Factors influencing the utilisation of facility-based delivery in Nigeria: a qualitative evidence synthesis

Introduction

High-quality facility-based birth reduces maternal and perinatal morbidity and mortality. Previous multi-country systematic reviews have analysed qualitative research studies to understand the barriers and facilitators of delivery in a health facility. However, questions remain as to the extent to which generic multi-context reviews capture nuanced insights from a specific country context. Nigeria contributes significantly to the global burden of maternal mortality and hence the need to explore the country’s contextual factors affecting maternal mortality viz-a-viz a previous international review.

Methods

To synthesise published and unpublished qualitative research on factors that influence decision-making and use of facility-based delivery services in Nigeria using a qualitative evidence synthesis methodology. Multiple electronic databases, citation chaining and checking of reference lists were searched. Studies were screened by title, abstract and full text. The quality of the included studies was evaluated using the Critical Appraisal Skills Programme (CASP) checklist for appraising a qualitative study. Synthesis of extracted data followed the ‘best-fit’ framework method which combines deductive and then inductive approaches to analysis.

Results

27 eligible studies were identified. Data were organised around four principal themes, further divided into subthemes: perceptions of pregnancy and childbirth, the influence of the sociocultural context and care experiences; resource availability and access and perceptions of quality of care.

Conclusions

Beyond the structural gaps that exist which affect quality care provided at health facilities, wider social determinants like sociocultural beliefs, care experience and resource availability impact upon the utilisation of facility-based delivery services. Future research should prioritise interventions and programmes to address prevalent gaps involving distance and access. In this way, progress can be made against longstanding deficits in the quality of maternal and infant care.