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Effect of Birth Preparedness Education on Birth Preparedness Practices among Pregnant Women in Nigeria

Abstract

Birth preparedness is an important component of maternal health because adequate preparation for childbirth can help pregnant women and their families anticipate potential complications, make timely decisions, and access appropriate skilled care. In Nigeria, maternal morbidity and mortality remain important public health concerns, and delays in recognizing complications, deciding to seek care, reaching appropriate health facilities, and obtaining necessary care may contribute to poor maternal and newborn outcomes. Birth preparedness education provides pregnant women with information about expected delivery, danger signs during pregnancy and childbirth, the importance of skilled birth attendance, selection of an appropriate health facility, arrangement of transportation, identification of a birth companion, financial preparation, availability of essential supplies, emergency contacts, and planning for timely referral when complications occur. Birth preparedness practices refer to the actions undertaken by pregnant women and their households to prepare for childbirth and possible emergencies, including identifying a place of delivery, arranging transportation, saving funds, identifying a skilled birth attendant, preparing essential delivery items, identifying a support person, and establishing an emergency plan. In Nigeria, inadequate maternal health information, financial constraints, transportation difficulties, cultural beliefs, geographical barriers, and limited access to quality maternal healthcare services may affect birth preparedness practices among pregnant women. Effective birth preparedness education may improve women's knowledge and encourage appropriate preparation for childbirth. Against this background, this study investigates the effect of birth preparedness education on birth preparedness practices among pregnant women in Nigeria. The study is anchored on the Health Belief Model, Social Cognitive Theory, and the Knowledge-Attitude-Practice framework. The Health Belief Model explains preventive maternal health behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action, providing a basis for understanding pregnant women's decisions to prepare for childbirth and possible complications. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, social influences, behavioural capabilities, and environmental conditions in shaping maternal health behaviour. The Knowledge-Attitude-Practice framework provides a basis for examining how improved knowledge and attitudes resulting from birth preparedness education may influence birth preparedness practices. Collectively, these theoretical perspectives provide a suitable framework for explaining how birth preparedness education may influence birth preparedness practices among pregnant women in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from pregnant women attending antenatal care services in selected healthcare 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 pregnant women. Where feasible, selected participant groups 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 a delivery facility, recognition of maternal and newborn danger signs, emergency planning, transportation arrangements, financial preparation, identification of a birth companion, preparation of essential delivery items, emergency contacts, and timely healthcare seeking. Birth preparedness practices will be assessed using indicators such as identification of a preferred place of delivery, arrangement of transportation, financial preparation, identification of a skilled birth attendant, preparation of delivery materials, identification of a birth companion, knowledge of emergency contacts, and development of an emergency referral plan. Descriptive statistics will be used to summarize participants' sociodemographic and obstetric characteristics, birth preparedness knowledge, exposure to education, and preparedness practices. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic or multiple regression analysis, will be used to determine the effect of birth preparedness education on birth preparedness practices. Appropriate diagnostic tests will also be conducted to assess the reliability of the research instrument, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that birth preparedness education has a significant positive effect on birth preparedness practices among pregnant women in Nigeria. Pregnant women exposed to structured birth preparedness education are expected to demonstrate improved knowledge of childbirth preparation, maternal danger signs, emergency planning, and skilled maternity care. Education may encourage women to identify appropriate delivery facilities, arrange transportation, save funds for delivery and emergencies, prepare essential delivery materials, identify birth companions, and establish emergency contacts and referral plans. However, education alone may not guarantee adequate birth preparedness because pregnant women may continue to face barriers such as poverty, transportation difficulties, geographical distance to health facilities, limited availability of quality maternal health services, cultural expectations, and inadequate family support. Consequently, birth preparedness education is expected to be most effective when supported by accessible maternal healthcare services, reliable transportation systems, financial protection, effective referral mechanisms, and supportive family and community environments. The study is expected to contribute to the literature on maternal health education, birth preparedness, antenatal care, skilled birth attendance, maternal and newborn health, and public health in Nigeria by providing empirical evidence on the effect of birth preparedness education on birth preparedness practices among pregnant women. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency (NPHCDA), state ministries of health, local government health authorities, primary healthcare facilities, healthcare professionals, midwives, community health workers, development partners, and policymakers regarding strategies for improving maternal preparedness for childbirth. The study will also provide evidence-based recommendations for strengthening antenatal birth preparedness education, improving emergency referral systems, promoting skilled birth attendance, strengthening transportation arrangements, increasing community and family support, and improving access to quality maternal healthcare services across Nigeria.

Keywords: Birth preparedness education, birth preparedness practices, pregnant women, antenatal care, skilled birth attendance, maternal health, maternal education, emergency preparedness, maternal and newborn health, healthcare seeking, public health, Nigeria.