CHAPTER ONE
Introduction
Background to the Study
Maternal health services (MHS) are major health concern globally. This is because they support and determine the state of maternal health of any country. Maternal health is essential for the survival of human race in both developed and developing nations, including Nigeria. Global leaders reemphasized the reduction of maternal mortality as the fifth target of millennium development goals – MDGs (Lucas and Gilles, 2003). About 99 per cent of all maternal deaths occur in developing countries, while less than one per cent of maternal deaths worldwide occur in developed countries (Bayer, 2001). This indicates that maternal deaths could be avoided if the proper health resources and services were available to women in developing nations. Most of these conditions like obstructed labour could be prevented with proper provision and utilization of maternal health services.
MHS are those services provided to women of child bearing period (15-49 years) for prevention, early detection and treatment of health hazards or diseases that may affect the normal child bearing (Mahaba, 1996). MHS are essential obstetrics care with effective communication and transportation between the community-based services and the referral centre (Lucas & Gilles, 2003). They are also services planned for pregnant women and rendered to make them to be in good health during pregnancy, deliver safely, and maintain good health up to 6 weeks following delivery. To the best of my knowledge and accessibility no study was done on provision and utilization of maternal health services in Enugu state. In this study, MHS shall be regarded as organised services which are provided to cater for the health needs of women of child bearing age during pregnancy, delivery and post-natal periods. The objectives of MHS are to ensure that as far as possible pregnant women should remain healthy throughout pregnancy, deliver healthy babies and recover fully from the physiological changes that take place during pregnancy and delivery. These services include antenatal care services, delivery care services, and postnatal care services.
Antenatal care services are regarded as pregnancy related health care checkups, which could occur either in a health facility or at home. With improved understanding of the need for women to prepare physically, mentally and even logistically for childbirth, antenatal care is recognized as a key maternal health service in improving a wide range of health outcomes for women and children (Carroli, Rooney, & Villar, 2001; Chen, Wen, Yang & Walker, 2007). Antenatal care services represent the opportunity to deliver interventions for improving maternal nutrition, providing health education, encouraging skilled attendance at birth and use of facilities for Emergency Obstetric Care (EMOC). Having a sufficient number of antenatal care visits and receiving appropriate and timely care during the visits ensure that women prepare for the childbirth.
World Health Organization – WHO (2001) recommended a minimum of four antenatal care visits, based on reviewing the effectiveness of different models of service delivery. They also specified the content of antenatal care visits, which include blood pressure measurement, urine testing for bacteriuria and proteinuria, and blood testing to detect syphilis and severe anemia. Some other services, including giving tetanus immunization, providing iron and folate tablets and teaching women about danger signs of pregnancy complications. The contents of antenatal care provide an indication of its quality. Pregnancy complications are primary sources of maternal and child morbidity and mortality, and therefore teaching women about signs associated with pregnancy complications and the appropriate action to take, are important components of antenatal care service.
Delivery care services are the assistance and medicare given at delivery which reduces the health risks of mother and children (National statistical office Malawi and Opinion Research Company Macro International-ORC, 2005). Delivery care services involve monitoring the women, relief of pain during delivery, conservation of energy and prevention of exhaustion, injury and excessive blood loss. The midwife requires significant knowledge and experience to enable her recognise and detect deviation from normal course and care for the women adequately. Delivery care services through access to health facilities and skilled health personnel are two important interventions for safe motherhood. This ushers the women to postnatal care.
Postnatal care services encompasses checkups with a health professional within six weeks of childbirth. It requires physical care for example general examination from head to toe, examination of lochia and perineal suture lines, psychological care which include enough rest and normal behavior with others establishing satisfactory mother-child relationship, social care in terms of allowing her to interact with people, and educational care teaching the new mother the basic things about good maternal nutrition how to ensure successful breast feeding, family planning and promotion of hygiene to prevent infection. It involves rooming in, that is, the baby in his cot remains at the mother’s bedside for 24 hours, mother and baby being treated as a unit. It is important for mothers to receive care at this time as it has been recorded that more than 60 percent of maternal deaths take place during the postnatal period (Gill, Pande & Malhotra, 2007). Adequate provision and utilization of these services ensure safe motherhood. Provision is defined according to Merriam-Webster (2014) as the act or process of supplying or providing something. In the context of this study, provision was regarded as supplies of necessary things ready for use to achieve better maternal health. Services to be made provision for include antenatal care services(e.g., blood pressure measurement, urine testing, blood testing, tetanus immunization, provision of iron and folate tablets, and teaching women about danger sign of pregnancy complication), delivery care service (skilled health personnel and access to health facilities) and postnatal care services (e.g., family planning services, techniques to avoid unwanted pregnancies can be given, maternal and child nutrition, immunization, hygiene and sanitation, prevention of infections including HIV and other STIs). Provision and utilization of these services are important for a successful outcome of pregnancies.
