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Influence of Birth Preparedness Education on Skilled Birth Attendance among Pregnant Women in Nigeria

Abstract

Skilled birth attendance is an important component of safe motherhood and maternal healthcare because trained health professionals can recognize and manage complications that may arise during labour, delivery, and the immediate postpartum period. Birth preparedness involves planning for childbirth by identifying a preferred place of delivery, arranging transportation, identifying a skilled birth attendant, preparing necessary financial resources and essential supplies, identifying potential blood donors where appropriate, recognizing pregnancy and labour danger signs, and establishing an emergency plan and referral pathway. Birth preparedness education provides pregnant women with information and practical guidance that may improve their ability to plan for delivery and make timely decisions regarding the use of skilled maternity services. In Nigeria, barriers to skilled birth attendance may include inadequate knowledge, financial constraints, transportation difficulties, geographical inaccessibility, cultural preferences, previous experiences with healthcare facilities, limited family support, and concerns about the quality of maternity services. Effective birth preparedness education may improve women's knowledge of the benefits of skilled delivery and encourage them to plan appropriately for childbirth. Against this background, this study investigates the influence of birth preparedness education on skilled birth attendance among pregnant women in Nigeria. The study is anchored on the Health Belief Model (HBM), Andersen's Behavioral Model of Health Services Use, and the Knowledge-Attitude-Practice (KAP) framework. The Health Belief Model explains health-seeking behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action, providing a basis for understanding pregnant women's decisions regarding skilled delivery. Andersen's Behavioral Model explains healthcare utilization through predisposing, enabling, and need-related factors and provides a framework for examining how knowledge, accessibility, affordability, and perceived need influence skilled birth attendance. The Knowledge-Attitude-Practice framework provides a basis for examining how improved knowledge and attitudes resulting from birth preparedness education may influence delivery practices. Collectively, these theoretical perspectives provide a comprehensive framework for explaining how birth preparedness education may influence skilled birth attendance among pregnant women in Nigeria. The study adopts a quantitative quasi-experimental research design. Primary data will be collected from pregnant women attending selected public and private antenatal care facilities in Nigeria using a structured interviewer-administered questionnaire. A multistage sampling technique will be employed to select states, local government areas, healthcare facilities, antenatal clinics, and eligible participants. Where feasible, selected participants or healthcare facilities will be assigned to intervention and comparison groups. Pregnant women in the intervention group will receive structured birth preparedness education covering the importance of skilled birth attendance, selection of an appropriate place of delivery, identification of a skilled birth attendant, transportation planning, financial preparation, essential delivery supplies, recognition of maternal and newborn danger signs, emergency planning, referral pathways, and the importance of timely decision-making during labour and delivery. Skilled birth attendance will be assessed based on whether the delivery was attended by an appropriately trained health professional and whether delivery occurred in an appropriate healthcare setting where applicable. Descriptive statistics will be used to summarize participants' sociodemographic and obstetric characteristics, exposure to birth preparedness education, level of birth preparedness, and skilled birth attendance. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and multiple logistic regression analysis, will be employed to determine the influence of birth preparedness education on skilled birth attendance. Appropriate diagnostic tests will also be conducted to assess the reliability of the research instrument, model assumptions, goodness of fit, and the robustness of the findings. The study anticipates that birth preparedness education will have a significant positive influence on skilled birth attendance among pregnant women in Nigeria. Pregnant women who receive structured birth preparedness education are expected to demonstrate improved knowledge of the benefits of skilled delivery and greater readiness to utilize skilled maternity services. Education may encourage women to identify appropriate delivery facilities, arrange transportation and financial resources in advance, recognize danger signs, and develop emergency plans that facilitate timely access to professional care. However, birth preparedness education alone may not guarantee skilled birth attendance because women may continue to face barriers such as healthcare costs, distance to health facilities, poor transportation infrastructure, cultural preferences, inadequate family support, limited availability of skilled health professionals, and concerns about the quality of maternity services. Consequently, birth preparedness education is expected to be most effective when combined with accessible, affordable, respectful, and high-quality maternal healthcare services. This study is expected to contribute to the literature on maternal health, safe motherhood, antenatal care, skilled birth attendance, health education, and public health in Nigeria by providing empirical evidence on the relationship between birth preparedness education and skilled birth attendance among pregnant women. The findings will provide useful information for the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency (NPHCDA), state ministries of health, hospitals, primary healthcare facilities, midwives, nurses, community health workers, maternal and newborn health programmes, development partners, and policymakers regarding strategies for improving skilled delivery utilization. The study will also provide evidence-based recommendations for strengthening birth preparedness counselling during antenatal care, improving community-based maternal health education, establishing effective referral and emergency transportation systems, increasing awareness of skilled maternity services, and improving the accessibility and quality of maternal healthcare services across Nigeria.

Keywords: Birth preparedness education, skilled birth attendance, pregnant women, maternal health, antenatal care, skilled delivery, birth preparedness, maternal healthcare utilization, safe motherhood, health education, public health, Nigeria.