Socio-economic factors contributing to exclusion of women from maternal health benefit in Abuja, Nigeria

Abstract

The study was conducted to describe how socio-economic characteristics (SEC) of women affect their utilization of maternal healthcare services in Abuja Municipal Areas Council (AMAC) in Abuja Nigeria. A non-experimental, facility-based cross-sectional survey was done. Data was collected using structured interviewer administered questionnaire in 5 district hospitals in AMAC. Sample size of 384 was calculated a priori based on the assumption that 50% of the target population utilized maternal healthcare services during their last pregnancy. Equal allocation of samples per facility was done. The ANC register was used as the sampling frame and proportionate allocation of samples per clinic days was undertaken in each facility. Data analysis included descriptive statistics, cross tabulations and measures of inequality. Logistic regression analysis was used to test the hypothesized relationship between socioeconomic characteristics (predictors) and maternal healthcare service utilization. Other than birth order that showed consistent effect, the results of this study indicated that the predictive effect (predisposing and enabling factors) of the SEC of women included in this study (age, education, birth order, location of residence, income group and coverage by health insurance) on maternal healthcare service utilization were not consistent when considered independently (bivariate analysis) as opposed to when considered together through logistic regression. In addition, the study revealed that there was inequality in the utilization of maternal healthcare services (ante-natal care - ANC, delivery care and post natal care - PNC, and contraceptive services) among women with different SEC, and the payment system for maternal healthcare services was regressive. Addressing these predictors in the natural co-existing state (as indicated by the logistic regression) is essential for equitable access and utilization of healthcare during pregnancy, delivery and the postnatal period, and for contraceptive services in AMAC, Abuja Nigeria. Targeted policy measures and programme actions guided by these findings are recommended to optimise returns on investment towards achieving national and global goals on maternal health in Nigeria