The predictors of acceptability of caesarian section by women of child bearing age

The predictors of acceptability of caesarian section by women of child bearing age

CHAPTER ONE

INTRODUCTION

1.1       Background of the Study

During child labor, women from all over the world take pride in embodying their femininity. However, as time goes on, it takes longer, which could cause the majority of women to deliver stillborn babies. It has been established that a woman can give birth via operation without engaging in strenuous labor, which calls into question the entire conceptional process (Abbas, 2012). The modern, cutting-edge caesarian section method of childbirth has, however, gained popularity as time passes and more pregnant women start to practice it. Although Caesarean sections are frequently performed today in both developed and developing nations, there is a common misconception that African women dislike them.

According to Adam and Awunor (2022), the perception of pregnant women regarding the Caesarean Section has not only been seen as not abnormal but also as a significant detraction from womanhood. Some Nigerian women reluctantly accept the situation despite this Luke warmness and blatant clinical indicators. Because of this, they hire unqualified and unskilled caregivers and only go to the hospital when life-threatening complications arise. Childbirth brings joy and happiness into every woman’s life, but the process is not without some level of stress. Humans have always had a natural tendency toward vaginal birth. In spite of numerous international development initiatives, including the Millennium Development Goals (MDGs), which have actively sought to lessen this burden over the years, maternal mortality from pregnancy-related causes still poses significant problems for sub-Saharan Africa.

According to Aku (2022), a caesarian section is a medical condition where a pregnant woman must undergo surgery prior to giving birth to a child. The World Health Organization (WHO, 2022) estimates that every year, more than 500,000 women die from complications related to pregnancy and childbirth, while in 2015, about 303,000 women died both during and after pregnancy and childbirth. The majority of these fatalities happened in countries with limited resources, like Nigeria. As an illustration, Nigeria contributed to about 14% (40,000) of all maternal deaths worldwide in 2010 and had the highest maternal mortality rate in 2011 (1000–150 deaths per 100,000 live births) (Arthur, 2022). Women lose their lives while giving birth as frequently as 1,000 times per day. Many of which are brought on by low resource settings refusing to perform cesarean deliveries. The world’s obstetric care has greatly improved thanks to the Caesarean section (CS) surgical technique (Benjamin, 2015).

When labor or pregnancy protraction is deemed undesirable and a vaginal delivery is not feasible, a Caesarean section (CS) helps a surgical practice smooth out the baby’s quick delivery (Benjamin, 2015). Low socioeconomic status, limited access to transportation and communication, traditional beliefs, a delay in using the available obstetric facilities, referrals of complicated cases, and a decrease in hospital staffing in rural areas were all significant contributors to the increased maternal mortality rate. In order to lower the high mortality ratio, caesarean section (CS), a crucial part of emergency obstetric care (EMOc), is still required (Bernstein, 2023). The acceptance and use of caesarean sections among Nigerian women living in urban and semi-urban settings is, however, low, according to studies (Chatora and Tumusime, 2004). Most women pray to avoid having a caesarean section, despite a clear clinical indication. There appear to be additional socio-cultural influences that limit its use, in addition to major factors like perceived high hospital bills, extended hospital stays, as well as morbidity and mortality from the operation.

Caesarean sections are common among unfaithful women, claim Adeoye and Kalu (2016). Because having a caesarean section is traditionally seen as a sign of failure, women who gave birth through one are thought to be weak. This might be explained by the fact that it is surrounded by apprehension, mistrust, aversion, misconception, guilt, misery, and anger. Additionally, Ugwu and de Kok (2015) found that women avoid having caesarean sections out of fear of their husbands leaving them and because of the procedure’s high cost and previous caesarean section use among their in-laws, who are unable to have the desired number of children. However, little is known about women who reside in rural areas. What barriers might prevent women who live in rural areas from having a caesarean section as a method of childbirth?

In most Nigerian healthcare facilities, the prevalence of CS is between 20 and 30 percent, compared to 10 to 35 percent globally (Sidney, 2018). CS is now safer thanks to advancements in CS technique, safer anesthesia, new, powerful antibiotics, and the accessibility of blood transfusion services. Additionally, it is becoming more acceptable to women and their families thanks to increased education and awareness (Case and Fair, 2017). Several CS are performed for a variety of acceptable medical and non-medical indications with positive results due to the procedure’s current safety. These may have had a significant impact on the procedure’s rising prevalence in both high- and low-income nations worldwide (Adeoye, 2019). However, many women and their families continue to hold a variety of unfavorable beliefs about caesarean deliveries in some low-income nations like Nigeria.

Women who had caesarean sections were viewed in these environments as weaklings and reproductive failures. It’s possible to blame a curse on an unfaithful woman for a woman’s inability to give birth naturally. In these circumstances, a woman’s ability to give birth vaginally is seen as proof of her femininity (Case and Fair, 2017). The morbidity and mortality associated with the procedure, extended hospital stays, and the perception of high hospital costs are additional factors cited for why women in developing nations are averse to CS. Despite the existence of evidence-based safe techniques and advancements, a sizable portion of the population in low-income countries still has deeply ingrained negative cultural perceptions about caesarean deliveries. Adeoye (2019) found that 34% of respondents attributed their negative perception of abdominal delivery to the cultural influence of their communities.

In addition, according to Aziken (2017), 11% of women refused to have a caesarean section because it was against the norm in their society. These cultural factors, according to Orji et al. and Belloet (2019), also include the perception that caesarean deliveries are the result of spiritual attacks, punishment for women’s infidelity, and a woman’s failure to perform her reproductive duties. Another significant factor in why many women will elect not to have a caesarean delivery is fear of dying during or following the procedure. In 2007, Chigbu and Iloabachie stated that the death of close family members during CS, previous unpleasant caesarean delivery experiences, and unpleasant tales they heard from other women were the causes of these fears.

Women also turned down the procedure because of the income and financial implications. According to Ezechi (2018), 66.5% of study participants said they would not have a caesarean section because of the procedure’s high cost, particularly in places where there are no functioning health insurance systems. Chigbu (2017) acknowledged the high cost of CS as the reason for rejecting the procedure. Low minimum wages, inadequate National Health Insurance Scheme implementation, and low uptake of family planning practices all contribute to increased economic pressure on households in low-income settings like ours, leaving little to nothing for proper health maintenance.

According to Jayleen (2017), women had limited access to CS in Enugu, southeast Nigeria, in contrast to the rising trend in the use of CS in low-income countries. Growing older and socioeconomic indicators of income and care access were found to be important determinants of access to CS. Therefore, they suggested more research be done to determine the obstetric circumstances under which women in this region receive CS and to clarify the role that socioeconomic factors play in CS access. This called for the current study, which evaluated caesarean delivery acceptance, reasons for potential aversion, and access factors in a tertiary health institution in Abakaliki, southeast Nigeria, with a view to providing local and regional data that will be helpful in developing, promoting, and implementing health interventions and policies aimed at improving the care of women and improving the outcome of pregnancy (Ezechi, 2018).

There is a lesser increase in the rate of caesarian sections, which is one of the most striking features of contemporary obstetrics (Jayleen, 2017). However, between 10% and 35% of cases are reported globally. The rate of caesarian sections is on the rise, which raises health risks for mothers and babies as well as healthcare costs when compared to vaginal delivery. Several factors, including those that are medical, institutional, legal, psychological, and socio-demographic, may be to blame for this, among others. The most frequent cause of the rise in the incidence of CS rate is repeat caesarean sections. There is a lot of proof that vaginal birth is a safe option after a Caesarean and should be provided if there are no contraindications.

Additionally, there has been an increase in the rate of CS due to the safety of surgical and aesthetic procedures in contemporary obstetrics. A maternal request for elective CS has been fulfilled due to the favorable attitude toward CS among staff and patients (Ezechi 2018). Obstetricians strongly prefer the abdominal route of delivery as a result of the rising prevalence of breech presentation at term. Obstetric unit policy and individual clinical judgment will always be important, but fear of lawsuits and rising patient expectations, especially among those who are paying for their obstetrician’s services, have led to an increase in the number of deliveries made via the abdominal route, which is thought to be safer for the baby.

The increase in the CS rate has also been attributed to changes in the management of labor complications and induction policy as well as a decrease in instrumental vaginal deliveries (Adeoye, 2019). While CS has made a significant contribution to improved obstetric care globally, vaginal delivery still has a lower rate of maternal morbidity and mortality. The natural physiological method of childbirth—vaginal delivery—can be associated with serious short- and long-term complications that can be expensive and life-changing for both the mother and the child.

Vaginal delivery is still the preferred method, though, in the absence of obstetric and medical indications for CS. In cases where it is clearly indicated and required for the survival of the mother and the baby, there is a strong aversion to CS in developing countries, especially in sub-Saharan Africa, according to studies. Women under the age of childbearing who have had previous CS scars and are at a high risk of uterine rupture default at a high rate in Nigeria. According to Adeoye (2019), some women with a history of CS don’t disclose their condition until a complication develops after a home labor trial fails. It is considered a failure of an essential reproductive function if a woman is unable to deliver vaginally in this setting.

Friends and family members may even make fun of women for choosing to have a caesarian section delivered. Depression and low self-esteem may result from this. Studies have been done on the connection between delivery method and postpartum depression. The Chenet Foundation (2020) found a link between CS and postpartum depression. In their opinion, patients see caesarean sections as proof that the woman’s natural birthing process was not properly handled. The fear of dying during surgery was another factor mentioned by women as a reason they would not have a caesarian section. Taking into account the high rates of maternal deaths linked to Caesarean sections.

This complication has been significantly decreased recently thanks to procedure improvements, aseptic techniques, and anesthesia. Others have said that their decision to decline was motivated by the procedure’s high price. This may be significant, particularly in Nigeria where the majority of the population’s standard of living is below the poverty line. Reducing maternal and perinatal mortality and morbidities from conditions like prolonged obstructed labor, uterine rupture, and antepartum hemorrhage will benefit from a significant increase in the acceptance of indicated caesarian section by women in developing nations like Nigeria before irreversible fetal or maternal injuries sets in. With the rising number of women exposed to formal education and changes in population dynamics, there is also a rise in the use of contraception. Therefore, the purpose of this study was to investigate how people view and accept Caesarean sections.

1.2       Statement of the Problem

Health care system in Nigeria have been provided to all sundry, such that the patient is expected to choose the nature of the health system to be used depending on the problem encountered at a time. Though this is true, caesarian section is one of the challenges that force many women during labour to choose their medical delivery mode and despites how fast and safe the mode is, many women still nurse fear of the unknown while some that have little or no problem wait to give birth to their baby through virginal push. This goes to record that the rate of patronage of the caesarian section as a simple way of delivery is still patronized by a very low percentage of women within child bearing age. As if it is not enough, some women could experience difficult pains during labour and in spites of the pains are not allowed to give birth through CS. This called for concern because of the high mortality rate during pregnancy.

Also many women that avoid the use of caesarian section, personal views shows that majority of them are being tight down by obnoxious cultural, religious, and lack of acceptability of the husband from in giving accent for the doctors to carry out the process. Having observed this it seems that there are many needs for reorientation of the families to prepare well for period of pregnancy since the delay in pregnancy can be taken care of through caesarian section. Against this the study is conducted to ascertain the predictors of acceptability of caesarian section by women of child bearing age in Eket federal constituency

1.3       Objectives of the Study

The main purpose of the study is to assess the predictors of acceptability of caesarian section by women of child bearing age in Eket federal constituency. Specifically, the objectives of this study shall be:

1. To ascertain how family income predict acceptability of caesarian section by women of child bearing age in Eket federal constituency.
2. To ascertain how educational level influence acceptability of caesarian section by women of child bearing age in Eket federal constituency.
3. To ascertain the extent to which health workers’ attitude influence acceptability of caesarian section in Eket federal constituency.
4. To ascertain the extent to which access(proximity) to antenatal health care influence acceptability of caesarian section in Eket federal constituency
5. To ascertain the extent to which religious belief influence acceptability of caesarian section by women of child bearing age in Eket federal constituency

1.4       Relevant Research Questions

The following research questions were put together to guide the study:

1. How does family income influence acceptability of caesarian section by women of child bearing age in Eket federal constituency?
2. How does educational level influence acceptability of caesarian section by women of child bearing age in Eket federal constituency?
3. To what extent does the Health workers’ attitude influence acceptability of caesarian section by women of child bearing age in Eket federal constituency?
4. To what extent does accessibility influence acceptability of caesarian section by women of child bearing age in Eket federal constituency?
5. To what extent does religious belief and practices influence acceptability of caesarian section by women of child bearing age in Eket federal constituency?

1.5       Research Hypotheses

The following research hypotheses were raised and tested at 05 level of significance;

1. Family income has no significant influence on acceptability of caesarian section by women of child bearing age.
2. Educational level of women does not have any significant influence on acceptability of caesarian section by women of child bearing age in Eket federal constituency
3. There is no significant influence of health workers’ attitude on acceptability of caesarian section by women of child bearing in Eket federal constituency
4. There is no significant influence of accessibility on acceptability of caesarian section by women of child bearing in Eket federal constituency
5. Religious belief does not have any significant influence   on acceptability of caesarian section by women of child bearing in Eket federal constituency

1.6       Significance of the Study

The findings of the study shall be of immense benefit to the pregnant women, Akwa Ibom State Ministry of Health, health specialist, Midwives, Nurses and other health workers, Government, pastors, and other researchers.

To the pregnant women, it would assist in creating awareness, knowledge and medium of receiving caesarian section with less cost despite their low income. The women under child bearing age would see the need of discarding practices that could not allow them utilized the services of the facility-based health centers. The study shall also make women under child bearing age consider the importance of forgoing traditional birth attendant service to using facility based caesarian section to assist them in receiving a professional education in all stages of their pregnancy.

Akwa Ibom State Ministry of Health and other health related Non-Governmental Organization (NGO) would be able to organize regular and timely public enlightenment for all women in rural area. The findings of the study would also assist health specialists in cultivating good attitude towards the women under child bearing age and ensuring that their private information and confidentiality is maintained as their ethical code entails.

To the midwives, nurses and other health workers, the findings of the study would assist them to shape their attitude towards offering better services to the women under child bearing age thereby encouraging them to utilize the available services. To the Government, it shall encourage them to provide medium of upgrading the educational standard of women to assist them in personal development. It shall also enable them to provide adequate road network and even distribution of health facilities to the interior part of the state. This would minimize continuous complain from the pregnant women.

The findings of the study shall also assist the priests, pastors and counselor in offering proper messages and counseling services that will improve the health status of the pregnant women, hence, minimizing the age-long improper religious doctrines and belief services. The findings of the study shall widen the scope and knowledge of young researchers on how to conduct research in related problem. It therefore means that, the present study shall make available literature for researchers who are willing to undertake a study.

1.7       Scope of the Study

The study was centered on acceptability of caesarian section by women of child bearing age in Eket federal constituency. The predictors of acceptability of caesarian section by women of child bearing age consisted of  family income, attitude, accessibility, religious belief and women educational status and acceptability of caesarian section by women of child bearing age care were the centered the of the study. Geographically, there are 10 Local Government in Eket federal constituency. 

1.8       Operational Definition of Terms

Caesarian Section: Caesarian section is also called cesarean birth, it is a clinical process used to deliver a baby when a vaginal delivery cannot be done safely.

Acceptability: It the act of accepting the medical process to ensure that the process is carried out successfully without any challenge.

Women of child bearing age: This are those women with the labour age and may have one labour challenge or the other