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Impact of Midwife-Led Continuity of Care on Antenatal Care Attendance among Pregnant Women in Nigeria

Abstract

Antenatal care is an important component of maternal healthcare because it provides opportunities for monitoring pregnancy, identifying and managing complications, providing preventive interventions, offering health education, and preparing women for safe childbirth and postnatal care. Regular antenatal care attendance enables pregnant women to receive recommended services throughout pregnancy and may improve maternal and newborn health outcomes. However, antenatal care attendance in Nigeria remains affected by factors such as financial constraints, geographical barriers, long waiting times, limited availability of skilled healthcare providers, poor continuity of care, inadequate health information, cultural practices, and previous negative experiences with healthcare services. Midwife-led continuity of care provides an approach in which pregnant women receive coordinated care from a known midwife or a consistent team of midwives throughout pregnancy and, where applicable, childbirth and the postnatal period. This model may strengthen the relationship between pregnant women and midwives, improve communication, enhance trust, and encourage continued engagement with antenatal services. Against this background, this study investigates the impact of midwife-led continuity of care on antenatal care attendance among pregnant women in Nigeria. The study will be anchored on the Continuity of Care Model, the Health Belief Model, and the Donabedian Model of Healthcare Quality. The Continuity of Care Model emphasizes consistency, coordination, communication, and an ongoing therapeutic relationship between healthcare providers and patients. The Health Belief Model explains how pregnant women's perceptions of pregnancy risks, perceived benefits of antenatal care, perceived barriers, confidence, and cues to action may influence their attendance at antenatal services. The Donabedian Model explains healthcare quality through structure, process, and outcome, with midwife-led continuity of care representing an important care-delivery process and antenatal care attendance serving as a measurable outcome. Collectively, these theoretical perspectives provide a suitable framework for explaining how midwife-led continuity of care may influence antenatal care attendance among pregnant women in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cohort research design. The study population will comprise pregnant women attending selected public and private hospitals, maternity centres, and primary healthcare facilities in Nigeria. A multistage sampling technique will be used to select states, local government areas, healthcare facilities, antenatal clinics, midwife-led care groups, and eligible pregnant women. Midwife-led continuity of care will be assessed using indicators such as assignment to a consistent midwife or midwife team, continuity of the care provider, frequency of contact with the same midwife, individualized care planning, continuity of antenatal consultations, communication quality, health education, counselling, appointment reminders, referral coordination, accessibility of the midwife, psychosocial support, and follow-up arrangements. Antenatal care attendance will be assessed using indicators such as number of antenatal visits, attendance according to recommended schedules, completion of scheduled antenatal contacts, missed appointments, timely attendance, continuity of attendance throughout pregnancy, and receipt of recommended antenatal interventions. Data will be collected using structured questionnaires, antenatal clinic registers, appointment records, maternal health records, midwifery care records, referral documents, and follow-up records. Descriptive statistics will be used to summarize pregnant women's demographic and obstetric characteristics, exposure to midwife-led continuity of care, and patterns of antenatal attendance. 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 midwife-led continuity of care on antenatal care attendance. Where a quasi-experimental design is adopted, antenatal attendance among women receiving midwife-led continuity of care may be compared with attendance among 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 continuity of care has a significant positive impact on antenatal care attendance among pregnant women in Nigeria. Women who receive care from a consistent midwife or midwife team are expected to demonstrate higher attendance, fewer missed appointments, and greater continuity of antenatal care than women receiving conventional care without consistent provider continuity. A sustained relationship with a midwife may improve trust, communication, satisfaction, and understanding of pregnancy-related health needs, thereby encouraging women to remain engaged with antenatal services. Individualized counselling and appointment follow-up may further reduce barriers to continued attendance and support timely uptake of recommended antenatal interventions. However, shortages of midwives, high patient workloads, staff turnover, inadequate facility infrastructure, geographical barriers, financial constraints, and limited implementation of continuity-of-care models may reduce effectiveness. The study therefore expects accessible, coordinated, woman-centred, and adequately staffed midwife-led continuity of care to contribute significantly to improved antenatal care attendance among pregnant women in Nigeria. The study is expected to contribute to the literature on midwife-led continuity of care, antenatal care attendance, maternal healthcare, midwifery services, continuity of care, pregnancy care, maternal health service utilization, 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, Nursing and Midwifery Council of Nigeria, state ministries of health, hospital management boards, maternity facilities, midwives, obstetricians, maternal health programme managers, development partners, and policymakers regarding strategies for improving antenatal care utilization. The study will also provide evidence-based recommendations for expanding midwife-led continuity-of-care models, improving midwife staffing, strengthening appointment and follow-up systems, reducing unnecessary provider changes, enhancing midwife-client communication, improving referral coordination, supporting individualized antenatal care, and integrating continuity of care into maternal health service delivery across Nigeria.

Keywords: Midwife-led continuity of care, antenatal care attendance, pregnant women, midwifery care, maternal healthcare, continuity of care, antenatal services, maternal health service utilization, pregnancy care, Nigeria, public health.