The influence of new maternal care facilities in rural Nigeria

Intrapartum care was begun in a public sector comprehensivehealth centre in Obukpa Town, a rural Nigerian community inMay 1987. Its influence on the utilization pattern of maternalhealth care services was studied in a sample of 488 women whounderwent an abortion or childbirth between May 1987 and July1989. There was an increase in utilization of prenatal carefacilities in the comprehensive health centre, from 52% in 1987to 66% in 1989, and a decline in the use of other health facilitiesfrom 41 % to 31 %. Use of the comprehensive health centre forintrapartum 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 andattendant 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 publicand private sectors for prenatal care, and marginally lowerfor intrapartum care at the comprehensive health centre. Serviceby traditional birth attendants was free or paid for in kind.The use of the comprehensive health centre was shown to declinewith increasing distance from a woman's residence, and distancewas considered the determining factor in the choice of a privateor public health care institution. The implications of thesefindings for maternal health policy are discussed and recommendationsfor change are made.