Barriers to demand and use of antenatal, delivery and post-natal care services among women in rural northern Nigeria

Maternal mortality in Northern Nigeria is among the highest in the world. To guide programme planning we interviewed 7,442 women in May 2009 in three northern states (Jigawa, Katsina, and Yobe) to understand patterns of antenatal care (ANC) and delivery. During their last pregnancy, 67.4% sought no advice, and only 24.9% had ANC at a clinic. At these visits, most women had their weight and blood pressure checked and received anti-tetanus vaccination, while 57-65% received counseling about complications, breastfeeding, or newborn care. About 91% delivered at home. Over half preferred home delivery because of comfort and convenience, while the balance were prevented from delivery at a facility by barriers of cost, transport, spousal permission, cultural norms, or health worker's attitude. Those delivering in a facility had complications (43.7%) or viewed a facility as safer (19.4%) or offering better care (25.7%). To complement these results, focus group discussions and in-depth interviews were conducted to investigate the community (both men and women, old and young, traditional community and religious leaders) and health staff views on primary health care (PHC) services in general and introduction of models of community PHC in particular. These are efforts to engage dialogue with all stakeholders aimed at launching a community action cycle which will be continued as different models of community PHC services are explored and successful one(s) implemented. There is an urgent need for our programs to increase awareness of pregnancy and delivery complications while reducing barriers to assessing risk and accessing facilities.