Understanding the Landscape of Childbirth in Nigeria

Childbirth, a universal human experience, is far from uniform across the globe.In Nigeria, a nation of over 200 million people, the decision of where to give birth is a multifaceted one, influenced by a complex interplay of factors. A qualitative study conducted between September and December 2023, delved into the experiences of nursing mothers, healthcare workers (HCWs), and community-based agents (CBAs) in Lagos, oyo, and Jigawa states, offering a granular view of the challenges and choices surrounding maternal healthcare.

The study, employing reflexive thematic analysis, highlights the critical need to understand these nuances to improve maternal health outcomes.The research team meticulously followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines to ensure the rigor and transparency of their findings.

Dr. Anya Abubakar Bello, a community health physician who was part of the research team, noted that, “Our goal was to understand the ‘why’ behind the choices women make, to identify the barriers preventing them from accessing the safest possible care.”

The Andersen Model: A Framework for Analysis

To structure their investigation, researchers employed the Andersen model of health service utilization. This model posits that three categories of factors influence healthcare choices:

• predisposing factors: These encompass demographic, social, and cultural characteristics that predispose women to seek or avoid maternal healthcare services.
• Enabling factors: These refer to the resources and opportunities that facilitate or hinder maternal healthcare access and utilization.
• Need factors: These reflect the perceived or actual need for maternal healthcare.

Using this framework, the study aimed to dissect the various elements affecting a woman’s decision to deliver at home versus in a healthcare facility.

Three States, Three realities: A Comparative Look

The study focused on three states representing Nigeria’s diverse geopolitical zones:

• Lagos State: The economic powerhouse of Nigeria, with a population of approximately 24.6 million in 2022. Researchers focused on the Ikorodu Local Government Area (LGA), a peri-urban area dominated by the Yoruba ethnic group. Lagos boasts a high literacy rate (85.3% for women, 93.0% for men). According to the Nigeria demographic and Health Survey (NDHS) 2018, 86.4% of pregnant women in Lagos utilize antenatal care (ANC) by a skilled health provider, and 75.7% have health facility childbirth. However, the maternal mortality ratio (MMR) remains high at 430 per 100,000 live births.
• Oyo State: Located in southwestern Nigeria, participants where recruited from Ibadan southwest and Lagelu LGAs within the Ibadan metropolis. Ibadan is a historic city with a predominantly Yoruba population. Literacy rates are high (85.3% for women, 90.2% for men). The NDHS 2018 indicates that 85.4% of pregnant women receive ANC from skilled providers, and 70.1% deliver in health facilities. Oyo’s MMR is lower than the national average, at 262 per 100,000 live births.
• Jigawa State: situated in northwestern Nigeria, Jigawa presents a contrasting picture. This predominantly Hausa-speaking state faces significant challenges in maternal healthcare access. While specific literacy and healthcare utilization rates were not detailed in this excerpt, Northwestern Nigeria generally lags behind the South in these indicators.

The selection of these three states allowed researchers to capture a wide range of experiences and perspectives on childbirth choices.

Researcher Perspectives and Trustworthiness

The research team acknowledged the potential for their own backgrounds and experiences to influence the interpretation of participants’ responses. They addressed this through continuous reflection and discussion within the team.

For example, Dr. Bello’s experience as a male community health physician provided a clinical outlook and contextual knowledge of the Nigerian healthcare system, while Dr.Kehinde Olamide Aina, a female public health researcher, brought a broader perspective focusing on systemic issues and social determinants of health. The contributions of nurses with clinical and research experience further enriched the analysis.

To ensure trustworthiness, the researchers employed several strategies:

• Triangulation: Interviewing different categories of participants (nursing mothers, HCWs, CBAs) to capture diverse viewpoints.
• Language Accessibility: Conducting all interviews in the participant’s preferred language.
• Interdisciplinary Analysis: Data analysis was conducted by a team with diverse professional backgrounds (nurses, public health researcher, community health physician).
• Team Review: Findings were discussed with the broader research team.

Ethical Considerations

The study adhered to strict ethical guidelines. Prior to each interview, participants provided verbal and written informed consent, ensuring anonymity and confidentiality. Participants were informed of their right to withdraw from the study at any time.

The study received ethical approval from the Jigawa State Ministry of Health (ref: JGHREC/2023/152), Lagos State University teaching Hospital (ref: NHREC04/04/2008), and the University of Ibadan/University college Hospital (UI/UCH) ethics committee (ref: UI/EC/22/0311).

Implications for the U.S. Healthcare System

While this study focuses on Nigeria, its findings have implications for understanding and addressing maternal healthcare disparities in the United States.

Like Nigeria, the U.S. faces significant disparities in maternal mortality rates, especially among women of color. According to the CDC, the maternal mortality rate in the U.S. in 2021 was 32.9 deaths per 100,000 live births, with Black women experiencing a rate more than twice that of white women.

Factors such as access to care, socioeconomic status, and cultural beliefs also play a significant role in shaping maternal health outcomes in the U.S. By understanding the complexities of childbirth choices in a different cultural context like Nigeria, U.S. healthcare providers and policymakers can gain valuable insights into addressing similar challenges domestically.

Such as, community-based interventions and culturally competent care, which are crucial in the Nigerian context, are also essential for improving maternal health outcomes in underserved communities in the U.S.

Further research is needed to explore the specific cultural and socioeconomic factors driving maternal health disparities in different regions of the U.S. and to develop targeted interventions that address the unique needs of diverse communities.