ADEJOH, Samuel Ojima; ALABI, Tunde A.; OSAZUWA, Peter and OLUFEYISAN, Motunrayo Ayobami
ABSTRACT
Maternal healthcare and mortality, among other troubling health issues, are on the front burner in developing countries, Nigeria
in particular. This study explored the influence of perceived causes of caesarean section, fear of caesarean section and infertility on the continued utilization of traditional birth attendants (TBAs). The study employed the qualitative method, utilizing in-depth interview to collect data from thirty (30) women who have ever been pregnant and ever used TBA. The data were content analysed using themes. It was found that the participants believed that these conditions can be treated using traditional herbs and concoction prepared by TBAs; hence, the preference for TBAs. Placenta size, low blood count, baby in the breech position, high blood pressure and prolonged labour were perceived and identified as factors that warrant caesarean section. Participants said the use of TBAs for child delivery is not only pain free, requiring no caesarean section, but also affordable and accessible; TBAs use incantation
whenever ‘delivery is difficult’. Thus, the study recommends that women should be sensitised on the circumstances that warrant caesarean section for child delivery and its probable effects. This will guide them in making informed decision on the place of delivery to avert maternal and neonatal risks.
KEY TERMS: Infertility, fear, traditional birth attendant, caesarean section, prolonged labour, Nigeria.
INTRODUCTION
Maternal mortality is one health issue that has remained a big challenge for governments in developing
countries like Nigeria. Maternal mortality in Nigeria is estimated at 814 per 100 000 as at 2015, with maternal deaths put at 58,000. In Nigeria, only 39% of women in Nigeria delivered their live birth in a health facility, while 59% delivered at home (National Population Commission, 2019). The high child and maternal mortality rates are attributed to non-utilisation of quality healthcare delivery services. In Nigeria, only six in ten mothers receive antenatal care from a trained medical professional. Nurses and midwives are the most frequently used source of healthcare (WHO, UNICEF, UNFPA, 2015). Problems such as money for treatment, distance to health facility, fear of caesarean section and transportation are some of the many difficulties stated by women as obstacles to accessing orthodox healthcare. Consequently, women patronize TBAs for child delivery and other health-related assistance. Against this background, this study explored how perception and fear of caesarean section and infertility influence utilization of traditional birth attendants for antenatal and delivery among ever pregnant women using the qualitative method of data collection.
BACKGROUND
The World Health Organisation (2019) reported that Nigeria accounted for nearly a quintile of the total maternal deaths in the world. These maternal deaths have been attributed to lack of adequate access to health care services. There is only one doctor to 6000 people in the country (BBC, 2019). Due to the insufficient health care services, the competition is high and those with lower household wealth and far physical distance have little or no access to government-approved hospitals/child delivery centres (Fotzo, Ezeh and Oronge, 2008; Titaley, Hunter, Dibley and Heywood, 2010). Aside poverty and physical distance, the preference for vaginal delivery could be a factor for non-use of hospitals for child delivery.
The rate of caesarean section (C/S) delivery has increased globally. However, the rate in Nigeria stands at 2%, and no state in the country had up to 10% rate of C/S delivery (Boerma et al., 2018). This may not be unconnected with the fact that C/S is perceived in negative light in the country and feared by many women. The prayer that won ni fi obe gbe’bi ni inu e (may you not be delivered via surgery/C/S) is an indication that delivery through C/S is perceived as unfortunate among many populations in the country. It is not uncommon to see women who deliver through vaginal delivery do thanksgiving in places of worship. Sunday-Adeoye and Kalu (2011) reported that only 1.4% of their respondents viewed C/S as very good. The participants of Chigbu and Iloabachie (2007) attributed their prevalence of C/S refusal to financial cost, fear of death and desire to experience vaginal delivery.
Consequently, expectant mothers who have low income, cannot afford the regular cost of transportation from their home to the health centre, have complications and have been advised to deliver through C/S resort to traditional birth attendants (TBAs) whose services are perceived to be cheaper and yield positive outcomes.
The second problem is that, many phenomenon –including infertility and maternal deaths- in Nigeria are often attributed to spiritual forces. In fact, women who are unable to conceive after few years of marriage -primary infertility- or unable to conceive again after the first successful delivery-secondary infertility- are usually threatened and embarrassed by the spouse’s family (Adejumo & Adekunle, 2017). The attribution of infertility to spiritual forces coupled with the pressure to get pregnant and the fear of losing their marriage push women to patronise TBAs who are viewed to have expertise in solving spiritual problems- a matter that is outside the purview of orthodox medicine. It is from the foregoing that this study seeks to provide answers to the questions;
(1) what are the perceptions of ever pregnant women on the causes of C/S? (2) How do women’s experience and fear of C/S make them patronise TBAs? (3) How does the problem of infertility expose women to the TBAs, and what are the outcomes of women’s patronage of TBAs? The answers to these questions have implications for nursing and medical social work practice as it will show what form of education and re-orientation, if need be, is required for improved child and maternal health.
The study revolves around acceptability and perceptions of TBAs. Consequently, the health belief model
(HBM) will be useful for this study. The HBM revolves around four constructs and hypotheses, namely; (1)
perceived severity- individuals who perceive a given health problem as serious and life-threatening are more likely to engage in any available behaviours to prevent the health problem from occurring (or reduce its severity); (2) perceived susceptibility- the extent to which an individual thinks that they are vulnerable to a disease will determine how serious they will engage in behaviours to reduce their risk of contracting same; (3) perceived benefits- if an individual believes that a particular health seeking action/behaviour will reduce susceptibility to a health problem or decrease its seriousness, they are likely to engage in that behaviour regardless of actual effectiveness of such action; (4) perceived barriers-even if an individual believes a health condition is lifethreatening and that a particular action will effectively reduce the threat, barriers may prevent engagement in the health-promoting behaviour. The HBM will help to understand people’s perception and fear of C/S and infertility, and how women’s perceived effectiveness or otherwise of TBAs influences their utilization of TBAs for child delivery and other maternal and child health assistance.
METHODS
The study used qualitative method of data collection. The qualitative method was informed by the need to have an in-depth understanding of women’s patronage of TBAs and their experiences therein. The study was conducted in Obafemi-Owode local government area, Ogun State, Nigeria. The study population was comprised of ever-pregnant women in the local government area; specifically, women of reproductive age (15-49) who had utilized the services of traditional birth attendants identified first through snowball in the four selected communities- Mowe, Asese, Ibafo and Magboro. The women are those who had ever patronised the TBA for child delivery or treatment of pregnancy related issues or currently utilizing the services of a TBA. An in-depth interview guide was used to collect data and the participants were asked questions directly and their responses were recorded using a tape recorder. The interview format was both open-ended and semi-structured. The languages of interview were English and Yoruba.
Regarding sampling, a total of 30 women participated in the study. However, data redundancy set in after the 28th participant was interviewed, but to ensure that data saturation was achieved, two more participants were interviewed to find out if new information will be extracted. Among the participants, twelve (12) pregnant women were from Mowe; 6 from Asese, 9 from Ibafo and 3 from Magboro communities. The purposive and snowball sampling techniques were adopted in selecting participants. Some of the participants were recruited at the homes of the TBAs as they come in for consultations and were approached with the knowledge and permission of the TBA. The interviews for those recruited at the homes of the TBAs took place in the premises of the TBAs but in a secluded place with just the participant and the interviewer to ensure confidentiality of information given. Some others were recruited through snowball technique as some of them were located in their homes, workplaces and
places of worship. For this group of participants, the interview took place, in a location comfortable for the participant to have the conversation with the interviewers. The permission to conduct the study was approved by the Department of Sociology, University of Lagos since there is no ethical review board yet in the Department.
The traditional rulers in each community also nodded to the study before participants were approached. An oral informed consent was obtained from the participants after the purpose of the study was explained to them. Participation in the study was voluntary and no name or any identifying information was collected or recorded. A thematic analysis was used in the data analysis because it was sufficient to analyse data and enabled the identification of the main themes that summarise all the views collected through annotating transcripts, identifying themes, developing code schemes and coding data. The findings were presented in three themes. A theme addresses each research question.
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