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. 2017 Sep 2;17(1):620.
doi: 10.1186/s12913-017-2560-1.

Who benefits from free institutional delivery? evidence from a cross sectional survey of North Central and Southwestern Nigeria

Anthony I Ajayi  1 , Wilson Akpan  2
Affiliations

Who benefits from free institutional delivery? evidence from a cross sectional survey of North Central and Southwestern Nigeria

Anthony I Ajayi et al. BMC Health Serv Res. .

Abstract

Background: The reasons for low utilisation of maternal health services in settings where the user-fee removal policy has been implemented continue to generate scholarly debates. Evidence of whether user-fee removal benefits the poor women in underserved settings is scanty and inconsistent. This article examines use of maternal health care services in the context of free maternal healthcare and profiles the beneficiaries of user-fee removal.

Methods: The study adopted a descriptive design. A three-stage cluster sampling method was used to select a representative sample of 1227 women who gave birth between 2011 and 2015. Questionnaires were administered using a face-to-face interview approach and data generated were analysed using descriptive and inferential statistics.

Results: The analysis shows that the use of maternal healthcare services has improved considerably in North Central and Southwestern Nigeria. While socioeconomic and geographical inequality in the use of maternal healthcare services appear to be disappearing in Southwestern Nigeria, it appears to be widening in North Central Nigeria. The findings indicate that 33.6% of women reported to have benefitted from the free child-delivery programme; however, substantial variation exists across the two regions. The proportion of beneficiaries of user-fee removal policy was highest in urban areas (35.9%), among women belonging to the middle income category (38.3%), among women who gave birth in primary health centres (63.1%) and among women who resided in communities where there was availability of health facilities (37.2%).

Conclusion: The study concludes that low coverage of the free maternal health programme, especially among women of low socioeconomic status residing in underserved settings is among the reasons for persistent poor maternal health outcomes in the context of free maternal healthcare. A model towards improving maternal health in underserved settings, especially in North Central Nigeria, would entail provisioning of health facilities as well as focusing on implementing equitable maternal health policies.

Keywords: Free maternal health policy; Inequality; Maternal health; User-fee removal.

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Conflict of interest statement

Ethics approval and consent to participate

The University of Fort Hare’s Research Ethic Committee (UREC) approved the study protocol (AKP031SAJA01). Written consent to participate was obtained from all study participants after explaining the aim of the study, and they alluded to understanding the aim of the study. The study was conducted by respecting the right of participants to privacy, anonymity, and confidentiality.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Trends in Antenatal care utilisation in Ondo, Ekiti, and Nasarawa states from 2008 to 2016
Fig. 2
Fig. 2
Trends in Births attended by skilled birth attendants in Ondo, Ekiti, and Nasarawa states from 2013 to 2016
Fig. 3
Fig. 3
Trends in Births that took place in health facilities in Ondo, Ekiti, and Nasarawa states from 2008 to 2016
See this image and copyright information in PMC

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