Improving pregnancy care quality: Understanding women’s experiences with maternal health services in Nigeria

Nigeria has a history of poor maternal healthcare. Nigerian women are 500 times more likely to lose their lives during childbirth compared to women from high-income countries (HIC). In 2020, Nigeria had the highest number of maternal deaths (82,000) in the world and accounted for more than a quarter (28.5%) of global maternal deaths. This translates to about 145 maternal deaths every day. Low quality of care is a major driver of poor maternal health outcomes in Nigeria.

Quality of care has two components: provision of care and experience of care. However, efforts aimed at improving maternity care in Nigeria often focus on the ‘provision’ aspect of care alone. While it is important to invest in the supply aspect of care, it is also imperative that women’s experiences of care are given equal attention.

Aims

This study aims to map women’s pregnancy journey to examine their experiences in accessing care and investigate their ideas of satisfactory quality of maternity healthcare.

At the end of the study, we hope to plot a pregnancy journey map to understand women’s experiences in accessing care, and their perception of the quality of care received. We also expect to have gained an understanding of women’s satisfaction with the various maternal healthcare services (antenatal, intrapartum, and postnatal care) provided at their health facility.

Research Methodology

This study comprises two phases with distinct methods:

Phase 1:

• A systematic search of databases to identify facility-based and community-based studies on women’s satisfaction with maternal services in Nigeria. This review is guided by a PICOTS (Population, Intervention, Comparator, Outcomes, Timing, Setting) informed research question and eligibility criteria. The resulting studies will then be analysed.

Phase 2:

• The systematic review will be followed by a qualitative study. In-depth interviews (IDIs) will be conducted using the patient’s journey mapping tool to explore women’s experiences of, and satisfaction with, care. The study participants will include purposively sampled women in the last month of pregnancy registered in public health facilities, and public health workers working in the maternity ward of the health facilities. The study participants will be recruited from three public health facilities in Abuja, Nigeria—Garki Village Primary Health Clinic Garki (primary health facility), Wuse General Hospital (secondary health facility), and National Hospital Abuja (tertiary health facility). This recruitment method has been selected for the study to provide a better understanding of the experiences of women from the three healthcare levels. The number of participants will be determined by the anticipated information power from the different participant groups.
• Recruitment process: We will brief the potential participants on what the study entails and give them a participant information sheet. Potential participants will be given a minimum of 24 hours to consider participating or not, and a chance to ask questions about the research. Thereafter, the study participants will be recruited and given a written consent form to sign before participating in the study. Participants who are able to give consent but are illiterate will have the consent read and explained to them by the principal investigator and make a “mark” on the subject signature line. Afterwards, interviews will be conducted in a quiet location within the facility.
• Duration of study: The patients will be contacted for an interview in the last month of pregnancy. The reason for recruiting women at the late stage of pregnancy is because at that stage they should have decided on the exact place to deliver, hence providing a better opportunity to understand their experiences with health services until that point of the pregnancy. Thereafter, a follow-up interview will be conducted with the patients two to six weeks after pregnancy ends, regardless of the eventual place of birth (e.g., private clinic, home, referral hospital). IDIs will also be conducted with the health providers. The overall study duration, from recruitment to the end of data collection, is five months, from November 2023 – March 2024.

Although the patient journey mapping tool has been used to understand patient’s experiences in burn care, palliative care, non-communicable diseases, and pre-eclampsia, there is scant literature investigating its application to maternal healthcare in low- and middle-income countries. To the best of our knowledge, this is the first study that uses the patient’s journey mapping approach to study women’s experiences and satisfaction with maternity health care in Nigeria. The findings from this study will inform policy, improve health responsiveness, and ensure that women are provided with satisfactory and patient-centred maternity care.

This research is supported by Imperial College London President’s Scholarship Board.

Banner photo by Muhammad-taha Ibrahim on Unsplash