Barriers to reproductive health services among internally displaced women in northern Nigeria

Abstract

Introduction - Uptake of Reproductive Health Services (RHS) among Internally Displaced Persons (IDPs) is one of the lowest in the world and remains low even though !DPs are in safer areas where access to RHS should not be a problem. The study assessed the utilization of three continuum of RHS · including contraception, antenatal care and delivery care among Internally Displaced Women (IDW) in northern Nigeria. Methods - The study used cross-sectional research design and data on 422 women from three IDPs' camps. The sample was drawn from a population of IDW aged 15-49 years old who have ever given birth. The data was collected by the use of a structured questionnaire and Focus Group Discussion guide. The binary and multinomial logistic regression models were used for the quantitative analysis, while qualitative data was analysed by the thematic approache using the NVIVO 11 qualitative data analysis software. Results - The results show that age group 25-34 (OR=0.49, Cl=0.26-0.91 ); living more than 5 km from a health facility (OR=2.13, Cl=1 .12-4.03 ); and not wanting anather child were significant predictors of current use of contraceptives by IDW after controlling for all covariates simultenously. The result confirmed the hypotheses that "younger IDW are more likely than the older IDW aged >35 years to have been using contraceptives". However, the hypothesis that "IDW living within one kilometer to a health facility are more likely than those living more than 5 kilometers to a health facility" and "IDW who do not want another child are more likely to have been using contraceptives", were not confirmed. The control factors that remained significant predicors of current use of contraceptives: are being Muslim (OR=0.50, Cl=0.29-0;89), having regular access to the radio (OR=1 .89, Cl=1 .09-3.29) and living in Durumi (OR=2.81 , Cl=1.15-6.88) and New-Kachinguro camps (OR=0.30, Cl+0.14-0.67). The results of the multinomial logistic regression model, which tested for the factors predicting the uptake of 4 or more ANC visits relative to no ANC visit revealed that IDW with no education (OR=46, Cl=0.22-0.94) are significantly less likely to have attended the 4 or more ANC visits. The result also revealed that IDW who lived within one km to a health facility and IDW with a history of delivery complications were 1.01 (Cl=1.47- 4.14) and 1.74 (Cl=1 .05-3.17) times respectively significantly more likely to have attended the 4 or more ANC visits. The findings confirmed the hypotheses the with no education are significantly less likely to have attended the 4 or more ANC visits "IDW living within one km to a health facility are significantly more likely to have attended the 4 or more ANC visits"; and "IDW with a history of delivery complications are significantly more likely to have attended the 4 or more ANC visits". The result also shows that the significant control factors of attending the 4 or more ANC visits are: being a Christian (OR=0.45, Cl=0.22-0.93); living in an urban camp (OR=3.24, Cl=1.45- 7.25); living in Durmi camp (OR=1.21 , Cl=0.12-077); living in New-Kuchingoro camp (OR=0.30. Cl=0.91-2.11); and having a regular access to the radio (OR=12, Cl=0.03- 0.46). Regarding the findings on factors predicting health facility delivery, the results of the study shows that I OW living 5 or more Km from a health facility (OR=0.35; Cl=0.17- 0.72) and having no history of pregnancy complications (OR=0.24; Cl=0.13-0.44) are significant predictors of being less likely to have had HFD. The finding also confirmed the hypotheses that "IDW were more likely to have delivered in health facilities if they lived within one kilometer of health facilities than if they lived more than five kilometers from a health facility"; and "IDW were more likely to have delivered in a health facility if they had a history of pregnancy complications than if they had no history of pregnancy complications". Of all the control variables in the model, only displacement in Durku camp (OR=0.34, Cl=0.15-0. 79), having no access to the radio (OR=0.41, Cl=0.22-0. 75 and poor attitude of health workers remained significant predictors of HFD (OR=0.17, Cl=0.09-0.31) after controlling for all covariates simultaneously. Results on perspectives on barriers to RHS among IDW revealed that, desire for more children to replace dead family members, poor knowledge on the need for ANC, nonfunctional clinics , scarcity of professional health workers in camps, lack of equipment in the health facilities in camps, proximity to health faxilities and poor attitude of health workers are barriers to uptake of RHS. Other barriers indentified are poor timing of delivery, poor communication between mothers and health workers during referrals, availability of traditional birth assistants in camps and sudden onset of labour. Conclusion - Overall, it can be concluded from the .evidence in the study that current use of contraceptives; attending the recommended 4 or more ANC visits during the last pregnancy; and delivering the last birth in health facilities is low among IDW, which could explain the high rate of poor maternal health and infant mortality among IDW in Nigeria. Recommendations - Greater attention to RHS during humanitarian emergencies by the government and humanitarian agencies is required to improve the uptake of RHS by IDW. This can be done by ensuring greater investments in health services in IDP camps and addressing the RHS needs of IDW specifically. Additionally, greater security in IDP camps are required in order to improve health service delivery in general and RHS for women in particular.