Abstract
The study was designed to determine attitude of pregnant women towards safe motherhood initiatives, in Orlu Urban of Imo State in Nigeria. The cross sectional survey design was used in the study. Data were collected using questionnaire. The six research questions were answered using mean and the null hypothesis was tested and analyzed using ANOVA. The population of the study consisted of 232 pregnant women who registered in all fifteen health facilities in Orlu urban. The study showed that: pregnant women had positive attitude towards prenatal/ante-natal care. Pregnant women had positive attitude towards nutritional care. Pregant women had negative attitude towards personal hygiene. Attitude of pregnant women towards essential obstetric care is positive. Pregnant women attitude towards child care is negative. Study further showed that based on the level of their education that there is no statistical significant difference in the attitudes towards all the component of SMl based on their level of education. Therefore the null hypothesis is accepted. The recommendations are: state ministry of health should formulate a reliable and valid program for evaluating the impact of positive attitude of pregnant women towards safe motherhood initiative components in all urban, communities and local governments of the federation. Appropriate training, seminars and workshops be organized regularly for women of reproductive age to be aware of the importance of having positive attitudes toward accepting internalizing and adopting high positive attitude for their safe motherhood education. This will help to develop positive attitudes towards their safe delivery. Safe motherhood initiative components should be inculcated in the school curriculum. There should be laws against pregnant women who patronize TBA’s and delivering in the homes of TBA’s
CHAPTER ONE
Introduction
Background to the Study
Maternal morbidity and mortality (MMM) is as old as the history of child bearing. It is a deceased state and death of a woman within 42 days after the termination of pregnancy, or within the pregnant period from any cause related to or aggravated by the pregnancy or its management (Sach 1987, Rowley 1987).
The rate at which pregnant women die due to pregnancy complications presently is quite alarming and it is a source of worry to the bereaved orphans, families, communities and the nation, World Health Organisation ( WHO, 2006). Due to the fact that child bearing is essentially a healthy and welcome process, traditional societies have managed, accept the risks as being unavoidable (Royston and Armstrong, 2006).
Indications are that maternal morbidity and mortality (MMM), globally every year, reaches over half a million (WHO; 2006). Most of the deaths from pregnancy related conditions are found in urban and rural areas of developing countries (Chiwuzie,Braimoh, Unuige 1985).
MMM rates in Nigeria are among the world highest, ranging from 800-1500 per 10,000 lives births. Despite the observation that traditional societies appear to have accepted the high MMM as unavoidable, researchers have shown that MMM and other pregnancy related problems are preventable (Royston and Armstrong 1989).
In the same vein, many researchers have analyzed the issue of MMM, and problems attributed to child bearing both in developed and developing countries. The conclusions are that they are preventable.
In a bid to find a lasting solution to increasing rate of MMM, governments, international agencies such as (WHO), United Nations Children’s Fund, (UNICF), and non- governmental organisations (NGOs) lunched the worldwide Safe Motherhood Initiative (SMI) at the International Conference in Nairobi in 1987(Onuzulike, 2006).
SMI is a global effort to reduce MMM in developing countries (Weston, 1986). The components of safe motherhood initiatives are prenatal care, ante-natal care, nutrition, family planning, personal hygiene during pregnancy, essential obstetric care, emergency care, postpartum care, post abortion care, prevention of sexually transmitted infections (STI’s), prevention of mother – to- child transmission (PMTCT) of HIV and AIDS and child care. The targets of safe motherhood initiatives are to reduce maternal mortality (deaths) to the lowest rate by the year 2015 in line with Millennium Development Goals (MDGs). However, for this present study the SMI in consideration are: prenatal/ante-natal care, nutritional care, personal hygiene while pregnant, essential obstetric care, child care and the pregnant women’s attitudes towards SMI based on level of education. The respondent’s educational level has link with attitude hence education brings changes in attitudes and enhances the quality of pregnant woman’s lives towards SMI.
Safe motherhood initiative aims at enhancing the quality and safety of pregnant women lives through the adaptation of a combination of health strategies. SMI means efforts to save pregnant women lives through a combination focused on three key areas; expanding and strengthening maternal health services, increasing access to family planning services; and improving the status of women through improving their cultural and legal status; and their access to educational and economic opportunities which are based on positive attitude (Maclaren, 1994).
There are three main health care delivery services enlisted by the safe motherhood initiative for the pregnant women to overcome maternal mortalities: pre natal care, Obstetric care and family Planning. It has been generally advocated that many maternal deaths in the developing world could be prevented if pregnant women are exposed to adequate health care attitudes during pregnancy (WHO, 1991). It has been claimed that most of the pregnancy complications and problems been experienced are deeply rooted in poor attitudes towards safe motherhood initiative components in urban and rural areas of the developing countries. This is caused by poor level of education towards SMI.
Hence studies are highly needed to ascertain the veracity of these claims based on their level of education. The researcher has therefore chosen to ascertain the application of these claims in Orlu Urban, Imo State Nigeria. To the best of the researcher’s knowledge, no such research had been conducted in Orlu urban. Statement of the Problem
Nigeria, the most populous country in Africa, has the largest number of MMM in the world (Udeinya, 1995 and WHO, 1980). According to them, the death is responsible for a total of approximately 80,000 per year (Udeinya, 1995).These figures are of grave concern to a developing country like Nigeria. MMM result in deficient infant care, infant malnutrition and increased infant mortality.
Observations of pregnant women in Orlu urban revealed that they appear to patronize TBAs. Indeed, what is seen is that some aspects of the SMI are observed like prenatal/ante- natal attendants. Whereas, the actual delivery could be done any where ranging from the MCH, TBA’s, maternities and hospitals. What comes to mind therefore is whether the pregnant woman is differentiated in attendance to these facilities by any recognizable criteria. Again, if such criteria are based on any attitudinal inclinations. For instance could the preference to any facility of choice be based on education .Such that the more educated pregnant women are, the more the inclination to attend to facilities where SMI are prevalent.
These observations are indeed the motivation or problem of this study. Principally to investigate the disposition of pregnant women attitude towards some isolated components of SMI and the pregnant women’s attitude towards safe motherhood initiatives based on level of education. The high MMM rate indicates that pregnant women lack SMI positive attitude. Nigeria contributed about 10 per – cent to the world’s annual estimates of maternal death (NASPM, 2003). Earlier high MMM has been identified as a result from poor attitude towards the components of Safe Motherhood Initiative in both urban and rural areas of Nigeria (Onuzulike, 2006).
Purpose of the Study
The purpose of this study was to investigate the attitude of pregnant women towards safe motherhood initiatives in Orlu urban, Imo state. Specifically; the study ascertained the:
1. Attitude of the pregnant woman towards prenatal/ante-natal care;
2. Attitude of the pregnant woman towards nutrition;
3. Attitude of the pregnant woman towards personal hygiene while pregnant;
4. Attitude of the pregnant women towards essential obstetric care;
5 Attitude of the pregnant woman towards child care and;
6. The pregnant women’s attitude towards safe motherhood initiative based on
level of education.
Research Questions
The following research questions were posed to guide the study in Orlu urban Imo Nigeria. 1. What is the attitude of the pregnant women towards prenatal/ante-natal care? 2. What is the attitude of the pregnant women towards nutrition? 3. What is the attitude of the pregnant women towards personal hygiene while
pregnant? 4. What is the attitude of the pregnant women towards essential obstetric care? 5 What is the attitude of the pregnant woman towards child care and; 6. What is the pregnant women’s attitude towards safe motherhood initiative
based on level of education?
Hypothesis
A null hypothesis was postulated and verified at .05 alpha levels.
1. The pregnant women’s attitude towards safe motherhood initiative components is not dependent on their level of education.
Significance of the Study
The present study showed attitude of pregnant women towards safe motherhood initiatives in Orlu urban of Imo State Nigeria. The anticipated data on attitude of pregnant women towards SMI that emerged from the present study are significant not only to child bearing woman but also Imo State ministries of Health and Information, Imo State hospitals Management Board, Policy makers, health educators and all female reproductive health intervention researchers and pregnant women to adapt to SMI positive attitude.
Data generated will help child bearing women and Imo State ministries of health to educate the pregnant women to know the appropriate place to seek medical help and attention for their pregnancy complication. In addition, the data generated on the attitude towards SMI will help the pregnant women attending MCH and TBA’s only to go to hospitals with skilled personals ,equipments and facilities on time for essential obstetric care immediately they noticed pregnancy complication danger signs at appropriate time without any delay for appropriate action
Pregnant women attending MCH and TBA’s only should inculcate attitude of going to hospitals with skilled personals ,equipments and facilities on time for essential obstetric care immediately they noticed pregnancy complication danger signs at appropriate time without any delay for appropriate action and child care. This will help to prevent infant mortality and morbidity rate in Orlu Urban Health District.
Again, the data generated on attitude of pregnant woman towards SMI based on level of education will be useful to the Ministry of Health and Information to have sufficient centres for the management, care and support for the orphans, motherless, people living with HIV and AIDS and host of others in the urban areas.
The data generated will enable the policy makers to have a policy that can withstand the light of the day for better performance of those that are vulnerable and disable by pregnant complication. This will also help the government to extend their hand of fellowship to them. The data generated will assist the Ministry of Health and Information to develop a policy statement that will help the masses to remove sentiment in the issue of abortion care in Nigeria
Imo State hospitals Management Board will benefit from the anticipated finings and will use the data as a veritable tool for further campaign against MMM in urban in Nigeria. Data on attitude of pregnant women on prenatal/ante-natal care from pregnant women attending MCH and TBA centre in Orlu Urban will ever remain a reference point. This is because they denote the first concerted effort to empirically elucidate pregnant women’s attitude on prenatal/ ante- natal care as one of the basic components of SMI in MCH clinics and TBA clinics in Orlu Urban Health District.
Furthermore, this study considered very significant because data that will emanate from the study will be relevant and useful to adolescent and female reproductive health workers and researchers to educate pregnant woman with low level of education to inculcate positive SMI attitude .Pregnant women who may eventually utilize child bearing women’s acquisition of attitude of benefits inherent in SMI components, attitudinal change and eventually eradication of reproductive health hazards among child bearing women attending various MCH and TBA clinics in Nigeria and Orlu Urban Health District in particular. The significance of such initiatives attitude cannot be overemphasized because it specifically aims at upgrading pregnant woman’s attitude towards SMI components like nutrition, personal hygiene while pregnant, essential obstetric care, child care and pregnant women attitude based on level of education. This will help them to improve their life style and way of life.
The data generated will help health educators in teaching the pregnant women to know how to attend for their personal hygiene for their healthful living and longevity. It will also help them to shun all the misconceptions about SMI negative attitude which contrast with the ideal.
In addition, the data generated on the attitude towards essential obstetric care will help the pregnant women attending MCH and TBA’s only to go to hospitals with skilled personals ,equipments and facilities on time for essential obstetric care immediately they noticed pregnancy complication danger signs at appropriate time without any delay for appropriate action
The study is also significant to child bearing women as an operational models in the sense that some theories and findings of the present study, such theory will be incorporated and adopted as operational model in the positive attitude and care due to its relevancy in Nigerian context.
Finally, within the field of public health education, maternal and child health, reproductive health in general and female reproductive health in particular, the data generated on attitude of pregnant women towards SMI and socio demographic factors like influence of level of education on pregnant women attitude towards SMI will be useful to all health educators, researchers, ministries of health and information and will augment the pool of available data in the field of reproductive health.
Scope of the Study
The study focused on attitude of pregnant women towards SMI in Orlu urban .The study were limited to pregnant women in Orlu Urban only .The high MMM are more in urban and communities. The location of Health facilities are fare to their homes .Due to logistics problems they seem to patronized MCH and TBA’s closer to their homes only. They are quiet ignorant of the benefit of both secondary and tertiary institutions and the importance of difference between skilled and unskilled personal. They have little or no interest in attending teaching or federal medical centres which have skilled personals, equipments and facilities. Their attitude of patronising both TBA’s and MCH more leaves them with the negative interest to SMI ,fate, high rate of MMM and attitude very contrast with the ideal are inimical to SMI positive attitude
The pregnant women were those who attended hospitals, Maternal and Child Health (MCH) and TBA’s clinics in Orlu urban, Imo Sate Nigeria .The location of Health facilities are fare to their homes. They are quiet ignorant of the benefit of both secondary and tertiary institutions and the importance of difference between skilled and unskilled personal. They have little or no interest in attending teaching or federal medical centres which have skilled personals, equipments and facilities.
Their attitude of patronising both TBA’s and MCH more leaves them with the negative interest to SMI ,fate, high rate of MMM and attitude very contrast with the ideal are inimical to SMI positive attitude in Orlu urban, Imo State. Their positive relationships to SMI attitude will prevent MMM in Orlu urban Imo State of Nigeria.
The components of safe motherhood initiative causing more problems which are covered include: prenatal/antenatal care, nutritional care, personal hygiene while pregnant, essential obstetric care, child care, attitude towards SMI based on level of education and null hypothesis postulated to verify pregnant women attitude towards SMI.