Influence of women’s decision-making autonomy on antenatal care utilisation and institutional delivery services in Nigeria: evidence from the Nigeria Demographic and Health Survey 2018

BMC Pregnancy and Childbirth, Volume 22, No. 1, Year 2022

Interpretation

Background: In the context of global health priority, understanding the role of power dynamics among women as an important intervention required towards achieving optimum maternal and child health outcomes is crucial. This study examined the influence of women’s decision-making autonomy on antenatal care utilisation and institutional delivery services in Nigeria. Methods: The data for the study were derived from the 2018 Nigeria Demographic and Health Survey and comprised a weighted sample of 20,100 births in the last five years that preceded the survey among married/cohabiting childbearing women. Descriptive and analytical analyses were carried out, including frequency tables and multivariate using the binary logistic regression model. Results: The study revealed that despite a large number of women initiating antenatal care visits before 12 weeks of pregnancy (75.9%), far fewer numbers had at least eight antenatal care visits (24.2%) and delivered in a health facility (58.2%). It was established that the likelihood of having at least eight antenatal care visits was significantly increased among women who enjoyed decision-making autonomy on their healthcare (aOR: 1.24, CI: 1.02–1.51) and how their earnings are spent (aOR: 2.02, CI: 1.64–2.48). Surprisingly, women’s decision-making autonomy on how their earnings are spent significantly reduced the odds of initiating antenatal care visits early (aOR: 0.75, CI: 0.63–0.89). Some socio-economic and demographic factors were observed to have a positive influence on quality antenatal care utilisation and delivery in a health facility. Conclusion: In conclusion, women’s decision-making autonomy on their healthcare and how their earnings are spent was significantly found to be protective factors to having eight antenatal care visits during pregnancy. Conversely, women’s autonomy on how their earnings are spent significantly hindered their initiation of early antenatal care visits. There is a need for more pragmatic efforts through enlightenment and empowerment programmes of women to achieve universal access to quality maternal healthcare services in Nigeria. The data for this study were obtained from the individual recode data file of the 2018 Nigeria Demographic and Health Survey (NDHS). The survey is a cross-sectional study and data were generated from 41,821 women aged 15–49 and 13,311 men aged 15–59. A detailed report of the data collection methods and procedures for 2018 NDHS has been published elsewhere [32]. The analyses for this study covered a weighted sample of 20,100 births in the last five years that preceded the survey among childbearing women (15–49 years) who were ever-married/living with partners. This is to improve the representativeness of the data from the group of women interviewed in the survey (i.e. 2013–2018).

AI Digest

Study Justification:

This study aims to investigate the influence of women’s decision-making autonomy on antenatal care utilization and institutional delivery services in Nigeria. Understanding the power dynamics among women is crucial for improving maternal and child health outcomes. By examining the relationship between decision-making autonomy and healthcare utilization, this study provides valuable insights for policymakers and healthcare providers.

Highlights:

1. The study found that a large number of women in Nigeria initiate antenatal care visits before 12 weeks of pregnancy, but fewer have at least eight antenatal care visits and deliver in a health facility.
2. Women who have decision-making autonomy regarding their healthcare and how their earnings are spent are more likely to have at least eight antenatal care visits.
3. Surprisingly, women’s decision-making autonomy on how their earnings are spent reduces the odds of initiating antenatal care visits early.
4. Socio-economic and demographic factors also influence the utilization of quality antenatal care and delivery in a health facility.

Recommendations:

1. Pragmatic efforts should be made to empower and enlighten women, focusing on enhancing their decision-making autonomy regarding healthcare and financial matters.
2. Programs and interventions should be designed to promote early initiation of antenatal care visits while considering the influence of women’s decision-making autonomy on how their earnings are spent.
3. Universal access to quality maternal healthcare services should be a priority, and strategies should be developed to address the barriers faced by women in accessing and utilizing these services.

Key Role Players:

1. Ministry of Health: Responsible for developing and implementing policies and programs to improve maternal healthcare services.
2. Non-Governmental Organizations (NGOs): Involved in implementing empowerment and enlightenment programs for women.
3. Healthcare Providers: Play a crucial role in delivering quality antenatal care and institutional delivery services.
4. Community Leaders: Can help in raising awareness and promoting the importance of women’s decision-making autonomy in healthcare.

Cost Items for Planning Recommendations:

1. Development and implementation of empowerment and enlightenment programs: Includes costs for designing materials, conducting training sessions, and organizing awareness campaigns.
2. Capacity building for healthcare providers: Training programs to enhance the skills and knowledge of healthcare providers in delivering quality maternal healthcare services.
3. Infrastructure improvement: Investments in healthcare facilities to ensure availability of necessary equipment and resources for antenatal care and institutional delivery services.
4. Monitoring and evaluation: Budget for monitoring the progress and evaluating the impact of the implemented interventions.
Please note that the provided cost items are general categories and the actual cost estimation would require a detailed analysis and planning specific to the context and scale of the interventions.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study utilized data from a large sample size and employed descriptive and analytical analyses, including multivariate logistic regression. However, the abstract does not provide information on the specific variables included in the regression model or the statistical significance of the findings. To improve the strength of the evidence, the abstract should include more details on the methodology, such as the variables used, the statistical tests performed, and the significance levels. Additionally, it would be helpful to provide information on any potential limitations of the study and suggestions for future research.

Abstract

The data for this study were obtained from the individual recode data file of the 2018 Nigeria Demographic and Health Survey (NDHS). The survey is a cross-sectional study and data were generated from 41,821 women aged 15–49 and 13,311 men aged 15–59. A detailed report of the data collection methods and procedures for 2018 NDHS has been published elsewhere [32]. The analyses for this study covered a weighted sample of 20,100 births in the last five years that preceded the survey among childbearing women (15–49 years) who were ever-married/living with partners. This is to improve the representativeness of the data from the group of women interviewed in the survey (i.e. 2013–2018).

Materials

N/A

Innovations

Based on the information provided, here are some potential innovations that could improve access to maternal health in Nigeria:

1. Women’s empowerment programs: Implementing programs that focus on empowering women and promoting their decision-making autonomy in healthcare and financial matters. This could include providing education and resources to enhance women’s knowledge and confidence in making informed decisions about their own health and the utilization of maternal health services.

2. Early antenatal care interventions: Developing interventions that target women’s decision-making autonomy on how their earnings are spent, aiming to increase the likelihood of initiating antenatal care visits early. This could involve providing financial incentives or support to encourage women to seek antenatal care services during the early stages of pregnancy.

3. Mobile health (mHealth) solutions: Utilizing mobile technology to improve access to maternal health information and services. This could include developing mobile applications or SMS-based platforms that provide pregnant women with timely and relevant information about antenatal care, delivery services, and postnatal care. Additionally, mHealth solutions could facilitate appointment reminders and provide access to teleconsultations with healthcare providers.

4. Community-based interventions: Implementing community-based programs that focus on raising awareness about the importance of antenatal care and institutional delivery services. These interventions could involve community health workers or volunteers who engage with pregnant women and their families, providing education, support, and referrals to appropriate healthcare facilities.

5. Strengthening healthcare infrastructure: Investing in the improvement and expansion of healthcare facilities, particularly in rural areas, to ensure that pregnant women have access to quality antenatal care and delivery services. This could involve upgrading existing facilities, providing necessary medical equipment and supplies, and training healthcare providers to deliver comprehensive maternal healthcare services.

It is important to note that the effectiveness of these innovations would need to be evaluated through rigorous research and monitoring to ensure their impact on improving access to maternal health in Nigeria.

AI Innovations Description

Based on the findings of the study, the following recommendation can be developed into an innovation to improve access to maternal health in Nigeria:

1. Empowerment and education programs: Implement comprehensive empowerment and education programs targeting women in Nigeria. These programs should focus on increasing women’s decision-making autonomy regarding their healthcare and how their earnings are spent. By empowering women and providing them with the necessary knowledge and skills, they will be better equipped to make informed decisions about their maternal health, including seeking early antenatal care and utilizing institutional delivery services.

2. Community-based interventions: Develop community-based interventions that aim to raise awareness about the importance of antenatal care and institutional delivery services. These interventions can include community health workers who educate and engage with women at the grassroots level, providing information about the benefits of regular antenatal care visits and delivering in a health facility. Additionally, these interventions can address cultural and social barriers that may prevent women from accessing maternal health services.

3. Strengthen healthcare infrastructure: Invest in improving healthcare infrastructure, particularly in rural areas where access to maternal health services is limited. This can involve building and equipping more health facilities, ensuring they have trained healthcare professionals and necessary resources to provide quality antenatal care and delivery services. Additionally, efforts should be made to improve transportation systems to facilitate women’s access to healthcare facilities.

4. Policy and advocacy: Advocate for policies that prioritize and support maternal health in Nigeria. This can include policies that promote women’s rights and decision-making autonomy, as well as policies that allocate sufficient resources for maternal health services. Engage with policymakers, stakeholders, and civil society organizations to raise awareness about the importance of maternal health and advocate for policy changes that improve access to quality maternal healthcare.

By implementing these recommendations, Nigeria can work towards achieving universal access to quality maternal healthcare services, ultimately improving maternal and child health outcomes in the country.

AI Innovations Methodology

Based on the provided study, here are some potential recommendations to improve access to maternal health:

1. Increase women’s decision-making autonomy: Empower women to have more control over their healthcare decisions, including antenatal care utilization and choice of delivery services. This can be achieved through education, awareness campaigns, and community engagement programs.

2. Enhance financial support: Provide financial assistance or subsidies to pregnant women to cover the costs of antenatal care visits and institutional delivery services. This can help remove financial barriers that prevent women from accessing these essential services.

3. Strengthen healthcare infrastructure: Invest in improving the quality and availability of healthcare facilities, particularly in rural and underserved areas. This includes ensuring the presence of skilled healthcare providers, necessary medical equipment, and adequate resources for maternal health services.

4. Promote early initiation of antenatal care: Implement strategies to encourage women to initiate antenatal care visits early in their pregnancy. This can be done through community outreach programs, health education campaigns, and incentives for early antenatal care attendance.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could involve the following steps:

1. Define the indicators: Identify specific indicators that measure access to maternal health, such as the percentage of women receiving at least eight antenatal care visits or the percentage of women delivering in a health facility.

2. Collect baseline data: Gather data on the current status of these indicators in the target population. This can be done through surveys, interviews, or existing data sources.

3. Define the intervention scenarios: Develop different scenarios based on the recommendations mentioned above. For example, simulate the impact of increasing women’s decision-making autonomy by a certain percentage or providing financial support to a specific number of women.

4. Apply the simulation model: Use a statistical or mathematical model to simulate the impact of each intervention scenario on the selected indicators. This could involve running regression analyses, predictive modeling, or simulation techniques.

5. Analyze the results: Evaluate the simulated outcomes and compare them to the baseline data. Assess the effectiveness of each intervention scenario in improving access to maternal health.

6. Refine and iterate: Based on the results, refine the intervention scenarios and repeat the simulation process to identify the most effective strategies for improving access to maternal health.

It is important to note that the methodology for simulating the impact may vary depending on the available data, resources, and specific objectives of the study.

Author

Dima Health

Statistics:

Citations: 3

Identifiers:

DOI: 10.1186/s12884-022-04478-5

Research Areas:

Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants

Study Countries:

Nigeria

Study Design:

Cross Sectional Study, Grounded Theory, randomised-control-trial

Study Approach:

Quantitative

Participants Gender:

Male & Female