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Impact of Maternal Transport Support on Access to Maternity Services among Women in Rural Nigeria

Abstract

Access to timely and appropriate maternity services is essential for reducing preventable maternal and newborn morbidity and mortality. Women living in rural communities in Nigeria may experience significant transportation barriers when seeking antenatal care, skilled delivery, emergency obstetric care, and postnatal services. Long distances to healthcare facilities, poor road conditions, inadequate public transportation, high transportation costs, and limited availability of emergency transport may delay women's access to essential maternity services. Maternal transport support programmes, including community transport schemes, transport vouchers, organized emergency transportation, and other transportation assistance initiatives, may help reduce these barriers and facilitate timely access to maternity care. Against this background, this study investigates the impact of maternal transport support on access to maternity services among women in rural Nigeria. The study will be anchored on Andersen's Behavioral Model of Health Services Use, the Social Ecological Model, and the Three Delays Model. Andersen's Behavioral Model explains how women's predisposing characteristics, enabling resources, and perceived healthcare needs influence their utilization of maternity services. The Social Ecological Model emphasizes the interaction between individual, household, community, transportation, healthcare-system, and broader environmental factors in shaping access to maternal healthcare. The Three Delays Model provides a framework for understanding delays in deciding to seek care, reaching an appropriate healthcare facility, and receiving adequate care after arrival. Collectively, these theoretical perspectives provide a suitable framework for explaining how maternal transport support may influence access to maternity services among women in rural Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise pregnant and postpartum women residing in selected rural communities across Nigeria. A multistage sampling technique will be used to select states, local government areas, rural communities, healthcare facilities, transport-support programme locations, and eligible women. Maternal transport support will be assessed using indicators such as availability of transport assistance, transport vouchers, community emergency transport schemes, organized ambulance services, transportation subsidies, distance to transport points, response time, affordability, reliability, and availability of transport during emergencies. Access to maternity services will be assessed using indicators such as distance and travel time to healthcare facilities, antenatal care attendance, timely initiation of antenatal care, skilled birth attendance, facility-based delivery, emergency obstetric care access, postnatal care attendance, referral completion, and ability to reach healthcare facilities when services are required. Data will be collected using structured questionnaires, maternity records, antenatal and postnatal registers, transport-support programme records, referral registers, and relevant programme documents. Descriptive statistics will be used to summarize participants' characteristics, availability and utilization of transport support, travel patterns, and access to maternity services. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of maternal transport support on access to maternity services. Where a quasi-experimental design is adopted, access indicators before and after implementation of transport support may be compared to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that maternal transport support has a significant positive impact on access to maternity services among women in rural Nigeria. Women who have access to reliable and affordable transportation support are expected to experience shorter travel delays and demonstrate greater utilization of antenatal, skilled delivery, emergency obstetric, and postnatal services than women without such support. Transport assistance may reduce the financial burden of travelling to healthcare facilities, improve the likelihood of reaching facilities during labour or obstetric emergencies, and strengthen the effectiveness of maternal healthcare referrals. Community-based transport schemes may also improve preparedness for delivery and emergencies by providing women and families with reliable transportation options before they are urgently needed. However, poor road infrastructure, inadequate transport availability, insufficient programme funding, long distances, insecurity, difficult terrain, and weak coordination between transport providers and healthcare facilities may limit effectiveness. The study therefore expects accessible, affordable, reliable, and well-coordinated maternal transport support to contribute significantly to improved access to maternity services among women in rural Nigeria. The study is expected to contribute to the literature on maternal transport support, access to maternity services, rural maternal healthcare, transportation barriers, antenatal care, skilled birth attendance, emergency obstetric care, postnatal care, 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, local government health authorities, primary healthcare centres, community health workers, transport-support organizations, development partners, women's health organizations, and policymakers regarding strategies for reducing transportation-related barriers to maternal healthcare. The study will also provide evidence-based recommendations for expanding community-based maternal transport schemes, improving transport voucher programmes, strengthening emergency referral transportation, improving rural road and transport infrastructure, coordinating transport services with healthcare facilities, and ensuring timely and equitable access to essential maternity services for women in rural Nigeria.

Keywords: Maternal transport support, access to maternity services, rural women, transportation barriers, antenatal care, skilled birth attendance, emergency obstetric care, postnatal care, maternal healthcare, rural healthcare access, Nigeria, public health.