'We delivered at home out of fear': Maternity Care in Rural Nigeria During the COVID-19 Pandemic

Zubairu Iliyasu; Amina A Umar; Fatima S Gaya; Nafisa S Nass; Hadiza M Abdullahi; Aminatu A Kwaku; Taiwo G Amole; Fatimah I Tsiga-Ahmed; Hadiza S Galadanci; Hamisu M Salihu; Muktar H Aliyu

doi:10.21106/ijma.632

'We delivered at home out of fear': Maternity Care in Rural Nigeria During the COVID-19 Pandemic

Int J MCH AIDS. 2023;12(1):e632. doi: 10.21106/ijma.632. Epub 2023 May 7.

Authors

Affiliations

¹ Department of Community Medicine, Bayero University, Kano, Nigeria.
² African Center of Excellence for Population Health and Policy, Bayero University, Kano, Nigeria.
³ Department of Obstetrics and Gynaecology, Bayero University Kano, Nigeria.
⁴ Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA.
⁵ Department of Health Policy & Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Tennessee, USA.

Abstract

Background and objective: The COVID-19 pandemic response overwhelmed health systems, disrupting other services, including maternal health services. The disruptive effects on the utilization of maternal health services in low-resource settings, including Nigeria have not been well documented. We assessed maternal health service utilization, predictors, and childbirth experiences amidst COVID-19 restrictions in a rural community of Kumbotso, Kano State, in northern Nigeria.

Methods: Using an explanatory mixed methods design, 389 mothers were surveyed in January 2022 using validated interviewer-administered questionnaires, followed by in-depth interviews with a sub-sample (n=20). Data were analyzed using logistic regression models and the framework approach.

Results: Less than one-half (n=165, 42.4%) of women utilized maternal health services during the period of COVID-19 restrictions compared with nearly two-thirds (n=237, 65.8%) prior to the period (p<0.05). Non-utilization was mainly due to fear of contracting COVID-19 (n=122, 54.5%), clinic overcrowding (n=43, 19.2%), transportation challenges (n=34, 15.2%), and harassment by security personnel (n=24, 10.7%). The utilization of maternal health services was associated with participant's post-secondary education (aOR=2.06, 95% CI:1.14- 11.40) (p=0.02), and employment type (civil service, aOR=4.60, 95% CI: 1.17-19.74) (p<0.001), business aOR=1.94, 95% CI:1.19- 4.12) (p=0.032) and trading aOR=1.62, 95% CI:1.19-2.94) (p=0.04)). Women with higher household monthly income (≥ N30,000, equivalent to 60 US Dollars) (aOR=1.53, 95% CI:1.13-2.65) (p=0.037), who adhered to COVID-19 preventive measures and utilized maternal health services before the COVID-19 pandemic were more likely to utilize those services during the COVID-19 restrictions. In contrast, mothers of higher parity (≥5 births) were less likely to use maternal health services during the lockdown (aOR=0.30, 95% CI:0.10-0.86) (p=0.03). Utilization of maternal services was also associated with partner education and employment type.

Conclusion and global health implications: The utilization of maternal health services declined during the COVID-19 restrictions. Utilization was hindered by fear of contracting COVID-19, transport challenges, and harassment by security personnel. Maternal and partner characteristics, adherence to COVID-19 preventive measures, and pre-COVID maternity service utilization influenced attendance. There is a need to build resilient health systems and contingent alternative service delivery models for future pandemics.

Keywords: COVID-19; Maternal Health; Maternal Health Services; Mixed Methods Study Design; Nigeria; Rural Nigeria.