ID Design 2012/DOOEL Skopje, Republic of
Open Access Macedonian Journal of Medical Sciences.
Effect of Free Maternal Health
Care Program on Health-seeking Behavior of Women during Pregnancy,
Intra-partum and Postpartum Periods in Cross River State of Nigeria: A Mixed
Betta Chimaobim Edu1*, Thomas U. Agan2,
Emmanuel Monjok3, Krystyna Makowiecka1
1London School of
Hygiene and Tropical Medicine, University of London, London, United Kingdom;
2Department of Obstetrics and Gynecology, University of Calabar
and the University of Calabar Teaching Hospital, Calabar, Nigeria; 3Departments
of Family Medicine and Community Medicine, University of Calabar and the
University of Calabar Teaching Hospital, Calabar, Nigeria
Increasing the percentage of maternal health service utilization in health
facilities, through cost-removal policy is important in reducing maternal
deaths. The Cross River State Government of Nigeria introduced a
cost-removal policy in 2009, under the umbrella of “PROJECT HOPE” where free
maternal health services are provided. Since its inception, there has been
no formal evaluation of its effectiveness.
This study aims to evaluate the effect of the free maternal health care
program on the health care-seeking behaviours of pregnant women in Cross
River State, Nigeria.
A mixed method approach (quantitative and qualitative methods) was used to
describe the effect of free maternal health care intervention. The
quantitative component uses data on maternal health service utilisation
obtained from PROJECT HOPE and Nigeria Demographic Health Survey. The
qualitative part uses Focus Group Discussions to examine women's perception
of the program.
Results suggest weak evidence of change in maternal health care service
utilization, as 95% Confidence Intervals overlap even though point estimate
suggest increase in utilization. Results of quantitative data show increase
in the percentage of women accessing maternal health services. This increase
is greater than the population growth rate of Cross River State which is
2.9%, from 2010 to 2013. This increase is likely to be a genuine increase in
maternal health care utilisation. Qualitative results showed that women
perceived that there have been increases in the number of women who utilize
Antenatal care, delivery and Post Partum Care at health facilities,
following the removal of direct cost of maternal health services. There is
urban and rural differences as well as between communities closer to health
facility and those further off. Perceived barriers to utilization are
indirect cost of service utilization, poor information dissemination
especially in rural areas, perceived poor quality of care at facilities
including drug and consumables stock-outs, geographical barriers, inadequate
health work force, and poor attitude of skilled health workers and lack of
trust in the health system.
Reasons for Maternal health care utilisation even under a cost-removal
policy is multi-factorial. Therefore, in addition to fee-removal, the
government must be committed to addressing other deterrents so as to
significantly increase maternal health care service utilisation.
Citation: Edu BC, Agan TU, Monjok E, Makowiecka K.
Effect of Free Maternal Health Care Program on Health-seeking Behavior of
Women during Pregnancy, Intrapartum and Postpartum Periods in Cross River
State of Nigeria: A Mixed Method Study. Open Access Maced J Med Sci.
Keywords: Free maternal health care service; utilisation; Cross River
*Correspondence: Dr Betta Chimaobim Edu. Formally Graduate student of
London School of Hygiene and Tropical Medicine, University of London, London
UK. Current Address: Primary Health Care Development Agency, Calabar, Cross
River State, Nigeria, Email: firstname.lastname@example.org
Received: 18-Mar-2017; Revised: 20-Apr-2017; Accepted: 03-Jun-2017; Online
Copyright: © 2017 Betta Chimaobim Edu, Thomas U. Agan, Emmanuel
Monjok, Krystyna Makowiecka. This is an open-access article distributed
under the terms of the Creative Commons Attribution-NonCommercial 4.0
International License (CC BY-NC 4.0).
Funding: This research did not receive any financial support.
Competing Interests: Publication of this paper has been supported by
Roche Macedonia DOOEL Skopje.
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- Edu BC
- Agan TU
- Monjok E
- Makowiecka K