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Effect of Antenatal Care Education on Birth Preparedness among Pregnant Women in Nigeria

Abstract

Birth preparedness is an important component of maternal and newborn health because appropriate preparation during pregnancy can improve women's readiness for childbirth, facilitate timely utilization of skilled maternal healthcare services, and support prompt response to obstetric emergencies. Birth preparedness involves actions such as identifying a skilled birth attendant and appropriate place of delivery, planning transportation, identifying potential sources of financial support, arranging necessary birth materials, identifying a support person, understanding pregnancy and childbirth danger signs, and developing an emergency plan. Antenatal care education provides pregnant women with relevant information about pregnancy, childbirth, danger signs, delivery planning, emergency preparedness, skilled birth attendance, transportation arrangements, financial preparation, essential birth materials, and appropriate healthcare-seeking. Birth preparedness refers to the extent to which pregnant women have made appropriate arrangements for childbirth and potential obstetric emergencies before the onset of labour. In Nigeria, inadequate birth preparedness may be associated with limited maternal health information, misconceptions, financial constraints, transportation challenges, geographical barriers, inadequate access to antenatal education, and delayed recognition of pregnancy and childbirth complications. Effective antenatal care education may improve pregnant women's knowledge, planning, confidence, and readiness for childbirth and emergency situations. Against this background, this study investigates the effect of antenatal care education on birth preparedness 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 health-related decision-making through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action, providing a basis for understanding pregnant women's decisions regarding birth preparation and emergency planning. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, social influences, and environmental conditions in shaping health-related behaviour. The Knowledge-Attitude-Practice framework provides a basis for examining how antenatal care education may improve pregnant women's knowledge and attitudes and encourage appropriate birth preparedness actions. Collectively, these theoretical perspectives provide a suitable framework for explaining how antenatal care education may influence birth preparedness among pregnant women in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from pregnant women attending selected public and private antenatal clinics in Nigeria using a structured interviewer-administered questionnaire and a standardized birth preparedness assessment tool. A multistage sampling technique will be employed to select states, local government areas, healthcare facilities, antenatal clinics, and eligible pregnant women. Where feasible, selected clinics or participant groups will be assigned to intervention and comparison groups. Pregnant women in the intervention group will receive structured antenatal care education covering the importance of antenatal care, pregnancy and childbirth danger signs, identification of a skilled birth attendant, selection of an appropriate place of delivery, transportation planning, financial preparation, essential birth materials, identification of a support person, emergency planning, and appropriate healthcare-seeking. Birth preparedness will be assessed using indicators such as identification of a skilled birth attendant, planned place of delivery, transportation arrangements, financial preparation, availability of essential birth materials, identification of a support person, knowledge of danger signs, and development of an emergency plan. Descriptive statistics will be used to summarize participants' sociodemographic and obstetric characteristics, antenatal care attendance, previous maternal health education, antenatal care knowledge, and birth preparedness scores. 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 antenatal care education on birth preparedness. Where appropriate, birth preparedness before and after the intervention will be compared. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that antenatal care education has a significant positive effect on birth preparedness among pregnant women in Nigeria. Pregnant women exposed to structured antenatal care education are expected to demonstrate improved readiness for childbirth, including greater likelihood of identifying a skilled birth attendant, selecting an appropriate place of delivery, arranging transportation, preparing necessary financial resources, obtaining essential birth materials, identifying a support person, recognizing pregnancy and childbirth danger signs, and developing an emergency plan. Education may also improve women's confidence in making timely decisions when complications occur and encourage early utilization of skilled maternal healthcare services. Interactive and culturally appropriate education is expected to improve knowledge retention and address misconceptions regarding childbirth and emergency preparedness. However, education alone may not guarantee adequate birth preparedness because women may continue to face financial constraints, transportation difficulties, geographical barriers, limited access to healthcare facilities, inadequate availability of skilled birth attendants, and other health-system challenges. Consequently, antenatal care education is expected to be most effective when supported by accessible and affordable maternal healthcare services, reliable transportation and referral systems, skilled birth attendants, and supportive community structures. The study is expected to contribute to the literature on antenatal care, birth preparedness, maternal health education, pregnancy care, emergency preparedness, maternal and child health, health promotion, and public health in Nigeria by providing empirical evidence on the effect of antenatal care education on birth preparedness among pregnant women. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, state ministries of health, National Primary Health Care Development Agency, hospitals, primary healthcare centres, antenatal clinics, maternal health programmes, midwives, nurses, community health workers, development partners, and policymakers regarding strategies for improving maternal preparedness for childbirth and obstetric emergencies. The study will also provide evidence-based recommendations for strengthening structured antenatal education, integrating birth preparedness into routine antenatal services, improving maternal danger-sign education, strengthening emergency planning and referral systems, enhancing community-based maternal health education, and promoting timely utilization of skilled maternal healthcare services in Nigeria.

Keywords: Antenatal care education, birth preparedness, pregnant women, Nigeria, antenatal care, maternal health, childbirth preparedness, emergency preparedness, maternal health education, pregnancy care, skilled birth attendance, maternal and child health, health promotion, public health.