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          CHAPTER ONE


1.1 Background to the Study

Maternal health and safe motherhood have received significant attention worldwide in the last three decades. Globally, much effort has been put into achieving a reduction in maternal mortality. In 2013 alone, the World Health Organization (WHO) recorded that 289,000 women died due to complications of pregnancy and childbirth worldwide, a significant reduction from

523,000 in 1990, with a decline of about 44% recorded between 1990 and 2015 (WHO, 2016). Sadly however, Sub Saharan Africa remains one of the regions in the world that has made the least progress in this regard with Maternal Mortality Ratio of 239 per 100 000 live births as compared with 12 per 100,000 live births in developed countries (WHO, 2016).Sub Saharan Africa also remains the region with the highest risk in the world for death due to obstetric complications where a woman faces about a 1 in 40 risk of dying during pregnancy and childbirth in her lifetime(WHO, 2014). In Nigeria, the most recent reported maternal mortality ratio is 576 maternal deaths per 100,000 live births, with maternal deaths accounting for 32% of all deaths among women of reproductive age (Nigeria Demographic and Health Survey, 2013).

Maternal morbidities can be referred to as all illnesses and complications associated with pregnancy and childbirth, short of death (Worku, Yalew, & Afework, 2013). Obstetric or maternal complications are acute conditions occurring during pregnancy, childbirth or post partum period (Worku, Yalew, & Afework, 2013).

Worldwide, about 80% of maternal deaths and 98% of stillbirths are ascribed to direct obstetric complications (Singh, Goli, & Parsuraman, 2014). A previous study in Nigeria revealed that mortality associated with obstetric complications was highest among the poor women(Olusola, 2011). In one of the widest disparities in International public health, maternal mortality rate in

Nigeria is almost 100 times worse than in industrialized nations (National Population Commission & ICF Macro, 2009). Annually, 3 million pregnancies occur in Nigeria on the average, and approximately 170,000 result in death, mainly due to obstetric complications (Ndubuisi, 2009). Obstetric complications as they account for maternal mortality in Nigeria are presented thus: haemorrhage (25%), sepsis (15%), complications of unsafe abortion (13%), hypertensive disorders of pregnancy (12%) and obstructed labour (8%) (Ndubuisi, 2009).

The word perception has been defined to mean a belief or opinion often held by many people and based on how things seem; the quality of being aware of things through the physical senses, and an individual‟s ability to notice and understand things that are not obvious to other people. In Nigeria, negative perception about possible pregnancy related complications abounds(U. M. Lawan, Takai, & Ishaq, 2015). This has in no little way contributed to the worsening maternal mortality figures in the country. The Prevention of Maternal Mortality Network (PMMN), a research initiative under the Safe Motherhood Initiative (SMI) observed that pregnancy and delivery is regarded by most communities as a natural phenomenon (Ndubuisi, 2009). They also discovered that signs and symptoms of obstetric complications are usually not recognized as reasons for concern in many parts of the country (Ndubuisi, 2009). For instance, in some parts of Nigeria, feet swelling in pregnancy which is a symptom that precedes eclampsia, is seen as an indication that the unborn child is a boy (Ndubuisi 2009). Similarly, in a study conducted in

South West Nigeria, exposure to cold and spiritual forces was among the perceived causes of eclampsia (Akeju et al., 2016). Similar negative perceptions also apply to antepartum haemorrhage, amongst others.

Poor perception of the etiology and treatment of these obstetric complications has also affected the obstetric behaviour which involves the utilization of basic maternity and emergency obstetric care services (Pembe et al., 2009). Previous studies have attributed poor health seeking behavior to wrong perception of pregnancy and delivery complications, amongst others. The “three delays” framework first described by Thaddeus and Maine (1994) asserts that maternal mortality in developing countries occur as a result of three delays to accessing appropriate health care; the 1st of this delay is the delay in perceiving that a problem is occurring while the woman is at her home, and in making a timely decision to leave the house in search of medical assistance, due to lack of proper understanding of obstetric complication (Pacagnella, Cecatti, Osis, & Souza, 2012).  

1.2 Statement of the Problem

Children are highly valued in Africa, with several African cultures allowing a woman to give birth to as many children as possible. However, the risks and possible complications that could result from pregnancy and delivery are understood by only a few, women inclusive. Several of these complications are erroneously ascribed to normal pregnancy and delivery processes that the woman must go through while pregnant; as such, these wrong perceptions and poor health seeking behaviours towards obstetric complications contribute in no little amount to maternal morbidity and mortality as seen above.

About 500,000 women die yearly from complications associated with pregnancy and of this figure, 99% of deaths occur in developing countries (Oyelese & Ananth, 2010). The United Nations (2008) reported that one out of every 22 women in Africa dies from pregnancy related complications. This implies that more than 150,000 African women die and millions suffer serious illnesses due to obstetric complications. It has been reported that about a third of total disease burden among women of reproductive age in Africa has been linked to health problems arising from pregnancy and childbirth complications, abortion and reproductive infections(Olusola, 2011).Studies have also revealed that women in Africa die more frequently from obstetric complications, than is seen in Europe and North America(National Population Commission & ICF Macro, 2009).

Nigeria makes up about 2% of the world‟s population, but sadly, 10% of the world‟s maternal deaths occur in the country (World Health Organization, 2008). Currently, Nigeria has the second highest number of maternal deaths in the world with about 59,000 maternal deaths occurring annually (Olaku, 2014). According to the National Demographic and Health Survey (NDHS 2013), Nigeria records a Maternal Mortality Ratio of 576 deaths per 100, 000 live births annually. Maternal mortality ratio is worst in Eastern Nigeria, with an average figure of  2,420 per 100,000 live births recorded in Anambra State(Olaku, 2014). The Eastern s zone has the second highest maternal mortality rate (1,549 per 100,000 live births) which is about ten times that in the South West. The rate in the North West (1025 per 100,000 live births) is about six times higher than what obtains in the South West (UNICEF, 2015)

In Anambra state, the Nigerian Urban Reproductive Health Initiative (Nigerian Urban

Reproductive Health Initiative, 2013) reported that about 1,999 women die annually from pregnancy related complications. MMR in Onitsha was found to be 800 per 100,000 live births (National Population Commission & ICF Macro, 2009), That is to say one out of ten pregnant women is likely going to die from obstetric conditions. Attendance at ante natal care was 30% and delivery by skilled birth attendants was 10% in Onitsha local government (NURHI, 2013).

In Onitsha local government, which is an easy reflection of Eastern Nigeria, several studies have been done on maternal mortality but there has been no broad study done to document the perception and health seeking behavior of women of child bearing age regarding obstetric complications in preventing maternal morbidity and mortality. It is in view of this that the researcher took a close look at perception and health seeking behavior for obstetric complications among women within Onitsha metropolis.

1.3 Significance of the Study

Findings from this study will help women to benefit from recommendations made which will improve the quality of health services they will receive from the prenatal period till the postpartum period.

Health institutions will benefit from this study in that recent written and theoretical information on obstetric complications will be added to the body of knowledge in the reduction of complications that lead to maternal morbidity and mortality. It will also be useful for future researchers who may have interest in studying maternal perceptions on obstetric complications and other related issues.

Policy makers which includes government at all levels will also benefit from this study. Results and recommendations from this study will help in policy formulations and serve as a basis for developing new and refined maternal welfare programs, services and strategies including those aimed at reducing maternal mortality.

1.4 Research Questions

This study is predicated upon the following research questions:

1.      What are the perceptions of women regarding obstetric complication?

2.      What are the obstetric complications experienced by women in the study location?

3.      What is the health seeking behaviour of women towards obstetric complication in the study location?

4.      What are the factors influencing health seeking behaviour of women in the study location?

5.      What is the relationship between perception of obstetric complications and the health seeking behaviour of women in the study location?

1.5 Aim of the study

This study is aimed at assessing perception and health seeking behaviour for obstetric complications among respondents who are women of reproductive age group in Onitsha.

The specific objectives of the study are as follows:

1.      To determine the perception of women regarding obstetric complication

2.      To identify obstetric complications experienced by women in the study location.

3.      To identify the health seeking behaviour of women towards obstetric complications in the study location.

4. To identify factors influencing health seeking behaviour of women in the study location

5. To determine the relationship between perception of obstetric complications and the health seeking behaviour of women in the study location.

  1.6 Scope of the Study

The scope of this study is limited to perception and health seeking behaviour for obstetric complications in Onitsha metropolis Anambra State, Nigeria. 

1.7 Operational Definition of Terms

Perception: Views, opinions, feelings of women in the study location about obstetric complications

Obstetric Complication: Any deviations from normal pregnancy, labour, and after delivery, that occurs in women within the study population during pregnancy, childbirth and after delivery

Health Seeking Behaviour: Actions or inactions engaged in by pregnant women in the study location during ante natal, labour or post-natal period to maintain and promote health, or treat complications when they occur

Women of Reproductive Age Group: women who fall between 15 to 49 years, who are married and have delivered at least one child within the last six months within the study population

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