Socio-cultural Factors Influencing The Acceptance Of Hospital Delivery Among Pregnant Women In Udung Okwong Community, Oron, Akwa Ibom State
Chapter One
Introduction
Background of the Study
There is no greater joy than the birth of a healthy baby and no greater tragedy than the death of a mother and her baby following a complicated pregnancy or difficulty labour especially when it occurs due to the refusal of hospital delivery (Lawani, Igboke & Chukwuemeka, 2019).
Motherhood is a thing cherished by most women, yet this valued and precious part of life is among the most hazardous experience that woman often engage in without being aware of the risk or danger they are in. Maternal health refers to the health of women during pregnancy, childbirth and post partum period. It encompasses the healthcare dimensions of family planning, pre-conception, prenatal and postnatal care, in order to reduce material morbidity and mortality (World Health Organization (WHO, 2012).
Historically, birthing was considered as a natural and social process where a pregnant woman was supported by neighbours at crossroads between technical and familiar fields. The event of birth took place in a domestic and strictly feminine environment: female care providers guided women through their labour (Andrissi, Petraglia, Giuliani & Filiberto, 2015). However, today, therapeutic pluralism has become common in many parts of the world where different approaches to care (traditional and modern) during childbirth exist side by side and are used simultaneously by women (Brown, 2013).
Maternal mortality and morbidity remain international pubic health problems. In 2013, it was estimated that 292,982 maternal deaths occur globally, with 99% of these occurring in developing countries. (Kassebaum, Bertozzi-villa, Coggeshall, Shackelford, Steiner & Heuton, 2014). Majority of deaths from obstetric complications are preventable. But every pregnant woman face risks which may not always be detected through the risk assessment approach during antenatal care. Therefore the presence of a skilled birth attendant in every delivery is the most critical intervention in reducing maternal morbidity and mortality (Bayu, Adefris Amano & Abuhay, 2015). Global efforts to improve maternal health have included attempts to increase the proportion of women giving birth with a skilled attendant (Campbell & Graham, 2016). This often goes hand in hand with women attending antenatal appointments and delivering at a health facility (Gabrysch & Campbell, 2012).
According to Jejeebhoy (2012), women’s acceptance of hospital delivery is determined by their level of education, as such literate mothers will want to deliver in hospitals or health centres because of their exposure and knowledge gained, while uneducated mothers due to their level of understanding and belief would prefer to deliver at home either by the traditional birth attendant, herbalist and spiritualist, thus affecting their choice of birth place. He further went on to mention that the lives of women are challenged by several other factors including attitude of health workers, geographical barrier, accessibility to health care, cultural factors, socio-economic status, distance, poor roads, sudden onset of labour, and short labour. These factors identified have generated serious concern, since any birth requires an appropriate care.
Pregnant women in rural areas (for example, Udung Okwong community) face multiple intersecting vulnerabilities, including poverty, gender inequality and unequal distribution of money, power and resources. And this can influence their acceptance of hospital delivery. Decisions made during childbirth in rural areas are also influenced by constraints of poverty and other social determinants that are often out of the direct control of the individuals involved – in this case the pregnant women (Treacy, Bolkan & Sagbakken, 2018).
Alberta (2013), also mention that deep rooted traditional and cultural beliefs are negatively affecting the health seeking behaviours of the mothers, thus affecting the acceptance of hospital delivery by pregnant women. For instance, the extended family and the culture of most part of rural areas in Nigeria have significant influence on acceptance of hospital delivery. She stated that the oldest person in the family is often the decision maker and spoke person on hospitalization. Lawani et. al. (2019) also observe that socio-cultural status of most people in the community is another factor that hinders the acceptance of hospital delivery by pregnant women. It is therefore necessary to explore the various socio-cultural factors influencing the acceptance of hospital delivery among pregnant women.
Statement of the Problem
Majority of pregnant woman who deliver outside the health facilities gives girth at home, where risks of mortality are on the increase in the absence of professional attendance. However, it has been estimated that only 50% of the women in the world have access to such skilled care in developing countries (Ikeako & Lloabachie, 2014).
Approximately, 350,000 maternal deaths occurred worldwide in 2010. This means every day women die due to pregnancy and childbirth (Gill, Phiri-Mazala, Guerina & Kasimba, 2011). Again, in 2013 it was estimated that there were 292,982 maternal deaths globally, with 99% of these occurring in developing countries (Kassebaum et-al., 2014). Some of the maternal deaths during childbirth are deaths that can be prevented when delivery is conducted in the hospital by professionals. Over the years, the rate of maternal mortality during childbirth in Africa and in Nigeria specifically has seemed not to drop significantly (Brown, 2013).
The interest of the researcher to investigate this subject was mostly aroused when she observed that a greater number of pregnant women usually attended antenatal clinic in St. Lukes”s Hospital, Anua but the number was significantly reduced when it comes to number of women delivered in the hospital. The researcher also observed during her clinical experience that it was common for women to be rushed into the labour ward in St. Luke’s Hospital, Anua, from the traditional birth attendance (TBA) only at the point of death. A few of them were managed to recovery but a good number died, or lost their babies to complications like eclampsia, intra-uterine fetal death, post partum haemorrhage and sepsis. These complications would have been properly managed if these deliveries were conducted by skilled health professionals in an equipped health facility. This makes the researcher wish to explore the various socio-cultural factors influencing the acceptance of hospital delivery among pregnant women in Udung Okwong Community.
Objectives of the Study
To determine the influence of level of educational on the acceptance of hospital delivery among pregnant women in Udung Okwong Community.
To determine attitude of health workers which influence the acceptance of hospital delivery among pregnant women in Udung Okwong Community.
To ascertain cultural beliefs that influence the acceptance of hospital delivery among pregnant women in Udung Okwong Community.
Research Questions
What is the influence of educational level on the acceptance of hospital delivery among pregnant women in Udung Okwong Community?
What is the influence of health workers attitude on the acceptance of hospital delivery among pregnant in Udung Okwong Community?
What are those cultural beliefs that influence the acceptance of hospital delivery among pregnant women in Udung Okwong Community?
Significance of the Study
Findings from this study will be useful to mothers as they will be able to make effective choice regarding hospital delivery thus helping to reduce the rate of maternal morbidity and mortality.
The findings from this study will be of benefit to women of child bearing age as it will provide vital information on the socio-cultural factors influencing the acceptance of hospital delivery and the importance of hospital delivery.
Healthcare providers especially midwives will use the findings from this study to identify areas of emphasis during health talk in the antenatal clinic on acceptance of hospital delivery.
Government will also use the findings from this study to implement strategies that will ensure institutional deliveries by skilled birth attendants, and provision of standard health facilities that aim at curbing the incidence of maternal mortality resulting from unhealthy birth places and consequently promote safe motherhood in the study area and beyond.
Appropriate agencies like the Non-Governmental Organizations (NGOs) will utilize the findings to create awareness on the importance of institutional deliveries by skilled attendant under the concept of safe motherhood initiative.
To the future researchers, this study will serve as a reference material on related topics for further studies.
Scope of the Study
The study covered all women of child-bearing age (15-49 years) in Udung Okwong Community irrespective of their marital status. It is also delimited to socio-cultural factors influencing acceptance of hospital delivery such as: women’s level of education, attitude of health workers, and cultural beliefs.
Operational Definition of Terms
Socio-cultural Factors: Social –cultural factors in this study refer to level of education, health workers attitude and cultural beliefs such as traditional beliefs, values and norms which influence acceptance of hospital delivery.
Educational Level: This refers to educational attainment by the pregnant women, example primary, secondary and tertiary education or no formal education that may promote or discourage acceptance of hospital delivery.
Health Workers Attitude: Behaviours put up by the health workers at the health facility. This could be positive (example, encouraging the women, showing respect for clients) or negative (example shouting at women, lack of respect, not showing empathy) that may discourage patronage of hospitals for delivery services.
Cultural Beliefs: Sayings, activities or statements particular to a community, such as Udung Okwong that could affect acceptance of health services (example, older people or men being the decision makers about place of deliveries).
Hospital Delivery: Delivery conducted in a government approved hospital or health facility by professional birth attendants.
Acceptance: This is the process of applying or making use of available resources like the maternity unit (labour unit) of a government approved hospital during childbirth.
Pregnant Woman: Adult female human being with a developing embryo in her uterus at the time of this study.
Community: Group of people living in the same location, sharing the same language and tradition, example Udung Okwong.
Health Workers: These refer to hospital personel which pregnant women come in contact with during antenatal visits and delivery.
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