Safe motherhood in northern Nigeria: Results of a program to improve access to and quality of maternal and newborn care services

Background: In Kano and Zamfara states of Nigeria maternal mortality ratios are over 1000 per 100,000 live births and use of reproductive health services is low. The ACCESS program implemented interventions over three years to improve quality and access to maternal, newborn and family planning services.

Methods: We conducted a pre/post evaluation of the program using surveys of women who gave birth in the past year to measure changes in maternal and newborn care practices and identify barriers and enhancers to seeking care.

Results: Over 80% of respondents at baseline (n=415) knew a woman could die from a pregnancy-related complication. Yet only 48% of women had received antenatal care during their last pregnancy and only 19.6% had delivered in a health facility with a skilled birth attendant. The proportion of women who attended antenatal care increased significantly at endline (n=444), to 73%, but the proportion who delivered at a health facility was unchanged (19.1%). The main reason given for not delivering at a facility was that “it was unnecessary.” Regarding family planning, only 10.5% of women said they would use a contraceptive method in the future at baseline, compared with 28.6% at endline. Reported factors preventing women from using services include: need to obtain permission from husbands, lack of money, distance to facility, and concern that there may not be a female provider.

Implications: The Ministry of Health in Nigeria and other programs are currently using these findings to inform the scale up of interventions implemented by the ACCESS program.