Project – Barrier to utilization of Antenatal care among women of reproductive age
CHAPTER ONE
INTRODUCTION
1.1. Background to the Study
Antenatal care (ANC) is a cornerstone of maternal and child health services, aimed at ensuring the well-being of pregnant women and their unborn babies. The World Health Organization (WHO, 2016) recommends a minimum of eight ANC contacts during pregnancy to enhance maternal and neonatal outcomes. ANC visits provide opportunities for preventive interventions, health education, and timely identification of pregnancy-related complications. By promoting early detection and treatment of health risks, ANC serves as a critical intervention to reduce maternal and child mortality worldwide.
Despite these benefits, ANC utilisation remains suboptimal in many low- and middle-income countries (LMICs). Studies indicate that women in LMICs often begin ANC late in pregnancy or attend fewer visits than recommended (Gabrysch & Campbell, 2009). This pattern undermines the effectiveness of ANC, as early and consistent contact with healthcare providers is necessary for maximum benefit. In Nigeria, although maternal health services are widely available in principle, actual utilisation is far below global recommendations (NPC & ICF, 2019).
Nigeria bears one of the highest maternal mortality ratios globally, estimated at 512 deaths per 100,000 live births, which accounts for about 20% of global maternal deaths (NPC & ICF, 2019). Poor utilisation of ANC is a major contributing factor. While some improvements have been observed in urban areas, including Abuja, disparities remain across socioeconomic groups. Access to services does not always translate into utilisation, and systemic, cultural, and personal barriers often hinder women from seeking timely and adequate ANC.
In urban centres like Abuja Municipal Area, health facilities are more available compared to rural regions. However, availability alone does not guarantee utilisation. Research suggests that women still face obstacles such as cost of services, distance, waiting times, and perceived poor quality of care (Doctor et al., 2018). These barriers disproportionately affect women in their prime reproductive years, including those aged 24–35, who often juggle employment, family obligations, and limited resources.
Socio-demographic factors such as education, income level, and marital status have also been shown to influence ANC utilisation. For instance, educated women are more likely to recognise the importance of ANC and to overcome cultural or logistical barriers to care (Fagbamigbe & Idemudia, 2015). Conversely, women with lower education or limited decision-making autonomy may depend heavily on partners or family members to access services, which can delay or reduce their ANC attendance.
Health system barriers further complicate ANC uptake. Long waiting times, negative attitudes of healthcare workers, and inconsistent availability of essential drugs and equipment discourage women from attending regular visits (Adewuyi et al., 2018). For many women in Abuja Municipal Area, even where facilities exist, the perception of poor service delivery or high out-of-pocket payments serves as a deterrent. These structural barriers are often exacerbated by weak health financing and uneven health workforce distribution.
Cultural beliefs and household dynamics also play a significant role. In many Nigerian communities, pregnancy is considered a natural process that does not always require medical supervision, especially if no complications are apparent (Adewuyi & Auta, 2019). Furthermore, women’s autonomy in health-related decision-making can be restricted by patriarchal norms, with husbands or mothers-in-law exerting influence on whether ANC is sought. Such socio-cultural constraints may be particularly pronounced for younger women within the 24–35 age group who are still establishing their independence.
Economic barriers remain one of the strongest determinants of ANC utilisation. Even in urban areas where services may be geographically accessible, costs associated with registration, laboratory tests, transportation, and drugs discourage many women from attending ANC consistently (Doctor et al., 2018). Women in low-income households, informal employment, or without health insurance are particularly vulnerable to these financial constraints. This indicates that urban residency alone does not eliminate financial inequities in healthcare access.
Addressing these barriers requires context-specific research. Studies conducted in Nigeria have highlighted significant variations in ANC utilisation across regions and socio-economic strata (Fagbamigbe & Idemudia, 2015; Adewuyi et al., 2018). However, there is limited empirical evidence focusing specifically on Abuja Municipal Area and women in the 24–35 age group. Given that this demographic constitutes a large proportion of Nigeria’s childbearing population, understanding their barriers to ANC use is vital for maternal health programming in the Federal Capital Territory (FCT).
In light of these realities, this study seeks to explore the barriers to ANC utilisation among women aged 24–35 in Abuja Municipal Area. Identifying the socio-demographic, economic, health system, and cultural factors that hinder ANC uptake will provide useful insights for policymakers, healthcare providers, and development partners. Ultimately, addressing these barriers could contribute to improved ANC coverage, reduced maternal mortality, and better maternal and child health outcomes in Nigeria.
1.2. Statement of the Problem
Maternal health remains one of the most pressing public health challenges in Nigeria. Despite the global and national commitments to achieving Sustainable Development Goal (SDG) 3, which seeks to reduce maternal mortality, Nigeria continues to account for a disproportionate share of maternal deaths worldwide (NPC & ICF, 2019). A key factor contributing to this crisis is the inadequate utilisation of antenatal care (ANC). Many women initiate ANC late in pregnancy, attend fewer visits than recommended, or fail to seek care entirely, thus undermining the effectiveness of interventions designed to safeguard maternal and neonatal health.
In Abuja Municipal Area, which is relatively urban and better served in terms of health infrastructure, one might expect higher ANC utilisation. However, evidence shows that several barriers still limit women’s access to and use of ANC services (Fagbamigbe & Idemudia, 2015). Financial costs, including registration fees, diagnostic tests, and medication expenses, discourage women from attending all recommended visits. For women in informal employment or low-income households, the out-of-pocket expenses often outweigh perceived benefits, leading to delayed or incomplete ANC attendance.
Distance to health facilities remains a critical issue even in Abuja. Many communities are not within walking distance of functional health centres, and transportation costs can be prohibitive, especially for women with limited financial independence (Adewuyi et al., 2018). Long waiting times at clinics further discourage attendance. For working-class women, particularly within the 24–35 age group, the opportunity cost of spending an entire day at a facility conflicts with employment and household responsibilities.
Another barrier is inadequate partner or spousal support. In many Nigerian households, men play a dominant role in financial and health-related decision-making (Adewuyi & Auta, 2019). Without the encouragement or approval of their partners, many women delay seeking ANC or may forgo it altogether. This dependency reduces women’s autonomy in making vital health decisions, exposing them to increased risk of complications during pregnancy and childbirth.
The quality of ANC services also plays a significant role in underutilisation. Negative experiences such as poor attitudes of healthcare providers, lack of privacy, and shortages of drugs and supplies discourage women from returning for subsequent visits (Doctor et al., 2018). Perceptions of low-quality care foster mistrust in formal health services, leading some women to rely on traditional birth attendants or informal care providers who may not be adequately equipped to handle complications.
Cultural and social norms further complicate ANC utilisation. In some communities, pregnancy is seen as a natural event that does not require medical supervision unless complications arise (Gabrysch & Campbell, 2009). Younger women, particularly those in the 24–35 age bracket who may be having their first or second pregnancies, may also face pressure from family members who undervalue the importance of formal ANC. This reliance on cultural beliefs and family traditions often results in late initiation of ANC or complete non-utilisation.
The cumulative effect of these barriers is an increased risk of preventable complications such as pre-eclampsia, anaemia, and infections, which could otherwise be detected and managed during routine ANC visits (WHO, 2016). Neonatal outcomes are also jeopardised, as poor ANC attendance increases the likelihood of preterm births, low birth weight, and neonatal mortality. Inadequate ANC thus perpetuates the cycle of poor maternal and child health outcomes in Nigeria.
Therefore, the problem at hand is not merely the availability of ANC services but the complex interplay of socio-economic, cultural, health system, and gender-related barriers that prevent women in Abuja Municipal Area from fully utilising them. Without addressing these challenges, efforts to reduce maternal and neonatal mortality in Nigeria will remain insufficient. This underscores the need for empirical studies focused on identifying and analysing these barriers within specific contexts and age groups, particularly women aged 24–35, to inform tailored interventions.
1.3. Aim and Objectives of the Study
The aim of the study is to examine the barrier to utilization of Antenatal care among women of reproductive age. The specific objectives are:
- To determine the level and timing of ANC utilisation among women aged 24–35 in Abuja Municipal Area.
- To identify socio-demographic and economic barriers affecting ANC utilisation among the target group.
- To examine health system-related barriers influencing ANC utilisation in Abuja Municipal Area.
- To explore socio-cultural and household factors influencing ANC utilisation among women aged 24–35.
1.4. Research Questions
The research questions are buttressed below:
- What is the level and timing of ANC utilisation among women aged 24–35 in Abuja Municipal Area?
- What socio-demographic and economic barriers affect ANC utilisation among the target group?
- What health system-related barriers influence ANC utilisation in Abuja Municipal Area?
- What socio-cultural and household factors influence ANC utilisation among women aged 24–35?
1.5. Research Hypothesis
The hypothetical statement of the study is buttressed below:
H₀: Socio-demographic, economic, health system-related, and socio-cultural factors are not significantly associated with ANC utilisation among women aged 24–35 in Abuja Municipal Area.
H₁: Socio-demographic, economic, health system-related, and socio-cultural factors are significantly associated with ANC utilisation among women aged 24–35 in Abuja Municipal Area.
1.6. Significance Of The Study
The findings of this study will provide crucial evidence to guide health planners and policymakers in addressing the specific barriers that hinder antenatal care (ANC) utilisation among women of reproductive age in Abuja Municipal Area. By identifying structural, socio-cultural, and economic challenges that limit women’s access to care, the study will enable policymakers to design more targeted interventions. Such evidence-based decision-making is vital in Nigeria, where maternal mortality remains one of the highest globally, with ANC utilisation being a key determinant of maternal outcomes (World Health Organization [WHO], 2022).
In addition, the study holds significance for health facilities within the Abuja Municipal Area. The results can inform the development of patient-friendly approaches, including flexible clinic hours to accommodate working women, streamlined service delivery to reduce waiting times, and improved staff–patient relationships to enhance trust and comfort. These modifications could increase ANC attendance rates and ultimately improve maternal and child health outcomes in urban areas where women face competing priorities and time constraints (Fagbamigbe & Idemudia, 2017).
The study will also benefit public health stakeholders and development partners such as non-governmental organizations (NGOs), donor agencies, and community-based organizations that are actively engaged in maternal health interventions. By shedding light on context-specific barriers in Abuja, the findings will enable these stakeholders to adapt global maternal health strategies to local realities. This alignment can maximize the impact of programs aimed at reducing maternal and neonatal morbidity and mortality (Adedokun et al., 2018).
Furthermore, this study contributes to the growing body of academic literature on maternal health in Nigeria. While previous studies have explored ANC utilisation in rural communities, relatively little research has been conducted in urban areas like Abuja, where challenges such as migration, rapid urbanization, and socio-economic inequalities uniquely shape healthcare-seeking behaviours. Thus, the study provides fresh insights into maternal health in an urban Nigerian setting (Ononokpono & Odimegwu, 2014).
From a socio-economic perspective, improved ANC utilisation has implications for household and community well-being. When mothers access timely and quality antenatal services, it reduces the risk of pregnancy-related complications, thereby lowering healthcare costs and safeguarding family livelihoods. The study’s findings could therefore indirectly support sustainable development goals (SDGs), particularly SDG 3, which emphasizes good health and well-being (United Nations, 2015).
For healthcare professionals, this study provides a framework to reflect on their service delivery practices. By highlighting patient-reported barriers such as long waiting times, unfriendly attitudes, or hidden costs, the study encourages a re-examination of professional standards and ethics in maternal care. This could foster a more empathetic and supportive environment where women feel valued and motivated to return for subsequent ANC visits (Doctor et al., 2012).
The research is also significant in promoting gender equity in healthcare access. Women in their reproductive years face unique health challenges that are often compounded by socio-cultural norms, economic dependency, and decision-making limitations within households. By addressing these barriers, the study contributes to empowering women and strengthening their agency in seeking essential maternal healthcare services in urban Nigeria (Ganle et al., 2016).
Finally, the study’s relevance extends to future researchers who may build upon its findings to conduct comparative studies across different Nigerian cities or between urban and rural populations. Such comparative analyses will deepen understanding of ANC utilisation dynamics across diverse contexts, thereby enriching the evidence base for designing robust, scalable, and sustainable maternal health interventions in Nigeria and beyond.
1.7. Scope of the Study
This study is limited to women of reproductive age (24–35 years) residing in the Abuja Municipal Area Council (AMAC) of the Federal Capital Territory, Nigeria. The age bracket was chosen because women within this range represent a significant proportion of the reproductive population, and they are most likely to engage with antenatal services during pregnancy. The focus on this group ensures that the findings are relevant to the demographic segment that experiences the greatest demand for maternal health services.
The study specifically investigates women’s experiences, perceptions, and the barriers they face in utilising antenatal care (ANC). It explores determinants such as socio-economic factors, cultural practices, educational level, healthcare infrastructure, and service delivery issues. By concentrating on these dimensions, the research aims to provide a holistic understanding of why women in Abuja may underutilise ANC despite the availability of healthcare facilities in an urban setting.
1.8. Delimitation of the Study
Geographically, the study is delimited to Abuja Municipal Area, which is characterized by a mix of urban, semi-urban, and peri-urban populations. This delimitation is important because the socio-demographic composition and healthcare infrastructure in Abuja differ considerably from rural areas in Nigeria. Hence, findings from this study cannot be generalized to all Nigerian women but will specifically reflect the realities of urban and semi-urban populations in the capital city.
The study does not cover clinical outcomes such as maternal or neonatal mortality rates, obstetric complications, or postnatal care indicators. Instead, its scope is restricted to the utilisation of ANC services and the barriers that prevent women from accessing them. This focus ensures that the study remains manageable, clear, and directly linked to service delivery improvements rather than clinical measurements.
In terms of participants, the study is delimited to women within the specified age group who are either currently pregnant or who have given birth within the last two years. This timeframe ensures that the participants’ experiences and perceptions of ANC services are recent and relevant, thereby reducing recall bias. Healthcare providers, policymakers, and community leaders are not included as direct respondents, though their perspectives may be indirectly reflected in the literature reviewed.
Additionally, the study is limited by resources, time, and accessibility. Only selected communities within Abuja Municipal Area will be included, and the findings will therefore represent a sample of the population rather than the entire municipality. While this may limit generalizability, it provides valuable context-specific insights that can serve as a foundation for broader studies.
By clarifying these boundaries, the scope and delimitation section ensures that the research maintains a clear focus, avoids unnecessary complexity, and provides reliable findings that are relevant to the stated objectives.
1.9. Definition of Terms
Antenatal Care (ANC): A type of preventive healthcare provided to pregnant women throughout pregnancy to monitor their health and that of the unborn child. It includes regular medical checkups, health education, and interventions aimed at reducing pregnancy-related risks (World Health Organization.
Utilisation of ANC: The extent to which pregnant women access and use antenatal healthcare services, measured by the timing of the first visit, number of visits, and adherence to recommended guidelines.
Barriers: Factors or challenges that prevent or discourage pregnant women from accessing or fully utilising ANC services. These may include financial constraints, cultural beliefs, distance to health facilities, lack of awareness, or poor quality of services.
Women of Reproductive Age: For this study, women aged 24–35 years who are biologically capable of conceiving and bearing children. This group is often actively engaged in childbearing and is therefore central to maternal healthcare interventions.
Maternal Health: The health of women during pregnancy, childbirth, and the postpartum period, with a focus on preventing complications that could result in maternal morbidity or mortality.
Perceptions: The attitudes, beliefs, and personal interpretations of women regarding ANC services, including their views on accessibility, affordability, quality, and relevance of care.
Abuja Municipal Area Council (AMAC): One of the area councils within the Federal Capital Territory of Nigeria, covering both urban and semi-urban populations with varying access to healthcare services (National Bureau of Statistics.
Determinants: Socio-economic, cultural, and health system-related factors that influence whether or not women seek and utilise ANC services.
