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 Format: MS WORD ::   Chapters: 1-5 ::   Pages: 85 ::   Attributes: Questionnaire, Data Analysis, Abstract ::   119 people found this useful

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Pregnancy and childbirth complications are the leading causes of maternal mortality worldwide, as an estimated 830 women lose their lives daily from preventable pregnancy- and/or childbirth-related causes. Over 99% of those maternal deaths occur in low- and middle-income countries (LMICs, including India). Antenatal care (ANC) provides a unique opportunity for screening and diagnosis, health promotion, and disease prevention among pregnant women, and their families and communities. Appropriate utilisation of ANC services corresponds to improved maternal and newborn health, as well as a reduction in maternal deaths during pregnancy and childbirth.

Based on the benefits of ANC, the World Health Organisation (WHO) recommends that pregnant women should attend at least four ANC visits to increase opportunities for risk stratification and/or the identification, prevention, and management of pregnancy and/or co-morbidities, as well as health promotion.

Worldwide, approximately 64% of women had attended four or more ANC visits in 2016. However, the attainment of the recommended ANC visits varied between and within countries, with LMICs reporting lower percentages. In Nigeria, previous reports have indicated that the proportion of women who had four or more ANC visits has increased by approximately 58% over a 10-year period, from 37% in 2006  to 61% in 2016. While this improvement in ANC service use may be commendable, it also suggests that many Indian women do not achieve the recommended four or more ANC visits, a proxy for comprehensive maternal care during pregnancy. This lack of access to appropriate ANC may have potentially adverse short- and long-term impacts on Indian women and newborns. These adverse effects may include maternal death or health loss from hemorrhage, hypertensive disorders, sepsis, and abortion, as well as stillbirth and neonatal death.

Past nationally representative studies conducted based on the 2005–2006 Nigeria Demographic and Health Survey (DHS) data elucidated a number of factors associated with the underutilization of ANC services. These factors included low parental education, urban residence, a lack of mass-media exposure, lower household wealth, the region of residence, and belonging to Scheduled Castes, Scheduled Tribes, and the other backward class. In addition, previous sub national studies suggested that financial and cultural issue, as well as a lack of awareness of the benefits of ANC among women and their partners, were also barriers to appropriate ANC service use. Nevertheless, it is uncertain whether these factors have changed in the past 10 years in Nigeria, given the improvements in household economic and educational status, social mobility of women, and the implementation of the Government of India maternal and child health interventions. These programs included the National Rural Health Mission (2005), the National Urban Health Mission (2008), and the Reproductive, Maternal, Newborn, Child, and Adolescent Health Strategy, introduced in 2013 to improve maternal and child health outcomes, including promotion of ANC service use. Understanding the contextual factors that influence a mother’s decision to attend, or not to attend ANC is crucial to healthcare practitioners and policymakers, as it can offer relevant information and opportunities for targeted policy interventions.

Additionally, findings from the 2005–2006 Nigeria DHS may also differ from those obtained from the 2015–2016 DHS, the data source for the present study, due to variations in the sample size and methods used. The 2015–2016 India DHS collected data from 601,509 households, drawn from about 1.2 billion people, compared to 110,000 households in the 2005–2006 DHS, drawn from approximately 1 billion people. Also, the 2015–2016 DHS methodology now forms the foundation for future national household surveys in India. The availability of improved methodology for health information gathering and data also suggests the need for up-to-date evidence on the determining factors of ANC service use to guide national maternal health efforts. Therefore, the study aimed to investigate the enablers and barriers to ANC service use in Nigeria.

The World Health Organisation (WHO) notes how a woman dies in every two minutes from pregnancy or related causes, the world over. Forty percent of the countries with high levels of maternal mortality are in sub-Saharan Africa (SSA), and women in the region face 15 times the risk of dying from pregnancy and childbirth situations compared to women in developed countries. Statistics indicate that many maternal deaths occur because of preventable causes such as hemorrhagic shock, infections, obstructed labour, and hypertensive disorders in pregnancy and abortion in rural northern Ghana [3]. Antenatal care (ANC) has been a valuable tool in reducing maternal deaths through; 1) early identification and management of obstetric complications such as pre-eclampsia, 2, tetanus toxoid immunisation, 3) intermittent preventive treatment for malaria during pregnancy (IPTp), and 4) identification and management of infections including HIV, syphilis and other sexually transmitted diseases (STDs). Therefore, the WHO recommends up to eight ANC visits for all expectant mothers in developing countries.

Even though the strategy has proved useful in addressing many problems in pregnancies and ensuring safe births, profound barriers to ANC utilisation continue to exist in many locations due to the interactions of socioeconomic influences (such as accessibility, cost), health service-related factors (such as lack of trained staff and other resources) and a diverse array of cultural beliefs and practices.

For example, in Tigray Zone, Ethiopia, many expectant mothers had no knowledge of the benefits they would derive from utilizing skilled maternity care; this lack of health literacy, combined with mockery, shame and stigmatization from the family and community if they sought ANC, resulted in the absence of ANC uptake. In some communities of the Upper West Region (UWR) the expectant mother had to gain approval from the husband (and in some locations, permission from the community) before seeking ANC at a health facility, and a man accompanying their wife to ANC was seen as a violation of cultural norms. In these locations, expectant mothers could register for ANC but fail to follow-up or implement therapeutic interventions, and preference for home birth took precedence over ANC.

Despite strong international efforts to expand the worldwide coverage of basic primary health services for women, pregnancy and childbirth still represent a high-risk period for mother and child; especially in low-income and middle-income countries. Reductions in maternal and early child mortality remain high on the global development policy agenda, which can be seen in its inclusion in the Sustainable Development Goal. However, nearly 3 million babies die every year during their first month of life, and in low-income and middle-income countries, many of those deaths and morbidities are due to easily preventable causes. Undetected infections during pregnancy, such as malaria, syphilis, tuberculosis, tetanus or HIV/AIDS, as well as high blood pressure, diabetes and other pre-existing health conditions often complicate or aggravate pregnancy and pose significant risk for mother and child. Antenatal care (ANC)—the services offered to mother and unborn child during pregnancy—is an essential part of basic primary.

Healthcare during pregnancy, and offers a mosaic of services that can prevent, detect and treat risk factors early on in the pregnancy. The detection of high-risk pregnancies through the analysis of socioeconomic, medical and obstetrical factors represents a key element of ANC. It is also often used as a platform for additional interventions that have been shown to positively influence the maternal and child health status, such as immunization and nutrition programmes and breastfeeding counseling, or to educate women about the possibilities of family planning and birth spacing. In addition, ANC programmes are used to provide care and information that is not directly related to pregnancy but can reduce the possible maternal risk factors, such as promoting healthy lifestyles, tackle malnutrition or inform about gender-based violence. Hence, ANC is a potentially important determinant in reducing maternal and child morbidity and mortality.

Within the last decades, the provision of ANC services has increased worldwide. During 2010–2015, the ANC coverage, defined as the percentage of women aged 15–49 years who attended at least one ANC visit with a skilled provider, was around 85% globally and approximately 77% in the least developed countries. To our knowledge, there exists no global study for all low-income and middle-income countries, which analyses the association of existing ANC services that are offered to pregnant women in low-income and middle-income countries on child health outcomes.

Numerous studies have helped to develop an internationally accepted set of so-called essential ANC services by evaluating the effects of single interventions, such as tetanus and malaria prevention programmes, on maternal and neonatal health25–30 or by studying the optimal number and content of ANC visit. However, the de facto offered and used set of ANC services can deviate greatly from the recommended ANC interventions. A couple of studies evaluate the relationship between the utilisation of ANC services and prenatal outcomes in individual low-income and middle-income countries. The majority have shown the positive effects of ANC on newborn mortality, the occurrence of stillbirth and preterm labour and low birth weight. However, they exclusively focus on single countries, are often conducted at the clinic level and have small sample sizes. This limits their external validity. We identified only one study that focuses on a larger regional sample. Conde-Agudelo et al studied 837 232 births in Latin America between 1985 and 1997. One major risk factor associated with fetal death was the lack of ANC. We could not find a study that took into account the possible long-term effects of the utilisation of ANC services on children’s nutritional and vital status. With up to 193 Demographic and Health Surveys (DHS) from low-income and middle-income countries, we use the most comprehensive data for low-income and middle-income countries that currently exist. Specifically, we investigate whether the attendance of mothers at ANC services was associated with improved short-term and long-term survival rates or reductions in the prevalence of low birth weight, stunting and underweight in their children.

Antenatal care (ANC) is the care a pregnant woman receives during her pregnancy through a series of consultations with trained health care workers such as midwives, nurses, and sometimes a doctor who specializes in pregnancy and birth. An analytical review of the recent World Health Statistics showed that ANC coverage, between 2006 and 2013, was indirectly correlated with maternal mortality ratio (MMR) worldwide. This indicates that countries with low ANC coverage are the countries with very high MMR. For instance, ANC coverage in United Arab Emirates was 100% with MMR of 8 per 100,000 and Ukraine had 99% ANC coverage and MMR of 23. By comparison, in subSaharan Africa, Ghana had ANC coverage of 96% and MMR of 380/100000, Chad had 43% ANC coverage and a MMR of 980/100,000, and Nigeria had ANC coverage of 61% and MMR of over 560. Nigeria’s MMR is clearly above the African and global average of 500 and 210 respectively. The poor maternal health outcome in Nigeria could be a result of poor ANC utilization although ANC coverage may not provide information on the quality of care provided.

The importance of ANC services in the outcomes for pregnant women has been well documented. ANC enhances early identification and management of conditions that could be threatening to the mother and her unborn child. ANC by trained skilled providers’ screens for infections, treats malaria, reduces the incidence of prenatal illness and death, provides birth preparedness, identifies signs of danger in pregnancy and plans to handle possible delivery complications through timely treatment and referrals. It also reduces medical problems in pregnancy such as anemia, hypertension, ectopic pregnancy, obstructed labour, eclampsia, excessive bleeding and premature labour and delivery. In particular, a clinical audit of antenatal services in Nigeria found better maternal outcomes among women who had completed ANC than those who had not though it may not directly reduce the risk of death.

Two nationally representative surveys were conducted recently in Nigeria: Nigeria Demographic and Health Survey (NDHS) in 2013 and National AIDS and Reproductive household survey (NARHS) in 2012. The two surveys showed that the proportion of pregnant women who had not attended any ANC services in Nigeria was 33.9% and 34.9% respectively. According to the 2013 NDHS, only 60.9% among women of child bearing age (15–49 years) who had a live birth in the five years preceding the survey received ANC from a trained skilled ANC provider (i.e., a doctor, nurse or midwife, or auxiliary nurse or midwife). Only half (51.0%) reported making four or more ANC visits during the pregnancy. About one third (36%) of births were delivered in a health facility while 38% of all deliveries within the five years were assisted by a skilled birth assistant (SBA). The attendance of ANC and delivery in a facility by a trained birth assistant are far lower than most other Africa countries. In sub-Saharan Africa, overall 75% had at least one ANC attendance, 48% had 4 or more ANC visits and 48% of deliveries were supported by skilled birth attendants.

In comparison with ANC coverage in Nigeria, a neighboring developing country, Mali, had 57% of pregnant women having at least one prenatal contact with a skilled ANC provider within five years preceding the DHS in 2001. In another developing country, Indonesia, about 95% of pregnant women attended at least one ANC visit and 66% of women had four ANC visits within five years before the 2007 DHS. This implies that Nigeria has not attained maternal health care success achieved over a decade ago in Mali and over 5 years ago in Indonesia. The questions are why are pregnant women not attending ANC in Nigeria? What are the limiting factors? What are the barriers?

Studies have documented the socio-demographic and other factors affecting ANC use. Lincentto et al. identified inability to pay for ANC services or prescribed treatment as an important barrier to utilization of ANC, a finding supported by two other studies. In situations where ANC uptake requires travel and long waiting hours, pregnant women and their families experience huge opportunity costs, such as the loss of income in order to attend services. Long distances to health facilities as well as insufficient number of ANC providers at various ANC clinics negatively affect ANC utilization.

Several studies have identified rural–urban differentials in use of ANC in Nigeria and elsewhere. The higher ANC coverage in urban areas than in rural areas worldwide has been ascribed to inequities in the number of accessible health facilities. In Nigeria, urban bias in public health expenditure, inadequate financing coupled with difficulties in attracting health workers to and retaining them in rural areas have limited government’s ability to create an accessible community based health care system which could reduce inequities in rural–urban health facilities. This scenario also occurs in other developing countries.

Family members of pregnant women as well as the community, have roles to play in ANC attendance. Their involvement in ANC utilization or otherwise affects use of ANC services. Families and communities often consider pregnancy as a natural process of life and therefore, underestimate the importance of ANC. Misunderstandings, conflict or poor communication among formal and informal health care providers and with health service seekers may cause low utilization of ANC services in certain communities. Unprofessional practices, attitudes and behaviours of ANC providers may further increase the non-utilization of ANC. Unprofessional conduct may include failure to respect the privacy, confidentiality, and traditional beliefs of the health seekers,


There is a need to understand the reasons and in particular the limiting factors for the low rates of antenatal care ANC uptake and by extension birth deliveries by a skilled provider in Nigeria. While several studies have identified determinants and factors affecting Antenatal care utilization, very few have focused on documenting the relationship between poor antenatal care and the incidence of mortality. This study in not only going to examine the rate of poor Antenatal care in Nigeria but will also have a comprehensive examination on the relationship of poor antenatal care and the incidence of mortality, using Abadam Local Government as a case study.


The main aim and objective of this research is to examine the relationship between poor antenatal care and the incidence of mortality in Abadam Local Government. Other objectives of this study include:

1. to examine reasons behind poor Antenatal care in Abadam local government.

2. to determine the effect of poor antenatal care on the incidence of mortality in  Abadam Local Government.

3. To identify the effects of poor Antenatal care on pregnant women in Abadam local government.

4. to examine other factors that contribute to mortality rate in Nigeria especially in Abadam local government.

5. to proffer solution to poor Antenatal care and incidence of mortality in Abadam local government.


1. What are the reasons behind poor Antenatal care in Abadam local government?

2. What is the effect of poor antenatal care on the incidence of mortality in Abadam Local Government?

3. What are the effects of poor Antenatal care on pregnant women in Abadam local government?

4. What other factor contributes to mortality rate in Nigeria especially in Abadam local government?

5. What are the possible solutions to poor Antenatal care and incidence of mortality in Abadam local government?


H0: there is no significant relationship between poor antenatal care and the incidence of mortality in Abadam Local government.

H1: there is a significant relationship between poor antenatal care and the incidence of mortality in Abadam Local government.


Antenatal care (ANC) is an important determinant of maternal and prenatal mortality and ANC attendance is an essential component of maternal health care on which the health of mothers and newborns depend. Globally, the number of women dying due to complications during pregnancy and childbirth decreased by nearly 50% from 1990 to 2013 but the number of deaths remains unacceptably high especially in low-income countries where 99% of these deaths occur which could be as result of illiteracy and lack of awareness as well as poor health facilities. In many cases, the negligence of the government to provide good health facilities to such communities especially the rural communities could be one factor to increase in mortality when there is no proper Antenatal care given. This study will create awareness to the government to understand the importance of providing good health facilities to these communities, sending professional health personnel’s to educate these women on the need to go for Antenatal care and check up. Most of these women need orientation or re-orientation on the need to go for Antenatal care to preserve both mother and child. This will help to curb the incidence of mortality.

Secondly, the study will serve as an enlightening tool to women in Abadam local government and the country at large on the importance of Antenatal care. This is very important because some belief system have it that it is a tabor for a woman to go to the hospital, in such cases, you find such women dying out of ignorant. This study will be an eye opener and a tool of learning. Finally, the study will be in the archive of knowledge for further research and recommendations by other researchers, it will serve as research tool for further knowledge.


The study covers relationship between poor Antenatal care and the incidence of mortality in Abadam Local government.


1. Financial constraint- Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

2. Time constraint- The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.


Relationship: the way in which two or more people or things are connected, or the state of being connected.

Poor: of a low or inferior standard or quality.

Antenatal care: Prenatal care, also known as antenatal care, is a type of preventive healthcare. Its goal is to provide regular check-ups that allow doctors or midwives to treat and prevent potential health problems throughout the course of the pregnancy and to promote healthy lifestyles that benefit both mother and child.

Incidence: Incidence in epidemiology is a measure of the probability of occurrence of a given medical condition in a population within a specified period of time.

Mortality: the state of being subject to death.

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