) stated that this care is given through the antenatal clinics organized by a midwife while complicated cases will be detected and referred to a doctor for special advice. Antenatal clinic may be located in a hospital, health centre, mobile clinic and dispensary.
The second component of MHCS is the delivery service. This is otherwise known as intranatal, intrapartum or paturient care. Arkutu (1995) defined intrapartum care as health care provided to the mother at the onset of the first stage of labour, through out the completion of third stage of labour, that is, expulsion of placenta. Lucas and Gilles (2006) asserted that the modern trend is for an increasing proportion of birth to take place in maternity centres, hospitals and similar institutions. They further stated that home delivery may be appropriate provided that the person attending the delivery is suitably trained and equipped and that referral to a higher level of care is available early, in case of complications. In all, the most important issue in childbirth is skilled attendant at every birth, conducting delivery under hygienic condition, prompt recognition of delay and complications and referral of mothers for specialized obstetric services.
The last component of MHCS is postnatal care. Lucas and Gilles (2006) defined postnatal services as the care given to a mother from the time she is delivered of her baby to six weeks after. During this period, the woman recovers from the effects and injuries if any, associated with delivery. Postnatal care services are designed to supervise this process, to detect any abnormalities and to deal with them. In particular, the mother should be protected against hazards such as puerperal infection, to which she is liable at this stage. Lucas and Gilles further stated that postnatal service may be a convenient service through which family planning may be introduced. The introduction of family planning will help reduce the risk of early occurrence of another pregnancy, which may carry with it greater risks to the mother. Bradley (1990) pointed out that so many lives can be saved and complications prevented if care is available for mothers throughout pregnancy, childbirth and child rearing. Every mother should be examined early in her pregnancy to detect any risk to herself or her baby so that she can have the necessary care to prevent serious problems in pregnancy and childbirth.
