DETERMINANTS OF MIDWIVES SERVICE SCHEME UTILISATION AMONG WOMEN FARMERS IN SOUTHWESTERN NIGERIA

Abstract

Maternal mortality accounts for most deaths in agrarian communities of Nigeria due to poor access to midwives services and inadequate Skilled Birth Attendants (SBAs). The Midwives Service Scheme (MSS) was established to engage more SBAs and advocate better utilisation of pre and post-natal care services. Studies have focused on utilisation of MSS, however, information on underlying factors that predispose MSS target beneficiaries to its utilisation is scarce. Therefore, determinants of MSS utilisation among women farmers in southwestern Nigeria were investigated. A four-stage sampling procedure was used. Three states from southwestern states (Oyo, Ogun and Ekiti) were randomly selected. Thereafter, ten Local Government Areas (LGAs) from eighteen LGAs that adopted MSS programme in the selected states were sampled. Also, 30.0% of the MSS facilities in the sampled LGAs were selected, resulting in 13 MSS facilities. Proportionate sampling technique was used to select 20.0% of registered women farmers in the selected 13 MSS facilities to give 207 respondents. Interview schedule was used to collect data on respondents’ socioeconomic characteristics, Maternal Health Information Sources (MHIS), Maternal Health Information Seeking Behaviour (MHISB), attitude and accessibility to MSS services, affordability and effectiveness of MSS, utilisation of and constraints to MSS. Indices of MHISB (low, 20.0-37.8; high, 37.9-48.0), attitude (low, 55.0-64.1; high, 64.2-99.0), accessibility (low, 13.0-22.2; high, 22.3-34.0), affordability (low, 12.0-23.0; high, 23.1-34.0), effectiveness (low, 10.0-17.5; high, 17.6-40.0) and utilisation (low, 30.0-46.3; moderate, 46.4-64.7; high, 64.8-72.0) of MSS were generated. Data were analysed using descriptive statistics, Chi-square, Pearson Product Moment Correlation and Linear Regression at α0.05. Respondents’ age, family size and monthly income were 34.97±8.20 years, 6.70±1.50 persons and N22,014.43±13.08, respectively. More than half (55.6%) of the respondents had formal education and engaged in trading (58.0%) as their secondary occupation. Most (96.1%) of the respondents sourced maternal health information from community health extension workers. The maternal health information seeking behaviour, accessibility to MSS and affordability of MSS were low for 53.2%, 53.6% and 54.1% of the respondents, respectively. Though, respondents’ attitude toward MSS was favourable for 58.4%, effectiveness of MSS was rated low by 55.6% of the respondents and MSS was moderately utilised by 64.7% of the respondents. The MSS utilisation was 49.24±11.39 (Oyo), 45.08±9.28 (Ogun) and 44.00±10.71 (Ekiti). Respondents were mostly constrained by strike action of SBAs (1.89±0.25) and unavailability of essential drugs and vaccines at the MSS facilities (1.83±0.21). Respondents’ education (χ2=12.85), family size (r=0.02), monthly income (r=0.48), attitude to MSS (r=0.38) and constraints to MSS utilisation related positively and significantly (r=0.27) to MSS utilisation. The MSS utilisation was determined by MHISB (β=0.17), MHIS (β=0.19), its affordability (β= 0.24), respondents’ educational level (β=0.32), monthly income (β=0.50) and accessibility to MSS (β=0.60). Midwives Services Scheme utilisation in southwestern Nigeria was determined by maternal health information seeking behaviour, maternal health information sources, affordability, respondents’ educational level, monthly income and accessibility to the scheme.

Keywords: Women farmers, Skilled birth attendants, Child bearing, Maternal mortality

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