Factors enabling and constraining the use of maternal and newborn health services in northern Nigeria: Formative research findings and implications

The maternal mortality ratio (800 per 100,000 live births) and neonatal mortality rate (48 per 1,000 live births) in Nigeria are unacceptably high and are associated with low utilization and accessibility of maternal and newborn services and socio-cultural beliefs and practices. The ACCESS Program is working to improve access to and quality of maternal and newborn care services in northern Nigeria. ACCESS conducted formative research to explore the factors affecting use of routine and emergency maternal and newborn care services. Thirty-six focus group discussions and four in-depth interviews were conducted in Kano and Zamfara states with pregnant women, women who delivered in the past year, older women and men, husbands, traditional birth attendants, community health extension workers (CHEWS), community influentials, and health officials. Findings revealed that women prefer to deliver in the hospital. Factors preventing women from delivering at health facilities are: dominance of men in decision making; rude behavior of clinicians; traditional use of Hannu (a hand-like fruit) as a delivery warning sign; cost of delivery at hospitals; religious beliefs forbidding male healthcare providers from touching women; and distance to the facilities. Enabling factors include: willingness of women to deliver in hospitals and women's perceptions that health facilities can provide quality services. Programmatic opportunities for ACCESS include: presence of CHEWS who could be trained in health education; community-based women development and religious associations that could assist with community mobilization, and the readiness of the local governments to support a project to improve maternal and newborn care.