PREFERENCE FOR TRADITIONAL BIRTH ATTENDANT SERVICES AMONG PREGNANT WOMEN ATTENDING ANTENATAL CLINIC IN RUMUOMASI COMMUNITY, RIVERS STATE

Abstract

This study investigated the factors influencing pregnant women’s preference for Traditional Birth Attendant (TBA) services over healthcare facilities in Rumuomasi, Rivers State. A quantitative survey research design was adopted, utilizing a structured questionnaire to gather data from a sample of 133 pregnant women attending antenatal clinics in the community. Data were analyzed using frequency tables, simple percentages, mean, and standard deviation, with hypotheses tested using the t-test to determine significant factors driving these preferences. The findings indicated that several cultural, economic, and perceived quality factors significantly influenced the preference for TBA services. Specifically, the convenience of home-based delivery and alignment with cultural beliefs were strong motivators for TBA service use. The findings also revealed that despite perceived safety concerns, many women preferred TBA services due to economic constraints and the perception that these services provided more personalized and culturally sensitive care. The analysis of cultural beliefs showed a significant influence on women’s choices, as many respondents viewed TBA services as an integral part of their cultural identity, offering a sense of familiarity and comfort. Economic factors also played a critical role, as financial constraints and the affordability of TBA services over hospital-based care impacted the decision-making process for many respondents. Additionally, perceived quality of care, which was associated with trust in TBAs and their traditional practices, contributed to the preference among women in Rumuomasi, even though many respondents acknowledged the potential risks involved. This suggests that while awareness of healthcare options exists, practical and cultural factors significantly impact decisions. The study concluded that TBA services remain a preferred option for many pregnant women in Rumuomasi due to cultural affinity, financial accessibility, and convenience. This preference indicates that despite advancements in maternal healthcare, traditional practices continue to hold considerable sway, often filling gaps in access to formal healthcare. The study emphasized the importance of understanding these underlying factors when designing maternal health programs aimed at improving antenatal care utilization. Bridging cultural and economic gaps between healthcare facilities and communities may be essential in fostering greater acceptance of healthcare facility-based services.

CHAPTER ONE
INTRODUCTION

1.1 Background to the Study

In many parts of Africa, particularly within rural and semi-urban areas, the role of traditional birth attendants (TBAs) in maternal healthcare remains indispensable. Despite the presence of modern medical facilities in most urban settings, a substantial number of pregnant women prefer the services of TBAs. This choice stems from a mix of cultural beliefs, accessibility, affordability, and the perceived personal care TBAs provide, creating a healthcare approach that feels more personalized and embedded in cultural heritage (Omoruyi, 2021).

Research shows that the popularity of TBAs in maternal health extends beyond isolated, remote regions; it also includes areas with proximity to healthcare facilities. Many women in these areas opt for TBA services due to trust in traditional practices and family influence, illustrating how local customs affect maternal care decisions (Titaley et al., 2020). In some communities, family members, especially elders, play a pivotal role in advocating for TBA services, adding another layer of social expectation that shapes healthcare choices (M’Cormack-Hale & Beoku-Betts, 2019).

Traditional birth attendants are not only healthcare providers but also custodians of community health traditions. They often serve as a bridge between past and present, fostering a sense of cultural continuity for families. This cultural connection creates a feeling of comfort and safety among expecting mothers, which is often missing in clinical healthcare settings. For instance, studies highlight how some TBAs provide emotional support that is deeply intertwined with local beliefs and values (Negin et al., 2020).

Accessibility to TBAs in rural communities plays a vital role in their continued use. For many women, visiting a distant healthcare facility is not a feasible option due to poor infrastructure, lack of transportation, and cost concerns. TBAs are typically located within the community, making their services more accessible and often more affordable than conventional healthcare services. This geographic proximity greatly influences the maternal healthcare choices of rural women (Mhame et al., 2021).

In some regions, TBAs offer more than just antenatal and childbirth services. They also play a part in educating women about maternal health practices, breastfeeding, and child care within the cultural context. Such guidance can enhance maternal confidence and foster better health practices postpartum, even if these practices may not always align with modern healthcare guidelines (Sibley et al., 2020). This emphasis on local knowledge sometimes results in a perceived superiority of TBAs over medical professionals who might lack cultural understanding of local customs.

Despite their integral role, TBAs face challenges regarding their ability to provide comprehensive maternal care. They often lack formal medical training, which can limit their ability to manage complicated deliveries and address maternal health emergencies effectively. This lack of training is a critical gap in maternal health in rural Africa, which can have significant consequences for both mothers and newborns in cases of medical emergencies (Sialubanje et al., 2022). Enhancing TBAs' training could serve as a pragmatic solution to improve maternal health outcomes while respecting cultural practices.

The healthcare choices made by expectant mothers are influenced by socio-economic factors, with poverty playing a substantial role in determining access to medical facilities. Many families in rural and semi-urban regions struggle with low incomes, making the affordability of TBA services a compelling factor. In contrast, the costs associated with clinical antenatal care and hospital deliveries are often prohibitive for many women, particularly in underprivileged communities (Labiran et al., 2022).

Furthermore, cultural beliefs about pregnancy and childbirth significantly influence the continued reliance on TBAs. In many African cultures, childbirth is viewed as a natural process rather than a medical condition, leading families to favor traditional methods over clinical intervention. Such beliefs reinforce the perception that TBAs, who practice within these cultural frameworks, are more suited to handle childbirth. This cultural alignment of TBAs with community values strengthens their role as primary maternal caregivers (Jokhio et al., 2023).

Community support also reinforces the utilization of TBAs, with many women finding encouragement from family and friends who have previously benefited from TBA services. This communal aspect of maternal health decisions emphasizes a shared trust in traditional methods, which clinical healthcare services may lack. This shared trust and community endorsement are crucial in regions where healthcare infrastructure is either underdeveloped or distrusted (Jerve et al., 2021).

An analysis of TBA practices in different African communities reveals a complex interplay of factors that sustain their role in maternal health. In Rumuomasi, Rivers State, Nigeria, the continued preference for TBAs underscores ongoing challenges in providing accessible and culturally sensitive maternal healthcare. Local perceptions of childbirth, coupled with the economic benefits and accessibility of TBA services, highlight the community's reliance on traditional practices over modern medical options (Irwin et al., 2022).

One solution to bridging the gap between traditional and modern healthcare systems involves integrating TBA services with formal healthcare initiatives. Training TBAs in essential maternal health practices can equip them to handle complications more effectively and refer cases that require advanced medical care. Such integration efforts can potentially reduce maternal and infant mortality rates while respecting cultural preferences and fostering trust within the community (Mills et al., 2022).

In some cases, the integration of TBA services into formal healthcare has led to promising outcomes. For instance, projects that involve training TBAs in early detection of pregnancy complications and emergency response have proven effective in reducing maternal health risks. Additionally, partnerships between healthcare professionals and TBAs can create a more cohesive healthcare framework that values both traditional knowledge and medical expertise (Lawn et al., 2021).

Policymakers aiming to improve maternal health outcomes in African communities must understand the cultural and socio-economic factors influencing maternal care choices. The role of TBAs cannot be underestimated, as they provide essential services to underserved populations. Developing policies that recognize and integrate TBAs into healthcare systems could improve maternal health outcomes in a culturally appropriate and sustainable manner (Nwankwo et al., 2021).

For sustainable improvements in maternal healthcare, education plays a critical role. Educating communities on the importance of skilled birth attendance while respecting their reliance on traditional methods can bridge gaps in healthcare. Information dissemination that highlights the benefits of clinical care without dismissing TBA practices may encourage balanced maternal health choices, ensuring safer delivery outcomes (Ogden, 2023).

In cases where healthcare infrastructure is available but underutilized, educational interventions can encourage expectant mothers to seek clinical services for high-risk pregnancies while still valuing the cultural support provided by TBAs. This balanced approach can help in building a maternal healthcare system that values safety, accessibility, and cultural sensitivity (Nwankwo et al., 2021).

Collaborative initiatives, such as mobile clinics and outreach programs, have shown promise in addressing maternal healthcare challenges in remote regions. These initiatives can bring medical services closer to the people while also involving TBAs in healthcare delivery. Such collaborations enhance the healthcare infrastructure’s reach without undermining the TBAs' role in the community (Ojeifo, 2022).

The evolution of maternal healthcare practices in Africa underscores the importance of adaptive solutions that accommodate both traditional and modern methods. By leveraging the strengths of both healthcare systems, communities can benefit from comprehensive maternal care that aligns with cultural expectations while meeting medical standards (Ityavyar, 2023).

As African healthcare systems continue to evolve, it becomes essential to adopt inclusive approaches that respect traditional practices while advocating for safer, clinically-backed maternal health options. This approach acknowledges the importance of cultural beliefs in healthcare decisions and emphasizes the need for flexible, context-specific solutions to maternal health challenges in Africa (Itina, 2021).

1.2 Statement of Problem

In many parts of Africa, particularly in rural and semi-urban areas, traditional birth attendants (TBAs) continue to play a crucial role in maternal health, even as modern medical facilities become increasingly accessible. However, existing research often lacks a nuanced understanding of the socio-cultural and economic factors that drive pregnant women to choose TBAs over clinical antenatal services, particularly in regions like Rumuomasi, Rivers State, Nigeria. Studies generally focus on rural or isolated communities, overlooking the dynamics within urban or semi-urban areas where healthcare facilities are available yet underutilized by segments of the population (Itina, 2021). This oversight has led to a gap in targeted interventions aimed at these specific populations who, despite their proximity to modern healthcare, continue to prefer TBA services.

The issue is further complicated by a lack of comprehensive data on the level of influence exerted by cultural beliefs and family traditions in these maternal care choices. Many studies on maternal health fail to deeply explore how cultural norms surrounding childbirth affect the acceptance and usage of modern healthcare facilities (Sialubanje et al., 2022). Furthermore, the personal, empathetic relationship TBAs offer, often valued in contrast to the clinical approach of healthcare facilities, remains underexamined as a significant factor in maternal healthcare preferences (Opiah et al., 2020). Understanding this relationship is crucial, as it could inform the development of community-centered maternal health programs that incorporate the trusted aspects of TBA services with safe, evidence-based medical care.

Economic constraints also present a gap in the research, as studies frequently attribute TBA utilization solely to cultural factors without sufficiently addressing how economic barriers impact these healthcare choices. The cost-effectiveness of TBA services compared to clinical options often goes unexplored, limiting the ability of policymakers to address financial barriers effectively (Labiran et al., 2022). By not fully addressing the economic motivations for choosing TBA services, existing research has not provided a complete picture of the barriers that pregnant women face.

Lastly, current studies are limited in scope regarding the potential integration of TBAs into the formal healthcare system. Research seldom explores how trained TBAs might complement clinical services, thus bridging the gap between traditional and modern practices to improve maternal health outcomes (Jokhio et al., 2023). Addressing these gaps is essential to designing effective interventions that encourage safer childbirth practices while respecting the cultural and economic realities of communities like Rumuomasi.

1.3 Objective of the Study

The purposes of this study are to:

1. Investigate the factors influencing pregnant women's preference for TBA services in Rumuomasi.
2. Assess the level of knowledge and perception of the safety and risks associated with TBA services.
3. Identify potential measures that could encourage the use of healthcare facilities for antenatal care among pregnant women in Rumuomasi.

1.4 Research Questions

The study seeks to answer the following questions:

1. What factors influence the preference for TBA services among pregnant women in Rumuomasi?
2. How do pregnant women in Rumuomasi perceive the safety and risks of using TBA services?
3. What strategies can be implemented to encourage the use of healthcare facilities for antenatal care?

1.5 Research Hypotheses

To guide the research, the following hypotheses will be tested:

1. There is no significant relationship between cultural beliefs and the preference for TBA services among pregnant women in Rumuomasi.
2. Economic factors do not significantly influence the choice of TBA services over hospital-based antenatal care.
3. Perceived quality of care does not significantly impact the preference for TBA services among pregnant women.

1.6 Significance of the Study

This study explores the socio-cultural and economic factors driving pregnant women's preference for traditional birth attendant (TBA) services in Rumuomasi, a community within Rivers State, Nigeria. While modern healthcare facilities are available in nearby urban areas, many women continue to choose TBAs over clinical options. Understanding these preferences provides valuable insights for healthcare providers and policymakers seeking to address maternal health needs effectively. Key factors influencing this choice include cultural traditions that regard childbirth as a natural, non-medical event, the perceived empathy and familiarity offered by TBAs, and financial limitations that make clinical care less accessible for some women.

By identifying these factors, the study offers a foundation for developing interventions tailored to local needs. For example, policymakers and healthcare professionals could introduce community-centered programs that increase awareness of antenatal care’s benefits, while respecting cultural beliefs that shape maternal care choices. Additionally, integrating trained TBAs within the formal healthcare system could help bridge the gap between traditional and modern practices, encouraging safer childbirth experiences. Programs that facilitate training for TBAs in basic medical practices and safe delivery techniques may lead to better health outcomes while preserving community trust in these providers.

The findings from this study align with Nigeria’s broader health goals, particularly in reducing maternal and infant mortality rates. Nigeria has made it a priority to improve healthcare access, especially for women in underserved areas. This research supports that goal by highlighting areas where healthcare delivery can be adapted to local socio-cultural contexts. For instance, targeted education campaigns, which incorporate both modern healthcare principles and local beliefs, can help demystify clinical care, reduce fear of hospitals, and address misconceptions. By fostering trust in modern healthcare, such campaigns can encourage more women to seek clinical antenatal services, particularly in cases of high-risk pregnancies.

Furthermore, this research underscores the importance of culturally sensitive healthcare. When women feel that their cultural values are respected within the healthcare system, they are more likely to utilize available services. Culturally sensitive health education campaigns can help correct misinformation about clinical care without undermining community traditions, ultimately improving healthcare uptake. In this way, the study provides a model for creating balanced, respectful interventions that could enhance maternal and infant health outcomes. Through these insights, healthcare providers and policymakers can design effective, sustainable solutions that both address and respect the unique needs of communities like Rumuomasi.

1.7 Scope of the Study

The study is focused on pregnant women attending antenatal clinics in Rumuomasi, Rivers State. It examines the reasons behind their preference for TBA services despite accessing clinical antenatal care. This research does not cover other maternal health aspects or healthcare providers outside Rumuomasi. Additionally, it is limited to examining TBAs’ influence on antenatal care and does not extend to other healthcare services provided by TBAs.

1.8 Operational Definition of Terms

1. Traditional Birth Attendant (TBA): A person, often without formal medical training, who assists mothers during childbirth based on cultural practices and personal experience.
2. Antenatal Care (ANC): Routine healthcare provided to pregnant women to monitor fetal development and maternal health, typically involving visits to a medical facility.
3. Maternal Mortality: The death of a woman during pregnancy or within 42 days of childbirth, often due to complications from pregnancy or delivery.
4. Preference: The selection or inclination towards TBA services over professional antenatal care.
5. Perceived Quality of Care: The subjective evaluation of the care provided by TBAs, based on personal experiences or community beliefs.
6. Cultural Beliefs: The values, practices, and norms within Rumuomasi that influence healthcare choices, particularly those related to childbirth.
7. Economic Factors: The financial considerations impacting the decision-making of pregnant women, such as cost differences between TBAs and hospital services.
8. Healthcare Facility Utilization: The extent to which pregnant women access professional health services for antenatal care and childbirth.