Psychosocial influences on pregnancy and childbirth behaviours in north-western Nigeria: A cross-sectional analysis

  • Journal of Biosocial Science, Year 2022

listen audio

Study Justification:
The study aimed to assess the psychosocial influences on pregnancy and childbirth behaviors in north-western Nigeria. This is important because despite the availability of maternal health services such as antenatal care (ANC) and facility delivery, the uptake of these services remains low in the region. Understanding the psychosocial factors that influence these behaviors can help inform interventions and programs to improve pregnancy and childbirth practices.
Highlights:
– The study found that only 23.6% of women attended ANC four or more times (ANC4+) and 15.5% gave birth in a facility.
– Lack of perceived need and spousal opposition were the most commonly cited reasons for non-use of ANC and facility-based delivery.
– Women who knew the benefits of ANC and the recommended number of ANC visits were more likely to attend ANC4+ times.
– Positive views about health facilities for childbirth were associated with higher likelihood of attending ANC4+ times and having a facility delivery.
– Women who believed ANC was only for sickness or pregnancy complications had a lower likelihood of attending ANC4+ times.
– Self-efficacy and supportive spousal influence were also significantly associated with both ANC4+ attendance and facility delivery.
Recommendations for Lay Reader and Policy Maker:
– Social and Behavioral Change programs should address a range of psychosocial factors across cognitive, emotional, and social domains.
– Programs should focus on raising knowledge and dispelling myths about ANC and facility delivery.
– Building women’s confidence to access services and engaging spousal support in decision-making are important strategies.
– Improving the perceived and actual quality of maternal health services is crucial.
Key Role Players:
– Health policymakers and government officials responsible for maternal health programs
– Healthcare providers and facilities
– Community leaders and influencers
– Non-governmental organizations (NGOs) working in the field of maternal health
– Community health workers and volunteers
Cost Items for Planning Recommendations:
– Development and implementation of Social and Behavioral Change programs
– Training and capacity building for healthcare providers and community health workers
– Awareness campaigns and community mobilization activities
– Improvement of maternal health services infrastructure and quality
– Monitoring and evaluation of program effectiveness
– Research and data collection to inform evidence-based interventions

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study utilized a cross-sectional analysis and a population-based survey, which provides a good sample size and representative data. The study also used mixed-effects logistic regression models to derive predicted probabilities. However, the evidence is limited to self-reported maternal health behaviors and psychosocial influences, which may be subject to recall bias and social desirability bias. To improve the strength of the evidence, future studies could consider using longitudinal designs and objective measures of maternal health behaviors. Additionally, incorporating qualitative methods to gain deeper insights into the psychosocial factors influencing pregnancy and childbirth behaviors would be beneficial.

Antenatal care (ANC) and facility delivery are essential maternal health services, but uptake remains low in north-western Nigeria. This study aimed to assess the psychosocial influences on pregnancy and childbirth behaviours in Nigeria. Data were from a cross-sectional population-based survey of randomly sampled women with a child under 2 years conducted in Kebbi, Sokoto and Zamfara states of north-western Nigeria in September 2019. Women were asked about their maternal health behaviours during their last pregnancy. Psychosocial metrics were developed using the Ideation Model of Strategic Communication and Behaviour Change. Predicted probabilities for visiting ANC four or more times (ANC4+) and giving birth in a facility were derived using mixed-effects logistic regression models adjusted for ideational and socio-demographic variables. Among the 3039 sample women, 23.6% (95% CI: 18.0-30.3%) attended ANC4+ times and 15.5% (95% CI: 11.8-20.1%) gave birth in a facility. Among women who did not attend ANC4+ times or have a facility-based delivery during their last pregnancy, the most commonly cited reasons for non-use were lack of perceived need (42% and 67%, respectively) and spousal opposition (25% and 27%, respectively). Women who knew any ANC benefit or the recommended number of ANC visits were 3.2 and 2.1 times more likely to attend ANC4+ times, respectively. Women who held positive views about health facilities for childbirth had 1.2 and 2.6 times higher likelihood of attending ANC4+ times and having a facility delivery, respectively, while women who believed ANC was only for sickness or pregnancy complications had a 17% lower likelihood of attending ANC4+ times. Self-efficacy and supportive spousal influence were also significantly associated with both outcomes. To improve pregnancy and childbirth practices in north-western Nigeria, Social and Behavioural Change programmes could address a range of psychosocial factors across cognitive, emotional and social domains which have been found in this study to be significantly associated with pregnancy and childbirth behaviours: raising knowledge and dispelling myths, building women’s confidence to access services, engaging spousal support in decision-making and improving perceived (and actual) maternal health services quality.

N/A

The recommendation to improve access to maternal health in north-western Nigeria, based on the study “Psychosocial influences on pregnancy and childbirth behaviours in north-western Nigeria: A cross-sectional analysis,” includes implementing Social and Behavioural Change (SBC) programs. These programs should focus on addressing various psychosocial factors across cognitive, emotional, and social domains. The specific recommendations are:

1. Raising knowledge and dispelling myths: SBC programs should provide accurate and comprehensive information about the benefits of antenatal care (ANC) and facility-based delivery. This can help overcome misconceptions and increase awareness of the importance of these services.

2. Building women’s confidence to access services: SBC programs should address barriers such as lack of perceived need and spousal opposition. Emphasizing the positive impact of ANC and facility-based delivery on maternal and child health outcomes can empower women to make informed decisions and seek appropriate care.

3. Engaging spousal support in decision-making: Involving husbands and partners in discussions about maternal health can help overcome spousal opposition and increase support for ANC and facility-based delivery. SBC programs can promote open communication and encourage shared decision-making between couples.

4. Improving perceived (and actual) maternal health services quality: Enhancing the quality of maternal health services is crucial to increase utilization. SBC programs can focus on improving the perception of services by addressing issues such as long waiting times, disrespectful treatment, and inadequate facilities. Efforts should also be made to ensure that the actual quality of care meets the expectations of women.

By implementing these recommendations, it is expected that the uptake of ANC and facility-based delivery will increase, leading to improved maternal and child health outcomes in north-western Nigeria.
AI Innovations Description
The recommendation to improve access to maternal health based on the study “Psychosocial influences on pregnancy and childbirth behaviours in north-western Nigeria: A cross-sectional analysis” includes implementing Social and Behavioural Change (SBC) programs that address various psychosocial factors across cognitive, emotional, and social domains. These programs should focus on:

1. Raising knowledge and dispelling myths: Providing accurate and comprehensive information about the benefits of antenatal care (ANC) and facility-based delivery can help overcome misconceptions and increase awareness of the importance of these services.

2. Building women’s confidence to access services: Addressing barriers such as lack of perceived need and spousal opposition is crucial. SBC programs should emphasize the positive impact of ANC and facility-based delivery on maternal and child health outcomes, empowering women to make informed decisions and seek appropriate care.

3. Engaging spousal support in decision-making: Involving husbands and partners in discussions about maternal health can help overcome spousal opposition and increase support for ANC and facility-based delivery. SBC programs can promote open communication and encourage shared decision-making between couples.

4. Improving perceived (and actual) maternal health services quality: Enhancing the quality of maternal health services is essential to increase utilization. SBC programs can focus on improving the perception of services by addressing issues such as long waiting times, disrespectful treatment, and inadequate facilities. Additionally, efforts should be made to ensure the actual quality of care meets the expectations of women.

By implementing these recommendations, it is expected that the uptake of ANC and facility-based delivery will increase, leading to improved maternal and child health outcomes in north-western Nigeria.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, a mixed-methods approach could be used. Here is a brief description of the methodology:

1. Quantitative Analysis:
– Data Collection: Conduct a population-based survey similar to the original study, targeting randomly sampled women with a child under 2 years in Kebbi, Sokoto, and Zamfara states of north-western Nigeria.
– Survey Instrument: Develop a survey questionnaire that includes questions related to the main recommendations, such as knowledge about ANC and facility-based delivery, confidence in accessing services, spousal support, and perception of maternal health services quality.
– Sample Size: Determine an appropriate sample size to ensure statistical power and representativeness of the target population.
– Data Analysis: Use mixed-effects logistic regression models to assess the association between the psychosocial factors and maternal health behaviors (ANC4+ attendance and facility-based delivery). Adjust for ideational and socio-demographic variables as done in the original study.
– Predicted Probabilities: Derive predicted probabilities for ANC4+ attendance and facility-based delivery based on the regression models, considering different levels of the psychosocial factors.

2. Qualitative Analysis:
– In-depth Interviews: Conduct qualitative interviews with a subset of survey participants to explore their experiences, perceptions, and attitudes related to the main recommendations. Focus on understanding the impact of the psychosocial factors on maternal health behaviors and the effectiveness of the SBC programs in addressing these factors.
– Thematic Analysis: Analyze the qualitative data using thematic analysis to identify common themes and patterns related to the main recommendations. This analysis can provide insights into the mechanisms through which the recommendations influence access to maternal health.

3. Simulation:
– Utilize the quantitative findings, including the predicted probabilities, to simulate the impact of the main recommendations on improving access to maternal health. This can involve creating different scenarios where the psychosocial factors are modified based on the recommendations and estimating the resulting changes in ANC4+ attendance and facility-based delivery rates.
– Combine the quantitative and qualitative findings to provide a comprehensive understanding of the potential impact of the recommendations on improving access to maternal health.

By employing this mixed-methods approach, researchers can gain insights into the effectiveness of the main recommendations and provide evidence-based recommendations for implementing SBC programs to improve access to maternal health in north-western Nigeria.


Identifiers:
DOI: 10.1017/S0021932021000729
ISSN: 00219320
Research Areas:
Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health
Study Countries:
Nigeria
Study Design:
Cross Sectional Study
Study Approach:
Quantitative
Participants Gender:
Female
Partilhar isto:
Facebook
Twitter
LinkedIn
WhatsApp
Email