ABSTRACT

Antenatal care (ANC) utilization remains a pivotal determinant of maternal and neonatal health outcomes, particularly in sub-Saharan Africa where maternal mortality ratios continue to be disproportionately high. This study examined the impact of partner support on antenatal care utilization among pregnant women attending the University of Nigeria Teaching Hospital (UNTH), Enugu State, South-East Nigeria. The study adopted a descriptive cross-sectional design involving 320 pregnant women recruited through systematic random sampling from the obstetrics and gynaecology outpatient department of UNTH. Data were collected using a validated, structured, interviewer-administered questionnaire covering sociodemographic characteristics, obstetric history, levels of partner support (emotional, financial, and logistical), and ANC utilization patterns measured against the World Health Organization's recommended minimum of eight ANC contacts. Quantitative data were analysed using IBM SPSS Statistics version 26, with descriptive and inferential statistics including chi-square tests and binary logistic regression applied at p<0.05 significance level.

The findings revealed that 74.1% of respondents reported receiving some form of partner support during their current pregnancy, with financial support being the most prevalent (68.8%), followed by emotional support (61.3%) and accompaniment to ANC visits (44.1%). A statistically significant positive association was established between high levels of partner support and adequate ANC utilization (≥4 visits) (p=0.002, OR=3.47, 95% CI: 1.82–6.62). Multiparous women with low educational attainment and those from low-income households were significantly less likely to receive partner support and correspondingly less likely to utilize ANC services adequately. Barriers identified included partner ignorance about ANC benefits, cultural norms that regard pregnancy as a female responsibility, and financial constraints within households.

The study concluded that partner support is a significant independent predictor of ANC utilization among pregnant women at UNTH Enugu. Interventions targeting male partner education and engagement in antenatal care are strongly recommended as a strategy to improve maternal health outcomes in Enugu State and comparable health settings across South-East Nigeria. Health policies should integrate male-inclusive maternal health programming into routine antenatal services.

1.1 BACKGROUND TO THE STUDY

Antenatal care (ANC) constitutes one of the most critical components of maternal and reproductive health, serving as an essential platform for the detection, prevention, and management of pregnancy-related complications. The World Health Organization (WHO) revised its ANC model in 2016, recommending a minimum of eight ANC contacts to replace the earlier four-visit focused ANC model, in recognition of the complex and multifaceted health needs of pregnant women globally (WHO, 2016). Despite this global recommendation, a significant proportion of pregnant women in sub-Saharan Africa, including Nigeria, continue to fall short of the recommended number of ANC contacts, resulting in preventable maternal and neonatal morbidities and mortalities.

Nigeria's maternal mortality ratio stands among the highest in the world, with the country accounting for an estimated 28.5% of global maternal deaths as of 2023 (Healthy Newborn Network, 2024). Within Nigeria, the South-East geopolitical zone, while relatively better positioned than the North, continues to report sub-optimal ANC utilization rates, with uptake and quality concerns documented at teaching hospitals including UNTH Enugu. Nwabueze et al. (2023), in a cross-sectional survey of focused antenatal care awareness and utilization among pregnant women in Enugu State, found that despite relatively higher awareness of ANC services, actual compliance with recommended visit schedules remained inadequate, partly due to socioeconomic and psychosocial barriers.

One of the underexplored yet critically important determinants of ANC utilization is the role of male partners. Partner support, broadly conceptualised as the financial, emotional, informational, and instrumental assistance provided by a woman's male intimate partner during pregnancy, has been increasingly recognized as a pivotal enabler or barrier to maternal healthcare utilization. Evidence from Jigawa State, Nigeria, revealed that a majority of respondents who reported receiving support for ANC from their husbands had higher rates of ANC booking (Sabo et al., 2024). The spousal involvement in ANC has been shown to positively influence women's health-seeking behaviour, adherence to ANC schedules, and uptake of preventive interventions such as malaria prophylaxis and tetanus immunization.

Despite the mounting evidence globally on the importance of partner support in maternal health, empirical data specifically examining the relationship between partner support and ANC utilization within the tertiary hospital setting in South-East Nigeria remain sparse. The University of Nigeria Teaching Hospital, Enugu, as the premier tertiary health institution in the South-East, serves a diverse population that reflects the region's socioeconomic heterogeneity. Understanding how partner support influences ANC behaviour in this setting is essential for designing context-specific maternal health interventions. This study therefore aimed to assess the nature and extent of partner support received by pregnant women attending UNTH Enugu, and to determine its relationship with ANC utilization patterns.

1.2 STATEMENT OF THE PROBLEM

In spite of concerted national and global efforts to improve maternal health outcomes, Nigeria continues to face an unacceptably high maternal mortality ratio. A central contributor to this crisis is the persistent underutilization of antenatal care services, which deprives women of essential preventive, diagnostic, and therapeutic interventions during pregnancy. While considerable attention has been paid to supply-side barriers such as health facility inaccessibility, poor quality of care, and shortage of skilled healthcare providers, demand-side factors particularly the influence of intimate partner dynamics have received comparatively limited attention in research conducted within Nigerian tertiary hospitals.

At UNTH Enugu, preliminary observations suggest that a significant proportion of pregnant women attend ANC without their partners, arrive late for their first booking visit, or drop out of ANC entirely before completing the recommended number of contacts. This pattern is believed to be substantially influenced by the absence or inadequacy of partner support. Cultural norms prevalent in South-East Nigeria may position pregnancy management as a female-exclusive responsibility, thereby limiting partner engagement in ANC processes. When partners are uninformed about the importance of ANC, fail to provide financial resources for transportation and consultation fees, or are unsupportive emotionally, women's ability to consistently utilize ANC services is significantly compromised.

The evidence gap concerning the specific dimensions of partner support most predictive of ANC utilization adequacy at UNTH Enugu represents a significant research lacuna. Without this evidence, health planners and clinicians lack the empirical foundation necessary to design targeted male-engagement interventions. This study was designed to address this problem by systematically examining the relationship between various dimensions of partner support and ANC utilization among pregnant women at UNTH Enugu.

1.3 OBJECTIVES OF THE STUDY

The general objective of this study was to assess the impact of partner support on antenatal care utilization among pregnant women at the University of Nigeria Teaching Hospital (UNTH), Enugu.

The specific objectives were to:

i. Determine the sociodemographic characteristics of pregnant women attending ANC at UNTH Enugu.

ii. Assess the level and types of partner support (emotional, financial, informational, and logistical) received by pregnant women.

iii. Evaluate the pattern of ANC utilization among the respondents in terms of timing of first visit and number of ANC contacts.

iv. Examine the relationship between partner support and ANC utilization among pregnant women at UNTH Enugu.

v. Identify factors that mediate the relationship between partner support and ANC utilization.

1.4 RESEARCH QUESTIONS

The following research questions guided the study:

i. What are the sociodemographic characteristics of pregnant women utilizing ANC at UNTH Enugu?

ii. What are the types and levels of partner support received by pregnant women at UNTH Enugu?

iii. What is the pattern of ANC utilization among pregnant women at UNTH Enugu?

iv. Is there a significant relationship between partner support and ANC utilization among pregnant women at UNTH Enugu?

v. What factors mediate the relationship between partner support and ANC utilization?

1.5 RESEARCH HYPOTHESES

Ho1: There is no statistically significant relationship between partner support and ANC utilization among pregnant women at UNTH Enugu.

Ho2: Sociodemographic factors (educational level, income, parity) do not significantly moderate the relationship between partner support and ANC utilization.

1.6 SIGNIFICANCE OF THE STUDY

The findings of this study are significant for multiple stakeholders in maternal health planning and delivery. For health policy makers at federal and state levels, the study provides evidence-based insights that can inform the integration of male partner engagement strategies into Nigeria's national ANC policy frameworks. For healthcare administrators at UNTH and comparable tertiary institutions, the findings offer a basis for restructuring ANC services to be more partner-inclusive, such as creating designated sessions for partner health education.

For healthcare providers including obstetricians, nurses, and midwives the study highlights specific dimensions of partner support that they can address during ANC consultations through structured counselling. For researchers, the study contributes to the growing body of literature on demand-side determinants of ANC utilization in Nigeria, providing a template for future investigations in other geopolitical zones. Ultimately, by improving understanding of how partner support drives ANC utilization, the study contributes to the broader goal of reducing preventable maternal and neonatal mortality in Enugu State and South-East Nigeria.

1.7 SCOPE OF THE STUDY

This study was geographically delimited to the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu State, Nigeria. UNTH was selected because it is the premier tertiary health institution in the South-East geo-political zone, serving a large and diverse population of pregnant women from Enugu State and neighbouring states. The study population comprised pregnant women in their second and third trimesters who were registered and actively attending ANC at the obstetrics and gynaecology outpatient clinic of UNTH. Pregnant women in their first trimester were excluded to ensure that respondents had accumulated sufficient ANC experience to meaningfully report on partner support and utilization patterns. The study was cross-sectional in design and data were collected within a three-month period. It focused exclusively on heterosexual intimate partner dynamics and did not extend to support from other family members or healthcare providers.

1.8 DEFINITION OF TERMS

Antenatal Care (ANC): The comprehensive clinical, educational, and supportive care provided to pregnant women from the time of conception confirmation to the onset of labour, aimed at promoting maternal and fetal well-being, detecting pregnancy complications early, and preparing women for safe delivery and postpartum care.

Partner Support: The various forms of assistance, encouragement, and involvement provided by a pregnant woman's male intimate partner (husband, fiancé, or cohabiting partner) during pregnancy, encompassing emotional support (reassurance, affection), financial support (provision of funds for ANC visits), informational support (sharing knowledge about pregnancy health), and logistical support (accompanying the woman to ANC visits or providing transportation).

ANC Utilization: The actual use of antenatal care services by a pregnant woman, measured in this study by the timing of the first ANC booking visit (early = before 12 weeks gestation), the total number of ANC contacts made during the current pregnancy (adequate = ≥4 visits per WHO minimum standard), and adherence to recommended ANC schedules.

Adequate ANC Utilization: In this study, defined as making at least four antenatal care visits during the current pregnancy, in line with the WHO's focused antenatal care minimum recommendation, and booking the first ANC visit within the first trimester (before 13 weeks of gestation).

University of Nigeria Teaching Hospital (UNTH): A premier federal tertiary health institution located at Ituku-Ozalla, Enugu State, Nigeria. It serves as the teaching hospital for the College of Medicine, University of Nigeria, Nsukka, and provides specialist maternal and obstetric services to women across South-East Nigeria.

Intimate Partner: In this study, the male partner (whether legally married, engaged, or cohabiting) with whom the pregnant woman shares a romantic relationship and who may or may not reside in the same household.

Gestation: The period of development of the fetus within the uterus from conception to delivery, measured in weeks. First trimester: weeks 1–12; second trimester: weeks 13–26; third trimester: weeks 27–40.

Parity: The number of times a woman has given birth to a viable infant (≥22 weeks gestation). A nulliparous woman has had no previous deliveries; a primiparous woman has had one; and a multiparous woman has had two or more.

REFERENCES

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