Maternal Health Care Providers and the Challenges of Quality Services in Rural Communities of Kaduna State, Nigeria
It is widely assumed by maternal health care programmers and policy makers that expanding coverage of maternal health care services will improve reproductive health indices such as maternal mortality; this is without taking into account the quality of care especially in rural areas. Despite various attempts by Governments to increase the utilization of maternity service and improve maternal health, the progress made so far remains little in rural areas. This study examines the challenges faced by maternal health care providers in providing quality services in rural communities of Kaduna State. A community-based cross-sectional research design was adopted and data were obtained using both quantitative and qualitative methods. A survey of 300 women aged 15-49 years was carried out, using multi-stage sampling techniques involving Local Government Areas, wards, main streets, houses, households and individuals. Focus group discussions were conducted among women who delivered three months before the survey, and those who experienced acute morbidity and complications. In-depth interviews were conducted with maternal health care providers in the study communities. The study reveals inadequacy in equipment, number and quality of staff in the rural health facilities; younger women were more likely to have positive experience of care than older women. Care was discontinued if health care providers were perceived as unqualified, neglectful or too young. Many pregnant women were discouraged from taking their drugs due to the perception that the drugs increased the baby’s weight which makes delivery difficult. Engagement with political, religious leaders and community groups needs to be fostered through sensitization and sustained advocacy to remove constraints to accessibility of quality health care in rural areas.