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Effect of Midwife-Led Antenatal Care on Maternal Health Service Utilization in Nigeria

Abstract

Maternal health remains a major public health concern in Nigeria, where inadequate utilization of essential maternal health services contributes to preventable maternal and neonatal morbidity and mortality. Antenatal care provides an important platform for monitoring pregnancy, identifying potential complications, providing preventive interventions, offering health education, and preparing women for safe childbirth and appropriate postnatal care. However, utilization of antenatal and other maternal health services remains suboptimal among some women due to financial barriers, geographical inaccessibility, long waiting times, limited availability of qualified health personnel, poor quality of care, and sociocultural factors. Midwife-led antenatal care provides an approach in which qualified midwives take a central role in providing comprehensive antenatal services, including routine assessment, health education, screening, counselling, identification of pregnancy complications, and referral of women requiring higher-level care. Maternal health service utilization refers to the use of essential services such as antenatal care, skilled birth attendance, facility-based delivery, postnatal care, and recommended maternal health interventions. Against this background, this study investigates the effect of midwife-led antenatal care on maternal health service utilization in Nigeria. The study will be anchored on Andersen's Behavioral Model of Health Services Use, the Health Systems Framework, and the Continuity of Care Model. Andersen's Behavioral Model explains healthcare utilization through predisposing, enabling, and need-related factors and provides a framework for understanding women's use of maternal health services. The Health Systems Framework emphasizes service delivery, health workforce, health information, essential medicines and technologies, financing, and accessibility as important components of effective maternal healthcare. The Continuity of Care Model emphasizes coordinated care throughout pregnancy, childbirth, and the postpartum period and highlights the importance of sustained relationships between women and healthcare providers. Collectively, these theoretical perspectives provide a suitable framework for explaining how midwife-led antenatal care may influence maternal health service utilization in Nigeria. The study will adopt a quantitative cross-sectional or quasi-experimental research design, depending on the availability of suitable intervention and comparison settings. The study population will comprise pregnant women and women who recently completed pregnancy and received maternal health services in selected healthcare facilities across Nigeria. A multistage sampling technique will be used to select states, local government areas, healthcare facilities, and eligible participants. Midwife-led antenatal care will be assessed using indicators such as availability of qualified midwives, proportion of antenatal consultations conducted by midwives, continuity of care, frequency of antenatal visits, comprehensiveness of antenatal services, health education, counselling, screening for pregnancy complications, referral practices, interpersonal communication, waiting time, and continuity between antenatal, delivery, and postnatal services. Maternal health service utilization will be assessed using indicators such as antenatal care attendance, number and timing of antenatal contacts, skilled birth attendance, facility-based delivery, postnatal care attendance, uptake of recommended maternal health interventions, and completion of essential maternal health services. Data will be collected using structured questionnaires, antenatal records, maternity registers, delivery records, postnatal records, and facility assessment tools where appropriate. Descriptive statistics will be used to summarize participants' characteristics, availability of midwife-led antenatal care, and maternal health service utilization. Inferential statistical techniques, including chi-square tests, correlation analysis, and multiple regression analysis, will be used to determine the effect of midwife-led antenatal care on maternal health service utilization. Where appropriate, comparisons will be made between women receiving midwife-led care and women receiving conventional antenatal care. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that midwife-led antenatal care has a significant positive effect on maternal health service utilization in Nigeria. Women receiving comprehensive and continuous antenatal care from qualified midwives are expected to demonstrate higher utilization of recommended maternal health services than women with limited access to such care. Regular contact with midwives may improve health education, early identification of pregnancy complications, birth preparedness, referral, and women's confidence in the healthcare system. Continuity of care may also encourage women to maintain contact with healthcare services throughout pregnancy and increase the likelihood of skilled birth attendance and postnatal care utilization. Conversely, inadequate numbers of midwives, heavy workloads, limited resources, poor referral systems, inadequate facility infrastructure, long waiting times, and restricted access to maternal healthcare facilities may reduce the effectiveness of midwife-led antenatal care. However, maternal health service utilization may also be influenced by women's socioeconomic circumstances, education, cultural practices, distance to healthcare facilities, household decision-making, and availability of maternal health services. The study is expected to contribute to the literature on midwife-led antenatal care, maternal health service utilization, antenatal care, skilled birth attendance, facility-based delivery, postnatal care, reproductive health, maternal healthcare, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, nursing and midwifery authorities, healthcare facility managers, midwives, maternal health programme managers, development partners, and policymakers regarding strategies for improving maternal health service utilization. The study will also provide evidence-based recommendations for expanding midwife-led antenatal care, increasing the availability and equitable distribution of qualified midwives, strengthening continuity of maternal care, improving referral systems, reducing waiting times, enhancing maternal health education and counselling, ensuring adequate facility resources, and integrating midwife-led services into primary and secondary maternal healthcare systems across Nigeria.

Keywords: Midwife-led antenatal care, maternal health service utilization, antenatal care, Nigeria, midwifery, maternal health, reproductive health, skilled birth attendance, facility-based delivery, postnatal care, primary healthcare, public health.