The barriers preventing pregnant women from accessing midwife-led antenatal care in Nigeria

Abstract

Background: Nigeria records high maternal deaths despite available antenatal care services in the country. This review aims to synthesise literature on barriers affecting access to midwife-led antenatal care (ANC) among pregnant women in Nigeria.Methods: This is a systematic literature review and involved searching of studies done in Nigeria and published between 2007 and 2018. MEDLINE 1946 to present, CINAHL, JBI, and Pubmed Central were electronically searched to identify studies on barriers affecting access to midwife-led ANC among pregnant women in Nigeria. Reference lists were hand-searched, Grey literature; Google scholar, and NuSearch e-dissertation were also searched.  Citation chaining was also used. Twenty articles met the inclusion and exclusion criteria while only seven out of the twenty were included in the review after quality appraisal.Results: The data synthesis of the literature review showed disproportionate absence of the use of midwife-led ANC in this population. Several barriers were identified in the various works reviewed. The identified core barriers are economic relating to issues like high costs of services, poverty, unemployment, financial barriers; personal barrier relates to lack of autonomy, greater convenience of using other services and personal preference, low maternal educational levels, lack of information on healthcare services/ignorance about required health services, maternal age, marital status, parity/number of children; environmental relates to distance to health facility, location of residence/rural dwellers, geographical location, lack of transportation, and farness of ANC service provider; and cultural barriers relates to husband’s permission, culture of patriarchy, traditional beliefs, cultural sensitivity, cultural perception of the role of TBAs, ethnicity.Conclusions: This review highlights the need to thoroughly explore and address context-based barriers affecting access to midwife-led ANC in order to make safe motherhood a reality in Nigeria. The principal solution to these identified barriers is antenatal education by midwives which will help to empower women thereby increasing their access to midwife-led ANC. \textit{Recommendations:} Government/Policy makers should allocate sufficient fund to maternal healthcare and health promotion. They should improve ANC use by making it available, accessible and affordable to all women in Nigeria irrespective of their area of residence. Also incorporate in the educational curriculum of the approved schools of midwifery in Nigeria the suggested midwifery strategies such as named midwife, team midwife, caseload midwifery.Midwives should avail themselves of update courses in midwifery; play the necessary roles of a midwife especially being women-centered; develop interest in conducting midwifery research and using the best available evidence in their practice.