Bridging the Know–Do Gap: Integration of Obstetric Emergency Knowledge and Care-Seeking Readiness among Pregnant Women in Ilorin, Nigeria

In Nigeria, there has been a rising awareness among pregnant women about danger signs, but they are still arriving at health facilities at the last minute. This paper combines both the quantitative and the qualitative aspects of a sequential explanatory mixed methods research to explain the difference between the knowledge and action of pregnant women who attended antenatal care services in Ilorin, Kwara State. Three hundred and eleven women, selected by multi-stage sampling procedures, were surveyed at a teaching hospital and a cottage hospital and qualitative data were obtained through in-depth interviews with 20 respondents. Each of the survey indicators of recognition, intended first recourse, sources of information, decision making, travel time and financial readiness was compared to four themes of the interview and each of the comparisons was evaluated as confirmation, expansion or discordance. While 90.7% of women correctly identified an obstetric emergency, only 41.5% identified facial or leg swelling as a danger sign, while 25.7% would initially go to a chemist or a traditional birth attendant or stay at home, or pray at a prayer house. Only 10.3% had the ability to choose to go to a health care provider independently, 60.8% reported no health insurance and 60.8% reported no knowledge of costs in the event of an emergency. The explanations of these figures through interviews were spiritual attribution of complications, herbal first-line remedies, husband's authority, elders' authority, cash deposits and lack of night transportation. There was discordance in decision making – the majority of women who reported “joint” decisions said that they needed their husband's permission to make decisions, which means that surveys underestimate gatekeeping. Readiness to act, rather than knowledge, is the weak link. Antenatal programmes should be family based, include spiritual explanations and include support for emergency transport and financial protection.