Exploring health care professionals' and women's perspectives on the barriers to maternal health services: a qualitative study in Eku Town of Delta State, Nigeria

Uptake of maternal health services (MHS) have been shown to improve maternal health outcomes. In Nigeria, the maternal outcomes are classified among the poorest worldwide, despite the provision of free MHS to all pregnant women by many Nigerian state governments. The work was aimed at exploring the barriers to the uptake of MHS, from the perspectives of both women and health care professionals (HCP) in Eku Town of Delta State Nigeria, in order to gain a better understanding on views of MHS, and to guide future interventions, effective programs and policy strategies. Using an interpretivist and social constructivist epistemology approach, a qualitative study using 13 in-depth interviews were conducted. Seven women and six HCPs were recruited using purposive and snowballing sampling methods. Thematic content analysis was applied to the data. Three themes emerged. (1) Perspectives to free MHS. The majority of women preferred non-skilled Traditional Birth Attendants (TBAs) over the hospital heath service, as TBAs were viewed as more caring; with orthodox practice not being socially, culturally and religiously friendly. (2) Barriers to utilization: HCPs saw the barriers to hospital MHS as misconceptions by the women; the women mentioned the negative attitude of the HCPs and deficits in the free MHS scheme. (3) Enhancing utilization: HCPs stated that improved uptake of MHS required synergy between the community, government/hospital management through awareness, cultural/religious sensitivity, and HCP/TBA training. For the women, a change of HCPs hostile attitude and provision of more conducive hospital environment was required. There are a number of supply and demand factors that influence HCPs and women's perspectives of the uptake of MHS. Interventions and policies need to address both factors with the aim of improving the access and uptake of MHS in Nigeria.