FACTORS INFLUENCING PREFERENCE OF TRADITIONAL BIRTH ATTENDANT TO HOSPITAL DELIVERY AMONG WOMEN OF CHILD BEARING AGE IN OLUKU COMMUNITY

Abstract

This study explored the factors influencing women's preferences for traditional birth attendants (TBAs) versus hospital deliveries in Oluku Community, focusing on socio-cultural, economic, and quality-of-care dimensions. A quantitative survey research design was adopted to systematically investigate these factors. A structured questionnaire was meticulously designed and administered to a sample of 120 respondents drawn from the community. The collected data were analyzed using frequency tables, simple percentages, means, and standard deviations. Additionally, a t-test was employed to test the hypotheses formulated for this research. The findings revealed that socio-cultural factors significantly influenced the preference for TBAs over hospital deliveries. A majority of respondents expressed that cultural beliefs and traditions played a crucial role in their choice, with 49.1% strongly disagreeing that cultural beliefs did not affect their preference. Economic factors were also significant; the lower cost of services provided by TBAs was a major consideration for many, with 50% of respondents strongly agreeing that cost was a deciding factor. Accessibility issues further reinforced this preference, as the lack of accessible hospital facilities made TBAs a more convenient option for childbirth, with 62% strongly agreeing on this point. The perceived quality of care provided by TBAs was reported as more personalized and culturally sensitive compared to hospital-based services. Over 61% of respondents strongly agreed that TBAs offered a more culturally sensitive approach, which impacted their choice significantly. However, there was also a notable belief that TBAs provided care comparable to that of hospitals, though this was less emphatically endorsed. In conclusion, the study underscored the strong influence of socio-cultural beliefs, economic considerations, and accessibility issues on the preference for TBAs over hospital-based care in Oluku Community. The results highlighted that while TBAs are valued for their cultural sensitivity and lower costs, there is still a need to address accessibility and quality concerns associated with hospital-based services. Based on these findings, several recommendations were made. First, there should be enhanced community education to bridge the gap between traditional and modern healthcare practices. Second, improving the accessibility and affordability of hospital-based services could mitigate the reliance on TBAs. Third, integrating TBAs into formal healthcare systems could provide a hybrid approach that leverages the strengths of both systems. Fourth, continuous training and support for TBAs could ensure higher standards of care. Fifth, government policies should aim to improve healthcare infrastructure in remote areas to reduce accessibility issues. Lastly, further research should explore longitudinal impacts and include diverse geographic areas to generalize findings more broadly.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Childbirth is a significant event in a woman's life, often accompanied by a choice between various birth attendants and settings. In many parts of the world, especially in rural and semi-urban areas, traditional birth attendants (TBAs) play a crucial role in maternal healthcare. Despite advances in modern medicine and the availability of hospital-based maternity services, many women continue to prefer TBAs over hospital deliveries. This preference is influenced by various factors, including cultural beliefs, accessibility, perceived quality of care, and socio-economic status. Understanding these influences is vital for improving maternal health outcomes and ensuring that all women have access to safe childbirth services (Eze, 2020).

In Oluku Community, located in Nigeria, the preference for TBAs remains prevalent. The community is characterized by a blend of urban and rural features, with varying access to healthcare facilities. Traditional beliefs and practices continue to hold significant sway, influencing women's decisions regarding childbirth. TBAs are often trusted members of the community, known for their personalized care and deep understanding of local customs (Ogunyomi & Ndikom, 2020). This cultural alignment with TBAs provides comfort and a sense of continuity for expectant mothers, which is often lacking in hospital settings.

Accessibility is another critical factor influencing the choice of TBAs. In rural and semi-urban areas like Oluku, healthcare facilities are often sparse, and the infrastructure is inadequate, making it difficult for pregnant women to reach hospitals in time. TBAs, on the other hand, are usually community-based and easily accessible. They often offer flexible payment options or accept in-kind payments, which is a significant consideration for low-income families (Awotunde et al., 2021). This accessibility makes TBAs a practical choice for many women in these communities.

The perceived quality of care provided by TBAs also plays a crucial role in their preference. Many women in Oluku Community believe that TBAs offer more personalized and compassionate care compared to hospitals, where they may feel neglected or disrespected by medical staff (Imogie, 2021). The personalized attention and emotional support provided by TBAs can be particularly comforting during childbirth, a time of vulnerability for many women. This perception of care quality significantly influences the choice of birth attendants.

Socio-economic status significantly impacts the choice of birth attendants. In many cases, women from lower socio-economic backgrounds opt for TBAs due to the lower cost associated with their services compared to hospital deliveries. The financial burden of hospital care, including transportation, medical fees, and postnatal care, can be prohibitive for many families in Oluku Community (Fajemilehin, 1991). Consequently, TBAs become the more viable option, despite the potential risks involved. This financial aspect cannot be overlooked when considering the reasons behind the preference for TBAs.

The role of TBAs in the reduction of maternal mortality is a subject of debate. While some studies suggest that TBAs can be trained to recognize and refer complications early, others argue that their lack of formal medical training can lead to poor outcomes. In Oluku Community, there is a need for comprehensive training programs for TBAs to equip them with the skills necessary to manage basic complications and recognize signs that require urgent medical attention (Imogie, 2022). Training programs can help mitigate some of the risks associated with unskilled care.

The community's trust in TBAs is also reinforced by social factors. TBAs often share a close relationship with their clients, sometimes spanning multiple generations within a family. This deep-rooted trust and familiarity can make women feel more comfortable and secure during childbirth (Fofanah, 2020). Additionally, the fear of medical interventions and the perceived coldness of hospital environments further drive women towards TBAs. The role of trust in healthcare decisions is a critical factor in the preference for TBAs.

The influence of older generations on the younger ones is another factor to consider. In many cases, grandmothers and older women in the community, who have themselves utilized the services of TBAs, encourage younger women to follow the same path (Nwankwo et al., 2021). This generational influence reinforces the preference for TBAs and perpetuates the cycle of traditional birth practices. The respect for elder advice and continuity of cultural practices are strong motivators for choosing TBAs over hospital deliveries.

However, the reliance on TBAs does not come without risks. The absence of proper medical facilities and the lack of skilled care during childbirth can lead to severe complications, including prolonged labor, postpartum hemorrhage, and infections. In cases where TBAs are not adequately trained to handle such emergencies, the outcomes can be dire for both the mother and the child (Hall & Taylor, 2023). This underscores the importance of integrating TBAs into the formal healthcare system through training and collaboration.

Efforts to bridge the gap between traditional and modern healthcare practices are crucial. For instance, training programs that enhance the skills of TBAs, coupled with community education campaigns about the benefits of hospital deliveries, could reduce the risks associated with traditional childbirth practices (Ojeifo, 2021). Furthermore, improving the accessibility and affordability of hospital care would provide women with viable alternatives to TBAs. These efforts require coordinated action from healthcare providers, policymakers, and community leaders.

In essence, the preference for traditional birth attendants over hospital deliveries in Oluku Community is influenced by a complex interplay of cultural, socio-economic, and accessibility factors. While TBAs offer personalized care and cultural compatibility, the potential risks associated with their services cannot be ignored. It is essential to develop strategies that bridge the gap between traditional and modern healthcare practices, ensuring that all women have access to safe and competent childbirth care (Negin et al., 2020). This can be achieved through targeted training programs for TBAs, public health education, and the improvement of healthcare infrastructure in rural and semi-urban areas. Addressing these issues is crucial for reducing maternal and neonatal mortality rates and ensuring the health and well-being of mothers and their babies in Oluku Community.

1.2 Statement of Problem

The prevalence of traditional birth attendants (TBAs) in maternal healthcare, particularly in rural and semi-urban areas like Oluku Community, Nigeria, highlights a critical gap in healthcare services. Despite the availability of modern healthcare facilities, many women continue to prefer TBAs for childbirth, citing reasons such as cultural alignment, accessibility, and perceived quality of care. However, existing research has not sufficiently addressed the nuanced reasons behind this preference or the specific risks involved. Studies have often focused on the broader socio-cultural and economic factors without delving into the specific local beliefs and practices that sustain this preference (Imogie, 2022). Additionally, there is limited empirical evidence on the effectiveness of current training programs for TBAs in managing complications during childbirth and ensuring safe delivery outcomes (Awotunde et al., 2021).

Another significant gap is the lack of comprehensive data on the outcomes of births attended by TBAs versus those conducted in hospital settings, particularly in terms of maternal and neonatal mortality and morbidity rates. This information is crucial for developing targeted interventions that could mitigate the risks associated with TBA-led deliveries (Ofili & Okojie, 2023). Furthermore, there is a scarcity of studies exploring the potential for integrating TBAs into the formal healthcare system, which could provide a balanced approach to maternal healthcare by leveraging the strengths of both traditional and modern practices (Hall & Taylor, 2023).

This research aims to fill these gaps by conducting a detailed analysis of the factors influencing the preference for TBAs in Oluku Community, assessing the outcomes of TBA-led deliveries, and exploring strategies for integrating TBAs into the formal healthcare system. By addressing these issues, the study seeks to contribute to the development of safer and more effective maternal healthcare practices.

1.3 Objectives of the Study

The main objective of this study is to investigate the factors influencing the preference for traditional birth attendants over hospital delivery among women of childbearing age in Oluku Community. The specific objectives are:

1. To identify the socio-cultural factors that influence the preference for TBAs.
2. To assess the economic and accessibility factors contributing to the choice of TBAs.
3. To evaluate the perceived quality of care provided by TBAs compared to hospital services.

1.4 Research Questions

The study aims to answer the following research questions:

1. What socio-cultural factors influence women's preference for traditional birth attendants over hospital delivery in Oluku Community?
2. How do economic and accessibility factors affect the choice of TBAs among women in the community?
3. What are the perceptions of the quality of care provided by TBAs compared to hospital-based maternity services?

1.5 Research Hypotheses

To guide the investigation, the following hypotheses are proposed:

1. There is no significant relationship between socio-cultural beliefs and the preference for traditional birth attendants among women of childbearing age in Oluku Community.
2. Economic factors do not significantly influence the choice of traditional birth attendants over hospital delivery.
3. The perceived quality of care provided by traditional birth attendants is not significantly higher than that of hospital services among the women in the community.

1.6 Significance of the Study

The significance of this study lies in its potential to enhance understanding and improve maternal healthcare practices in Oluku Community and similar settings. The study's primary focus on the factors influencing the preference for traditional birth attendants (TBAs) over hospital deliveries provides critical insights into the underlying socio-cultural, economic, and logistical aspects that drive this choice. By identifying these factors, the study can inform public health strategies and interventions aimed at promoting safer childbirth practices.

One of the key contributions of this research is its potential to bridge the gap between traditional and modern healthcare systems. The findings could highlight the strengths of TBAs, such as their deep cultural understanding, trust within the community, and accessibility, while also addressing the limitations, particularly in managing complications and providing comprehensive maternal and neonatal care. This dual perspective is crucial for developing an integrated healthcare model that leverages the advantages of both traditional and modern practices. Such an approach could lead to improved training and regulation of TBAs, enhancing their ability to provide safer and more effective care.

Furthermore, the study's findings could inform policy decisions at the local, regional, and national levels. By providing empirical evidence on the outcomes of TBA-assisted births compared to hospital deliveries, the study can contribute to policy discussions on maternal healthcare. This evidence is particularly important for resource allocation, training programs, and the development of community-based healthcare initiatives. Policymakers could use the study's insights to design targeted interventions that encourage safer birthing practices and reduce maternal and neonatal mortality and morbidity rates.

The research also holds significance for healthcare providers and educators. Understanding the reasons behind the preference for TBAs can help healthcare professionals better address the needs and concerns of women in the community. This knowledge can guide the development of culturally sensitive educational programs that inform women about the benefits of modern healthcare services while respecting their cultural beliefs and preferences. By doing so, healthcare providers can build trust and encourage more women to utilize formal healthcare facilities, particularly for high-risk pregnancies.

In addition, the study's focus on Oluku Community, which exhibits a blend of urban and rural characteristics, provides valuable insights into the unique challenges and opportunities in such settings. The findings could be applicable to other communities with similar socio-cultural dynamics, thus extending the relevance of the research beyond the immediate study area. This broader applicability underscores the potential of the study to contribute to a wider discourse on maternal healthcare in diverse contexts.

Overall, the significance of this study is multifaceted. It addresses a critical gap in understanding the factors influencing maternal healthcare choices, offers practical insights for improving healthcare delivery, and provides a foundation for policy and program development. By exploring the complex interplay between cultural beliefs, accessibility, and healthcare practices, the study aims to promote safer and more effective maternal healthcare strategies, ultimately contributing to the well-being of mothers and infants in Oluku Community and beyond.

1.7 Scope of the Study

The study was limited to Oluku Community, focusing on women of childbearing age (15-49 years) who have experienced childbirth. It specifically examined the factors influencing the preference for traditional birth attendants over hospital delivery. The study considered socio-cultural, economic, and accessibility factors, as well as perceptions of the quality of care. Data collection was conducted through surveys and interviews with women who had recently given birth, as well as key informants such as TBAs and healthcare providers in the community.

1.8 Operational Definition of Terms

1. Traditional Birth Attendant (TBA): A person, usually a woman, who assists the mother during childbirth and initially acquired her skills by delivering babies herself or through apprenticeship to other TBAs.
2. Hospital Delivery: Childbirth that occurs in a medical facility, such as a hospital, under the supervision of trained healthcare professionals, including doctors and nurses.
3. Maternal Health: The health of women during pregnancy, childbirth, and the postpartum period.
4. Neonatal Mortality: The death of a newborn within the first 28 days of life.
5. Socio-cultural Factors: The social and cultural beliefs, practices, and norms that influence an individual's behavior and decisions, including healthcare choices.
6. Economic Factors: Financial considerations that affect access to and choice of healthcare services, including cost and affordability.
7. Accessibility: The ease with which healthcare services can be reached and utilized, including factors such as location, transportation, and availability of services.
   

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