MotherCare Nigeria maternal healthcare project qualitative research

In Nigeria, these forces vary from region to region, depending on a woman"s ethnic origin, socioeconomic status, rural or urban residence, and health status. This study examined the knowledge, attitudes, and practices of Nigerian women, their husbands/partners, and health care providers in the northeast state of Bauchi and the southwest states of Oyo and Oshun with respect to pregnancy, childbirth, and postpartum care. In-depth interviews and focus group discussions were conducted in rural and urban locations, with participants from Fulani, Hausa, and Yoruba communities. The findings reveal how cultural taboos and beliefs and socioeconomic forces can conspire to place a woman at a disadvantage during pregnancy. For example, among all three communities, pregnancy-related food taboos effectively eliminate several accessible, essential sources of protein from a women"s diet. Women"s workloads are not reduced, however, and many women are inadequately nourished and exhausted throughout their pregnancies. Husbands and in-laws help to maintain compliance with taboos. Attendance at prenatal clinics is not widespread, due to transportation and cost barriers, and among Fulani, the association of shame with pregnancy. On the other hand, unfortunately, prenatal care is sometimes seen as insurance against complications of delivery, leading to overconfidence about home births. And among Yoruba, even women who receive prenatal care may use traditional rather than formal medicine for labor complications. Many respondents were unaware of warning signs. Swelling of the extremities, headaches, bleeding, and premature rupture of the extremities are all considered normal, leading to delays in seeking hospital care. Once there, long waiting periods and a lack of adequate personnel and equipment may prevent effective treatment. Doctors and nurses express their irritation with this situation, while community members protest their poor handling by health professionals, which may be an outcome of trying to save women who arrive too late or cannot afford the care required. The gulf between traditional communities and western medicine is also illustrated by the underutilization of traditional birth attendants and the insufficient training provided them and traditional healers. Those TBAS who have received clinical training express dissatisfaction with the lack of follow-up training and links with the formal health care system. Often women are not referred to the hospital by traditional health workers until the eleventh hour, although among the Yoruba, first-time mothers are considered high-risk and often sent right to the hospital to labor. Respondents often saw hospital care as inadequate and staff as hostile. Fulani from more remote villages feel that hospital personnel singled them out for longer waits and particularly ill treatment because they are regarded as being "in a bush." Doctors" unwillingness to permit nurses to be trained to perform limited clinical procedures probably increases waiting time. In more urban areas of Oyo state, hospitals are able to impart with some success health information on maternal care. With respect to breastfeeding, however, hospitals in general appear to be doing little to change the widely held belief that colostrum is "dirty" and unhealthy for babies. The realities of the women"s lives described by respondents present a challenge -- and suggest solutions -- to policymakers, health planners, and program managers. (Author abstract)