The influence of new maternal care facilities in rural Nigeria

Intrapartum care was begun in a public sector comprehensive health centre in Obukpa Town, a rural Nigerian community in May 1987. Its influence on the utilization pattern of maternal health care services was studied in a sample of 488 women who underwent an abortion or childbirth between May 1987 and July 1989. There was an increase in utilization of prenatal care facilities in the comprehensive health centre, from 52% in 1987 to 66% in 1989, and a decline in the use of other health facilities from 41 % to 31 %. Use of the comprehensive health centre for intrapartum care increased from 15% in 1987 to 36% in 1989, while home delivery declined from 60% to 38% in the same period. Use of other health institutions for delivery remained unchanged. Logistic regression analysis showed that place of delivery and attendant at delivery varied significantly with year of delivery. Women were more than twice as likely to deliver in health institutions (OR =2.216, p = 0.01) and to be attended by trained staff (OR = 2.525, p = 0.003) in 1989 than in 1987. The cost of service was found to be about the same for the public and private sectors for prenatal care, and marginally lower for intrapartum care at the comprehensive health centre. Service by traditional birth attendants was free or paid for in kind. The use of the comprehensive health centre was shown to decline with increasing distance from a woman's residence, and distance was considered the determining factor in the choice of a private or public health care institution. The implications of these findings for maternal health policy are discussed and recommendations for change are made.