Experiences with Facility Delivery Services Within the Context of a Maternal Neonatal Health Project in Gombe State, Northeast Nigeria A Qualitative Study

Background In Gombe State, the use of facility delivery services is low (27%), and maternal and child health indices are poor. The Gombe State Primary Health Care Development Agency in collaboration with a non-governmental organization (Society for Family Health) implemented a maternal neonatal health (MNH) project from 2016 to 2018. The project supplied essential health commodities to health facilities, provided pregnant women with cost-free emergency transportation, and implemented the Village Health Worker program. Village health workers are lay indigenous women trained to educate women on MNH care. They provided simple community-based maternal and newborn care through home visits and facilitated linkage to health facilities. We explored women's experiences with facility delivery services within the context of the MNH project. Methods Qualitative data were obtained through focus group discussions with women who delivered within the last 12 months. Participants were asked questions related to their experiences with the access and use of facility delivery services. Participants were also asked about provider gender preferences and the influence of family members on the use of facility delivery services. Data were organized with NVivo 12 (Pro for Windows) and analyzed using directed content analysis. Results Six focus group discussions were conducted with 58 participants. Mean age was 25.1 (± 5.3) years old. Thirty-seven 37 (64%) participants delivered in the facility, and 21 (36%) delivered at home within the last 12 months. All the women preferred facility delivery over home delivery for quality care. Furthermore, most women reported experiencing immediate and respectful care with facility delivery services, and healthcare workers' competence and attitude were more important than gender. However, use of facility delivery services was limited by the availability of local traditional birth attendants, absent husbands at onset of labor, imminent delivery, long distance to facility, expensive transportation fees, healthcare worker absenteeism and long clinic wait times. Conclusion Even within the context of an MNH project designed to improve use of facility delivery services, socio-economic and facility level factors could limit women’s use of facility delivery services. Therefore, MNH projects should be designed to ameliorate the effect of these factors that limit use of facility delivery services.