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

Abstract

Maternal mortality remains a major public health concern in Nigeria, with many maternal deaths associated with preventable complications during pregnancy, childbirth, and the immediate postpartum period. Skilled birth attendance is an important component of safe motherhood because trained healthcare professionals are equipped to identify and manage complications during labour and childbirth and to facilitate timely referral when advanced care is required. Safe motherhood education provides pregnant women with information about antenatal care, birth preparedness, danger signs during pregnancy and labour, the importance of skilled birth attendance, available maternal health services, emergency referral, and appropriate healthcare-seeking practices. In Nigeria, utilization of skilled birth attendance may be affected by inadequate maternal health knowledge, cultural beliefs, financial constraints, distance to healthcare facilities, transportation challenges, poor perceived quality of care, family influences, and limited access to maternal health services. Effective safe motherhood education may improve pregnant women's understanding of the importance of skilled care and encourage them to plan for and utilize skilled birth services. Against this background, this study investigates the influence of safe motherhood 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 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 seek skilled delivery care. Andersen's Behavioral Model explains healthcare utilization through predisposing, enabling, and need-related factors, providing a framework for understanding how individual characteristics and access to maternal healthcare services influence skilled birth attendance. The Knowledge-Attitude-Practice framework provides a basis for examining how improved maternal health knowledge and attitudes resulting from safe motherhood education may influence utilization of skilled birth services. Collectively, these theoretical perspectives provide a comprehensive framework for explaining how safe motherhood 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 antenatal clinics and community-based maternal health programmes in Nigeria using a structured interviewer-administered questionnaire. A multistage sampling technique will be employed to select states, local government areas, communities, healthcare facilities, and eligible participants. Where feasible, selected healthcare facilities or communities will be assigned to intervention and comparison groups. Pregnant women in the intervention group will receive structured safe motherhood education covering the importance of antenatal care, birth preparedness and complication readiness, pregnancy and labour danger signs, benefits of skilled birth attendance, available maternal health services, emergency transportation and referral planning, and appropriate healthcare-seeking practices. Skilled birth attendance will be assessed based on whether delivery occurred or is planned to occur under the supervision of an appropriately trained healthcare professional, including a doctor, midwife, nurse, or other qualified skilled birth attendant. For women who have delivered during the study period, actual place and attendant at delivery will be documented where applicable. Descriptive statistics will be used to summarize participants' sociodemographic and obstetric characteristics, exposure to safe motherhood education, 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 safe motherhood 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 robustness of the findings. The study anticipates that safe motherhood education will have a significant positive influence on skilled birth attendance among pregnant women in Nigeria. Pregnant women exposed to structured safe motherhood education are expected to demonstrate improved knowledge of pregnancy and childbirth complications, greater awareness of the benefits of skilled delivery care, improved birth preparedness, and increased utilization of skilled birth services. Education may also encourage women to identify appropriate delivery facilities in advance, make transportation arrangements, recognize danger signs, and seek timely professional care when complications occur. However, education alone may not guarantee skilled birth attendance because women may continue to face barriers such as financial constraints, geographical distance, transportation difficulties, inadequate healthcare infrastructure, cultural preferences for home delivery, family decision-making influences, and concerns about the quality of maternal healthcare services. Consequently, safe motherhood education is expected to be most effective when supported by accessible, affordable, respectful, and high-quality maternal healthcare services. This study is expected to contribute to the literature on maternal health, safe motherhood, health education, skilled birth attendance, reproductive health, health-seeking behaviour, and public health in Nigeria by providing empirical evidence on the influence of safe motherhood education on 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 health programmes, development partners, and policymakers regarding strategies for improving maternal and newborn health outcomes. The study will also provide evidence-based recommendations for strengthening antenatal health education, integrating birth preparedness education into routine maternal healthcare, improving referral and emergency transportation systems, expanding access to skilled delivery services, addressing cultural and financial barriers to facility-based delivery, and promoting respectful maternity care across Nigeria.

Keywords: Safe motherhood education, skilled birth attendance, pregnant women, maternal health education, skilled delivery care, birth preparedness, antenatal care, maternal health, reproductive health, healthcare-seeking behaviour, public health, Nigeria.