Why women utilize traditional rather than skilled birth attendants for maternity care in rural Nigeria: Implications for policies and programs

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Study Justification:
– The study aims to address the persistently high rate of maternal mortality in rural Nigeria by investigating why women in these areas prefer traditional birth attendants (TBAs) over skilled birth attendants (SBAs) for maternity care.
– Understanding the reasons behind this preference is crucial for developing effective policies and programs to improve maternal health outcomes in rural Nigeria.
Study Highlights:
– The study utilized a qualitative research design, including focus group discussions, key informant interviews, and community conversations, to gather data from twenty rural communities in Edo State, Nigeria.
– Findings revealed several reasons for the utilization of TBAs, such as perceptions of higher efficacy of traditional medicines, cultural practices, ease of access to TBAs compared to SBAs, higher costs of services in health facilities, and the friendly attitude of TBAs.
– The study concludes that addressing these factors identified by community stakeholders can promote skilled birth attendance and reduce maternal mortality in rural Nigeria.
Recommendations for Lay Readers:
– Policies and programs should focus on improving access to skilled birth attendants in rural areas to ensure safer and more effective maternity care.
– Efforts should be made to educate communities about the benefits of skilled birth attendance and dispel misconceptions regarding traditional medicines.
– Strategies to reduce the cost of services in health facilities should be implemented to make them more affordable for women in rural areas.
– Training and capacity-building programs should be provided to enhance the skills and knowledge of skilled birth attendants.
Recommendations for Policy Makers:
– Develop and implement policies that prioritize the availability and accessibility of skilled birth attendants in rural areas.
– Allocate resources to support training programs for skilled birth attendants and ensure their continuous professional development.
– Invest in community education and awareness campaigns to promote the benefits of skilled birth attendance and address cultural beliefs and practices.
– Explore innovative financing mechanisms to reduce the financial burden of maternity care services in health facilities.
Key Role Players:
– Policymakers and government officials responsible for developing and implementing healthcare policies.
– Senior health providers involved in maternal health services.
– Women leaders who can advocate for improved maternity care in rural areas.
– Community leaders who can influence community perceptions and practices regarding childbirth.
Cost Items for Planning Recommendations:
– Training programs for skilled birth attendants.
– Community education and awareness campaigns.
– Infrastructure development to improve access to health facilities.
– Subsidies or financial support to reduce the cost of maternity care services.
– Monitoring and evaluation systems to assess the impact of implemented policies and programs.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on qualitative research design, including focus group discussions, key informant interviews, and community conversations. While these methods provide valuable insights into the reasons why women in rural Nigeria use traditional birth attendants (TBAs) instead of skilled birth attendants (SBAs), the evidence is limited to a specific geographic area and may not be generalizable to other regions. To improve the strength of the evidence, future research could include a larger sample size and a more diverse range of rural communities in Nigeria. Additionally, quantitative data could be collected to complement the qualitative findings and provide a more comprehensive understanding of the factors influencing the use of TBAs.

Objective: Data from the Nigeria Demographic and Health Survey indicate that many pregnant women in rural Nigeria use traditional birth attendants (TBAs) rather than skilled birth attendants (SBAs) for maternal health care. This is one factor that accounts for the persistently high rate of maternal mortality in Nigeria. The objective of this study was to identify the pervading reasons that women use TBAs for pregnancy care in rural Nigeria and to make recommendations for policy and programmatic reform. Design: Qualitative research design consisting of focus group discussions, key informant interviews, and community conversations, followed by inductive thematic analysis. Setting: Twenty rural communities (villages) in Etsako East, and Esan South East Local Government Areas of Edo State, South-South, Nigeria. Participants: Twenty focus group discussions with men and women in a marital union; 15 key informant interviews with policymakers, senior health providers, and women leaders; and 10 community conversations with key community leaders. Findings: Some reasons proffered for using TBAs included perceptions of higher efficacy of traditional medicines; age-long cultural practices; ease of access to TBAs as compared to SBAs; higher costs of services in health facilities; and friendly attitude of TBAs. Key conclusions and implications for practice: The continued use of TBA is a major challenge in efforts to achieve the Sustainable Development Goal 3 in Nigeria. We conclude that efforts to address the factors identified by community stakeholders as inhibiting the use of SBAs will promote skilled birth attendance and reduce maternal mortality in rural Nigeria.

Based on the research findings and implications for practice outlined in the publication “Why women utilize traditional rather than skilled birth attendants for maternity care in rural Nigeria: Implications for policies and programs,” the following recommendations can be developed into innovations to improve access to maternal health:

1. Strengthening the capacity of skilled birth attendants (SBAs): Develop innovative training programs that utilize interactive and practical learning methods to enhance the skills, knowledge, and competencies of SBAs. This can include simulation-based training, e-learning platforms, and mentorship programs using technology.

2. Community engagement and awareness: Utilize innovative communication strategies such as mobile phone apps, social media campaigns, and community radio programs to raise awareness about the benefits of skilled birth attendance and the risks associated with traditional birth attendants (TBAs). Engage community influencers and local celebrities to amplify the messages and reach a wider audience.

3. Affordable and accessible maternal health services: Implement innovative financing models such as community-based health insurance schemes or mobile money platforms to reduce the financial burden on pregnant women and their families. Explore partnerships with private sector organizations to provide subsidized or free maternal health services in rural areas.

4. Integration of traditional and modern practices: Develop innovative training modules that promote respectful and culturally sensitive care, incorporating both traditional and modern practices. This can include the use of traditional birth attendants as community health workers who work in collaboration with SBAs, ensuring a seamless referral system and continuity of care.

5. Strengthening health systems: Utilize innovative approaches such as telemedicine and teleconsultation to improve access to skilled birth attendants in remote areas. Implement mobile clinics or outreach programs that bring maternal health services closer to rural communities, ensuring the availability of essential drugs and equipment.

By implementing these innovative approaches, policymakers and program implementers can work towards reducing the reliance on TBAs and increasing access to skilled birth attendance in rural Nigeria. These innovations have the potential to contribute to the reduction of maternal mortality rates and the achievement of Sustainable Development Goal 3.
AI Innovations Description
Based on the research findings and implications for practice outlined in the publication “Why women utilize traditional rather than skilled birth attendants for maternity care in rural Nigeria: Implications for policies and programs,” the following recommendation can be developed into an innovation to improve access to maternal health:

1. Strengthening the capacity of skilled birth attendants (SBAs): Enhance the skills, knowledge, and competencies of SBAs to provide high-quality and culturally sensitive maternal health care. This can be achieved through targeted training programs, continuous professional development, and mentorship opportunities.

2. Community engagement and awareness: Implement community-based interventions to raise awareness about the benefits of skilled birth attendance and the risks associated with traditional birth attendants (TBAs). Engage community leaders, women leaders, and other influential stakeholders to promote the use of SBAs and dispel misconceptions surrounding traditional practices.

3. Affordable and accessible maternal health services: Address the cost barriers associated with accessing skilled birth attendance by implementing policies that reduce the financial burden on pregnant women and their families. This can include subsidizing maternal health services, providing health insurance coverage, and improving the availability of affordable transportation options to health facilities.

4. Integration of traditional and modern practices: Foster collaboration and partnership between TBAs and SBAs to create a holistic approach to maternal health care. This can involve training TBAs on basic emergency obstetric care, encouraging referrals to SBAs when complications arise, and promoting respectful and inclusive care that incorporates traditional practices where appropriate.

5. Strengthening health systems: Improve the infrastructure, equipment, and supplies in health facilities to ensure that SBAs can provide safe and effective maternal health care. This includes ensuring the availability of essential drugs, functional equipment, and adequate staffing levels.

By implementing these recommendations, policymakers and program implementers can work towards reducing the reliance on TBAs and increasing access to skilled birth attendance in rural Nigeria, ultimately contributing to the reduction of maternal mortality rates and achieving Sustainable Development Goal 3.
AI Innovations Methodology
To simulate the impact of the main recommendations outlined in the abstract on improving access to maternal health, a mixed-methods approach could be employed. Here is a brief description of the methodology:

1. Baseline data collection: Conduct a survey or review existing data to establish the current utilization of skilled birth attendants (SBAs) and traditional birth attendants (TBAs) in rural Nigeria. This will provide a baseline against which the impact of the recommendations can be measured.

2. Intervention implementation: Implement the recommendations outlined in the abstract, including strengthening the capacity of SBAs, community engagement and awareness campaigns, addressing cost barriers, integrating traditional and modern practices, and strengthening health systems. These interventions can be implemented in selected rural communities in Edo State, Nigeria.

3. Data collection during intervention: Collect data during the intervention period to assess the implementation of the recommendations and their impact on access to maternal health. This can include surveys, interviews, and focus group discussions with pregnant women, community leaders, healthcare providers, and policymakers.

4. Data analysis: Analyze the collected data using appropriate statistical methods and qualitative analysis techniques. Quantitative analysis can involve comparing the utilization of SBAs and TBAs before and after the intervention, assessing changes in maternal health outcomes, and evaluating the cost-effectiveness of the interventions. Qualitative analysis can involve identifying themes and patterns in the experiences and perceptions of stakeholders regarding the recommendations.

5. Evaluation and interpretation: Evaluate the impact of the recommendations based on the data analysis. Assess the extent to which the utilization of SBAs has increased, the reduction in maternal mortality rates, changes in community awareness and attitudes towards skilled birth attendance, and improvements in the availability and quality of maternal health services. Interpret the findings in the context of the original research objectives and implications for practice.

6. Recommendations and scaling up: Based on the evaluation findings, develop recommendations for scaling up the interventions to other rural areas in Nigeria. Identify areas for further improvement and potential challenges in implementing the recommendations on a larger scale.

By following this methodology, researchers and policymakers can gain insights into the effectiveness of the recommendations in improving access to maternal health in rural Nigeria and inform future policies and programs in this area.

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