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Awareness of Antenatal Services and Health Seeking Behaviour
among Pregnant Women in Osun State
1
Ajayi, Ifeoluwa Grace.,
2
Prof. Enyindah, Cosmos.,
3
Dr. Akpan, Margaret Inemesit.,
4
Dr. Onisile,
Deborah F.,
5
Dr. Ayamolowo, Sunday J.,
6
Adejumo, Bosede.,
7
Laogun, Olapeju Abiola
1
Department of Midwifery, University of PortHarcourt RN, RM, RPHN, MSc Midwifery, Nigeria
2
Department of Obstetrics and Gynaecology, University of PortHarcourt B.MED.SC (HONS), MBBS,
FWACS, Nigeria
3
Department of Public Health, University of Calabar PhD Epidemiology, MPH, BSc Nursing,
FWACPNM, Nigeria
4
Department of Nursing Science, Redeemer’s University RN, PhD, FWAPCN, Nigeria
5
Department of Nursing Science, Obafemi Awolowo University RN, PhD, Nigeria
6
Department of Midwifery, University of PortHarcourt RN, RM, MSc Midwifery, Nigeria
7
Department of Public Health, University of PortHarcourt RN, RM, RPHN, MSc Public Health, Nigeria
DOI: https://doi.org/10.51244/IJRSI.2025.120800195
Received: 20 Aug 2025; Accepted: 04 Sept 2025; Published: 19 September 2025
ABSTRACT
Antenatal care (ANC) plays a crucial role in ensuring maternal and fetal well-being, yet awareness and
utilization of these services vary across different populations. This study examined the awareness of antenatal
services and health-seeking behaviour among pregnant women in Osun State, Nigeria. A cross-sectional survey
was conducted among pregnant women in Osun State, using a well-structured 82-item questionnaire to assess
their awareness, health-seeking behaviour, attitude towards their health and influencing factors for their
utilization. Three hundred and twenty-two (322) pregnant women participated in the study and were selected
using simple random sampling technique across 8 of the 30 local government areas in Osun State regardless of
their age and marital status. Data were analyzed using Statistical Package for Social Science (SPSS) version
23.0. The findings of this study revealed that most (57.1%) of the respondents were aware of antenatal
services, have a fairly good (57.8%) health-seeking behaviour, but poor (53.4%) attitude towards their health.
This study also revealed that there was a statistically significant association between sociodemographic
variables, age, education level and income, and health-seeking behaviour of pregnant women in Osun State at
p less than 0.001; and that there was no statistical significant association between age and education level, and
attitude of pregnant women in Osun State at p greater than 0.05, however, there was a statistically significant
association between income and attitude of pregnant women in Osun State at p value 0.045. The study
highlights the 9need for targeted health education programmes, improved healthcare accessibility, and
community-based interventions to enhance ANC utilization. Strengthening maternal healthcare policies and
addressing socioeconomic barriers can contribute to better maternal and neonatal outcomes.
Keywords: Awareness, Antenatal Services, Health seeking Behavior, Pregnant women
INTRODUCTION
Reproductive health is a key concern in the majority of developing nations, and accurate data on maternal
fatalities is needed. Nigeria is still far from meeting the SDG target, according to recent figures, with 917
maternal deaths for every 100,000 live births in 2017 (World Bank, 2022) and 82,000 in 2020 (WHO et al.,
2023), which accounts for 28.5% of all maternal deaths worldwide. Southern Asia and Sub-Saharan Africa
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accounted for more than 87% (225,000) of the projected global maternal deaths in 2023, despite recent World
Health Organization research stating that the maternal mortality ratio decreased by 40% globally between 2000
and 2023. About 70% of maternal deaths occurred in Sub-Saharan Africa alone (182,000), and about 17%
occurred in southern Asia (43,000). In 2023, 92% of all maternal deaths took place in low-and lower-middle-
income nations, and the majority of these deaths were avoidable. (WHO, 2025). Pregnancy and childbirth are
normal physiological and social processes rather than disorders in and of themselves. However, because they
are the leading causes of death, disability, and illness among women, especially in developing nations, they
require special attention for the sake of both the women own health and the survival of their children. In
Nigeria, maternal mortality is still a major issue (NDHS, 2018). WHO uses a delay model to explain this issue,
which takes into account poor health services in facilities, delays in getting to medical facilities, and delays in
seeking medical attention. This paradigm has been linked to socioeconomic and human health system elements
like poverty, inadequate emergency obstetric care, and fatalistic thinking. These issues have contributed to high
burden of maternal and adult mortality in Nigeria by increasing the prevalence of infectious illnesses,
postpartum hemorrhage, hypertensive disorders, unsafe abortions, and protracted labor. SDG 3.1 aims to lower
the global maternal death ratio to less than 70 per 100,000 live births by 2030 (NDHS, 2018). Given this
background, it is crucial to conduct this study on awareness of pregnant women about antenatal services and
their health seeking behaviour in Osun State because of the high incidence of maternal death and morbidity in
the Subregion of West Africa and Nigeria inclusive.
The World Health Organization (WHO) defines antenatal care (ANC) as the treatment a woman receives while
she is pregnant. The main goal of ANC is to safeguard and advance the well-being of expectant mothers and
their in-growing fetuses in order to produce a healthy mother and baby by the end of the pregnancy period.
Latunji and Akinyemi, (2018) defined healthcare seeking behaviour (HSB) as "any action or inaction
undertaken by individuals who perceive themselves to have a health problem or to be ill for the purpose of
finding an appropriate remedy" in their study on factors influencing health seeking behaviour among civil
servants in Ibadan, Nigeria. Pasand et al., (2016) noted that two important and more general topics of research
in medical sociology and other fields that are related are health behaviour and illness behaviour. Despite the
fact that they both deal with people's health and illness, their methods for examining how people react to these
problems differ.
Pregnant women were found to have good behaviours (58.5%), favorable attitudes (98.75%), and average
knowledge (96%). Numerous deliveries occurred in government facilities, and the sociodemographic
connection revealed that awareness and practices about ANC were significantly correlated with age, family
type, education, and occupation (Bashir et al., 2023). Nwabueze et al., (2023) stated that focused antenatal care
(FANC) is a more recent and superior method of antenatal care for expectant mothers than the conventional
model. In order to enhance the health of the child and the mother, FANC places a strong emphasis on
individual evaluation and decision-making by the pregnant patient and the healthcare professional. Maternal
mortality indicators have not substantially dropped in Nigeria even after the country implemented FANC
treatment. Mazharul et al., (2018) conducted research that evaluated the compliance with WHO
recommendations about health care-seeking behaviour during the entire pregnancy, the delivery process, and
the postpartum phase in Bangladesh, it was discovered that 37% of deliveries took place in medical facilities,
65% of mothers visited post-natal clinic (PNC) at least once, while 31% of mothers had prescribed four or
more ANC visits. Just 18.0% of mothers had at least one PNC visit, minimum of four ANC checks, and a
delivery in a medical center, which is the WHO's suggested ideal level. When other factors were taken into
account, mothers under the age of 20, those living in rural areas, those without education or media exposure,
multiparous women, those with low incomes, and husbands without education or jobs seemed to be important
predictors of ideal standard of care for mothers. It was not so likely that mothers in Barisal, Chittagong, and
Sylhet regions would obtain the best possible medical care. It was therefore determined that Bangladeshi
women's use of pregnancy-related maternal health care, childbirth, as well as the postpartum phase does not
fully align with WHO guidelines. Nwachukwu et al., (2023) conducted a study titled "Predisposing Factors and
Need Factors as Determinants of Healthcare seeking behaviour of Pregnant Women in Uvwie, Delta, Nigeria",
most of respondents (71.7%) reported having a low degree of health care seeking behaviour, whereas the
remaining respondents (28.3%) reported a high level of healthcare seeking behaviour. While they were
pregnant, over half of the 221 respondents (54.4%) said they see traditional birth attendants (TBAs) and other
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traditional providers. 326 (80.3%) of the respondents, the majority, said they ignore certain pregnancy
symptoms because they think they would go away on their own. The majority of respondents, 245 (60.3%),
said they self-medicate anytime they feel unwell or have mild symptoms while pregnant. The majority of the
346 respondents (85.2%) said that if they feel sick, they wait for a period of time (two or three days) to see if
their symptoms improve. Additionally, 299 (73.6%) of the respondents said they seek advice from a friend or
family member when dealing with pregnancy-related concerns. Of the 283 respondents, more over half
(69.7%) say they attend prenatal checkups on a regular basis while pregnant. During their pregnancy, 343
(84.5%) of the respondents said they get regular checkups. The study's findings then indicated that
respondents' perceived health needs and health literacy were insufficient. Healthcare seeking behaviour of
pregnant women is influenced by perceived health need and high health literacy. In their efforts to administer
and communicate health, skilled health professionals should incorporate techniques for enhancing health
literacy and emphasize the significance of health literacy in raising knowledge of the first point of care.
Factors Influencing Utilization of Healthcare Facilities Among Pregnant Women
Road network distance has no discernible effect on the use of antenatal care by married women in the Thatta
district of Pakistan's catchment population, according to a study by Sumera et al. (2020) on factors affecting
the utilization of antenatal care among married women of reproductive age in rural Thatta, Pakistan: findings
from a community-based case-control study. However, this study showed that in Pakistan's rural areas,
nulliparous women (32 out of 36) who lived in well-built homes with electricity and were aware of antenatal
care were the ones who used these services. Accordingly, the study suggests that in order to boost ANC
utilization and socioeconomic level in Pakistan's rural areas, more information and education should be
provided to nulliparous women. In light of this study's conclusions, it is advised that pregnant women attend
health education and awareness programs to broaden their understanding of prenatal care services. These
women ought to be made aware of the new ANC service regulations, their advantages, and where to get the
services. Furthermore, women's socioeconomic standing must be raised in order for them to be able to pay for
the ANC services rendered by medical facilities. To fully comprehend the factors influencing ANC services,
future research must evaluate the variables at the levels of the person, home, community and facility.
The sociodemographic characteristics of ANC, institutional delivery, and PNC services in India were the focus
of another study by Pintu & Pradip (2020) on the sociodemographic factors influencing the use of maternal
health care services in India. It was discovered that Maternal health care utilization in India is insufficient for
all socioeconomic levels and is affected by various demographic and socioeconomic factors. The two biggest
factors influencing the use of maternal healthcare services are women educational level (only 12% had
completed secondary school) and household wealth (44.6% poor). Rural areas use maternal health care
services at a rate of 70.3%, whereas urban areas use them at a rate of 29.7%. The usage of maternal healthcare
is also found to be significantly influenced by caste and religion, which recommends that women in
underprivileged groups should be empowered. Service use is also significantly predicted by a lower marriage
age (38.9%). The study's conclusions highlight the value of education and women's economic advancement.
Additionally, it is advised to eliminate child marriage, enhance rural areas' roads and transit systems, and
provide access to health information. Therefore, a focused approach is required in the quest to increase the use
of maternal healthcare services. To achieve this, the government should focus on improved educational
opportunities, the state of the economy, and accessibility to information and medical treatment.
Dereje et al., (2022) conducted a community-based cross-sectional study on the use of maternity waiting
houses and related characteristics among childbearing women in rural areas of the Finfinnee special zone,
central Ethiopia. In the special zone of central Ethiopia, Finfinnee, MWHs were used by one-third of
postpartum mothers who delivered in the previous six months. The study also found that women's age,
housewives, living far from health facilities (56.4%), having non-farmer spouses (16.9%), and having a high
level of wealth (33.5% median wealth) all had an impact on their usage of MWHs. Even while MWHs
frequently offer bedding, latrines, and health professional examinations, a sizable percentage of women were
not served meals or access to clean water. As a result, providing MWHs with minimal lodging services is
preferable. Furthermore, the main deterrent for nonusers to utilize MWHs was inadequate knowledge of the
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services offered and the purpose of MWHs. Therefore, it is preferable to use already-existing prenatal care and
other maternal health services, to promote MWHs' use, purpose, and advantages among expectant mothers.
A study on maternal healthcare seeking and factors influencing proper prenatal care and institutional birthing
among Indian tribes was published in the European Journal of Obstetrics and Gynecology. In 2024, Kusuma et
al. conducted a cross-sectional investigation across nine districts. Only 22 percent of mothers in the tribal
communities under this study had proper prenatal care; this problem was exacerbated by a number of
circumstances, including the absence of all-weather roads and the status of Practical Vulnerable Tribal Groups
(PVTG). Guidance on prenatal care, maternal education, and home visits were found to be positively
correlated. In a similar vein, mother education and road connectivity affected accessibility to medical facilities
during delivery. The report emphasizes how vulnerable these groups are as a result of their inadequate
resources and socioeconomic limitations. In addition to long-term initiatives for economic growth and
education, certain short-term actions are crucial, such as like campaigns to raise awareness about teen
pregnancy and early child marriage. Proposed tactics to provide fair access to maternal healthcare include
more outreach programs and better road connectivity. In addition to highlighting the significance of the
components of the healthcare system, as well as the part that outreach initiatives and medical professionals
play in enhancing coverage of maternal healthcare services in tribal areas, it highlights the necessity of making
healthcare services easily available and user-friendly. Context-specific, long-term solutions created in
partnership with local communities are essential. PVTGs need special consideration, with focused tactics
meant to solve their particular difficulties. For the newly constructed Health and Wellness Centers in tribal
areas to maximize primary healthcare services, implementation research is therefore essential.
Adedokun and Yaya (2020) conducted a study that used multinomial analysis of demographic and health
surveys (2010–2018) from 31 countries to determine the correlates of prenatal care consumption among
women of reproductive age in sub-Saharan Africa. According to this study, 35% and 53% of women in sub-
Saharan Africa, respectively, partially and adequately used prenatal care, whereas roughly 13% did not use it at
all. Women aged 25 to 34years (53.9%), those from the wealthiest households (54.4%), those with secondary
or higher education (71.3%), and overall were very likely to use prenatal care adequately. Women with
secondary or higher levels of education, come from the wealthiest families, work, live in cities, are exposed to
the media, and have no trouble getting to or getting permission to visit a medical facility are more likely to use
adequate prenatal care. Information about women who partially and adequately used prenatal care has also
been made public by this study, in addition to those who did not use it. The study came to the conclusion that
socioeconomic and demographic characteristics, obtaining authorization to attend a medical facility, reluctance
to go to a health facility alone, and difficulties getting to the medical facility are the corresponds with of
prenatal care usage in sub-Saharan Africa.
Oluwamotemi et al., conducted a study in 2020 titled factors associated with utilization of antenatal care
services among women of child bearing age in Osogbo, Nigeria. According to the study, most respondents
(90.7%) knew very little about prenatal care, and many (59.7%) were unaware that women who are pregnant
should start prenatal care the moment they confirm their pregnancy. Additionally, some respondents (29.7%)
still preferred home delivery. Therefore, it is advised that an ANC education program be implemented to
inform women about the value and many benefits of prenatal care, with a focus on the WHO-recommended
prenatal care visit for the best treatment during the gestational period. For a more thorough understanding of
the variables linked to the use of prenatal care, a cohort study that incorporates other variables not included in
this study is also advised.
According to Igbokwe, (2024) study, influence of cultural beliefs on the utilization of integrated maternal,
newborn, and child health services in Benue State, Nigeria, majority of child bearing mothers (CBMs) were
unemployed (66.0%) and married (79.7%), with majority of them falling into the 15–24 age range (42.7%).
The use of Integrated Maternal Newborn and Child Health (IMNCH) services was high among CBMs, and
there was a moderately favorable correlation between IMNCH use and cultural characteristics. The findings
also imply that, in Benue State, Nigeria, cultural characteristics were important factors determining the use of
IMNCH services. In Benue State, every health education program pertaining to mother and child health should
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consider the cultural values, beliefs, and customs of the populace in order to uphold positive ones and
discourage those that are harmful to the health and welfare of CBMs and their offspring.
The study conducted by Prakash et al., (2012) on health seeking behaviour and health service utilization by
pregnant mothers in Vadodara slums sought to determine the key areas of health seeking behaviour and service
utilization during pregnancy and childbirth among women living in Vadodara's urban slums, as well as the use
of child health care during the first month of a newborn's life. to determine the behaviour that can be changed
in order to enhance service utilization and lower women's morbidity and mortality. This research is qualitative
and longitudinal. A systematic random sampling method was used to choose 30 Anganwadis. After giving their
informed agreement, 60 women from 30 Anganwadis within the third pregnancy trimester were included in the
study. Their perceptions of pregnancy and their behaviour in seeking health care during pregnancy (Phase I)
were investigated. They were then monitored for the childbirth experience (Phase II) one month following
delivery. After the Anganwadi worker arrived and registered, it was discovered that approximately 87% of the
women were enrolled with Anganwadi. By the conclusion of the first trimester, 54% of the women were
registered. The majority of them favored visiting private hospitals. In the past, nearly all mothers (97%) sought
antenatal care to ensure the safe delivery and good health of their unborn child. For delivery, the majority
chose a private hospital. Just 8% of people chose home delivery. The Postnatal Checkup (PNC) was performed
on about two thirds of the women. It was then determined that, although being from a lower socioeconomic
level, the most of the women had preference for private hospitals for childbirth, and the majority of mothers
disregarded postpartum care.
An analysis of the 2018 Nigeria Demographic and Health Survey (NDHS) was used by Adewuyi et al.,
(January 24, 2024) to evaluate the use of prenatal care in Nigeria: analyzing discrepancies between urban and
rural locations. This study offers a thorough analysis of Nigeria's antenatal care (ANC) utilization,
emphasizing the differences between urban and rural areas. The 2018, Nigeria demographic and health survey
was examined using the data disaggregation method. They determined characteristics linked to eight (≥8) ANC
contacts or more nationwide and across urban and rural households, calculated ANC utilization, and evaluated
the reception of the components of antenatal care. According to the study findings, Nigeria's overall ≥ 8 ANC
use rate was 20.3%, with urban areas accounting for 35.5% and rural areas for 10.4%. The North-West was the
least in ANC use in remote regions (2.7%), while the North-East was the least in antenatal care usage in urban
areas and across the national (3.0% and 3.7%, respectively). Urban dwellers had greater percentages of all
ANC components, with 69% of women nationwide receiving iron supplementation, together with 70%
receiving tetanus toxoid vaccines, and 16% receiving medications for intestinal parasites in case of worm
infestation. At the urban, rural, and national households, maternal autonomy, health insurance, and the
education of the mother and husband were all frequently linked to higher ANC probabilities. In the urban
areas, all ethnicities had better ANC probabilities compared with the Hausas/Fulanis, but in remote areas, the
Yorubas were the only ones with higher odds. While occupation status of mother, affluence, type of birth, radio
listening and religion were significant basically in rural regions, use of internet was significant mainly in the
context of the nation, and television viewing was significant only in urban areas. The research concluded that
there are significant differences in the quality and use of ANC, with socioeconomically poor women, rural
inhabitants, and those living in rural northern regions being more vulnerable. To address the inequities and
enhance the use of ANC in Nigeria, targeted interventions are essential, giving priority to the most vulnerable
subpopulations.
THEORETICAL BACKGROUND
This conceptual framework was developed using the Health Belief Model, the Theory of Reasoned Action
(TRA) or Theory of Planned Behaviour (TPB), and the Health Locus of Control (HLC). The three primary
components of health behaviour which are individual perceptions, moderating influences, and likelihood of
action are explained by the health belief model. According to both TPB and TRA, people's intentions play a
critical role in shaping the attitudes that determine whether or not the anticipated action occurs. Depending on
people's ideas about the results of particular activities, attitudes can be either good or negative. Conversely, the
health locus of control hypothesis contends that an individual's degree of personal control over their actions or
behaviour determines the outcomes of their health behaviour. This clarifies the different elements affecting the
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use of prenatal care. This conceptual framework shows the relationship between awareness of antenatal
services, and health seeking behaviour as well as factors influencing both variables.
This conceptual framework offers a methodical approach to comprehending the connection between pregnant
women in Osun State's health seeking behaviour and their awareness of antenatal services. The dependent
variable in this research being health seeking behaviour, is affected by the independent variable, awareness of
prenatal care. Pregnant women are very likely to seek the right medical care if they are more aware of the
advantages and accessibility of prenatal care (ANC). However, this link may also be impacted by other
moderating factors such familial influence, socioeconomic position, cultural attitudes, and accessibility to
healthcare. This paradigm is helpful in determining whether additional hurdles or a lack of awareness are the
main causes of non-attendance at ANC. In order to guarantee that the study adequately captures the variables
impacting health seeking behaviour, it also aids in directing data collecting and elucidating relationships. The
application of the approach for this study can help policymakers and healthcare professionals create focused
awareness campaigns and increase ANC accessibility, which will eventually motivate more expectant mothers
to seek the care they need.
The following are the research questions and hypotheses
i. What is the level of awareness of antenatal services among pregnant women in Osun State?
ii. What is the health seeking behaviour pattern of pregnant women in Osun State?
iii. What is the attitude of these pregnant women towards antenatal care services in Osun State.
iv. What are the factors affecting utilization of healthcare facilities among pregnant women in Osun State?
Hypothesis
i. There is no significant association between sociodemographic data (Age, level of education and
income) and health seeking behaviour of pregnant women in Osun State.
ii. There is no significant association between sociodemographic data (Age, level of education and
income) with attitude of pregnant women in Osun State.
METHODS
Study Setting
The area of study was Osun State in the Southwest geopolitical zone of Nigeria, with total surface area of
about 14,875sqkm, with a projected population of 4,705,589 in 2016 and the female population is 2,305,739
(National Population Commission of Nigeria, National Bureau of Statistics Estimates, 2017). It comprises
three (3) senatorial zones with thirty (30) local governments which are: Western Zone - Ayedire, Ayedaade,
Ede-South, Ede-North, Ejigbo, Egbedore, Iwo, Irewole, Olaoluwa, Olorunda, Isokan; Eastern Zone - Ife-East,
Ife-Central, Ife-South, Ife-North, Atakunmosa West, Atakunmosa East, Ilesa West, Ilesa East, Obokun, Oriade;
and Central Zone - Boripe, Boluwaduro, Ifelodun, Ifedayo, Irepodun, Ila, Orolu, Odo-Otin, and, Osogbo.
The state has a total of eight hundred and sixty-five (865) public health facilities which provides
Obstetric/Gynecological services. These include 808 Primary Health Centers, 41 Comprehensive Health
Centers, 12 General/State Hospitals and 4 Tertiary health facilities.
Osun State is a multireligious place where people practice Islam, Christianity, and traditional beliefs. The
ancient beliefs of the Yoruba people of Osun state include their own cults and priests, an intricate hierarchy of
deities. Osun state is predominantly inhabited by Yoruba ethnic group and is characterized by a mix of urban
and rural communities.
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Study Population
The study population for this research were pregnant women residing in Osun State, Southwestern Nigeria.
These women represent a critical demographic for evaluating awareness and utilization of antenatal services.
The target population includes pregnant women within the community who may or may not be registered in a
health facility for antenatal care. This population was chosen due to their direct experience with maternal
health services and their relevance to the study objectives. Inclusion criteria include women who are currently
pregnant, aged 15-49years, and willing to give informed consent to participate in the study.
Study Design
This study used a descriptive cross-sectional research design to assess the level of awareness of antenatal
services, health seeking behavior and factors influencing their utilization of antenatal services of pregnant
women in Osun State.
Study Variables
Variables in this study includes awareness of antenatal services being the independent variable, and health-
seeking behavior being the dependent variable.
Sample Size Determination
Three hundred and forty-one (341) pregnant women made up the respondents for this study and were selected
by simple random sampling technique across the selected local governments in Osun State regardless of their
age and marital status.
Fischer’s sample size formular was used, which is: n = z
2
p q
d
2
Where, n = the desired sample size.
z = the standard normal deviate, usually set at 1.96 which corresponds to 95% confidence level.
p = prevalence of health seeking behaviour among pregnant women, estimated as 28.3% (Nwachukwu et al.,
2023)
Therefore, the value of p that was used in this study is 28.3%, that is, 0.28
q = 1 - p = 1- 0.28 = 0.72
d = degree of accuracy desired, usually set at 0.05.
Sample size is therefore calculated thus,
n = 1.96
2
x 0.28 x 0.72 = 0.774 = 309.6 = 310
0.05
2
0.0025
Non-Response Ratio was calculated as 10% of the sample size, that is 310 ÷ 10 = 31
So, the total sample size was 310 + 31 = 341 pregnant women.
Sampling
Quota sampling technique was utilised for this study. Since the target population are the pregnant women in
Osun State. Eight (8) local government areas were randomly selected out of the 30 local governments in the
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state. Three (3) local government areas from the Western Zone, three (3) from the Eastern Zone and two (2)
from the Central zone. About 42 pregnant women were selected by simple random technique within each
selected local government. The selected local governments include Atakunmosa West, Ife East, Ife South, Ede
North, OlaOluwa, Olorunda, Ifelodun and Osogbo. These selected local governments included both rural and
urban areas in order to capture diverse experiences.
Study Instrument
The instrument used for data collection for this research work was a well-structured questionnaire comprising
5 sections as follows:
Section A consists of the sociodemographic variables of the participants which include age, ethnicity, marital
status, religion, occupation, educational qualification, family setting, number of pregnancies, number of live
births among others.
Section B consists of questions about awareness of antenatal services among pregnant women.
Section C consists of questions to determine health seeking behaviour of pregnant women.
Section D consists of questions on attitude of pregnant women towards utilization of antenatal care services.
Section E consists of questions to identify factors influencing utilization of healthcare services by pregnant
women.
Statistical Package for Social Science (SPSS) version 23.0 was utilised to code, classify, computerize, tabulate,
and analyze the data. Percentages and frequency tables were also used to display the results. Chi-square
analysis was utilized to test for associations. Pregnant women's attitudes regarding seeking healthcare were
assessed using a dichotomous scale.
Data Collection
First-hand information was gathered from participants rather than depending on assumptions made by the
wider public. Self-administered questionnaire-based interviews were done, and the report was acquired at the
same time.
Duration of study
It took roughly six weeks to gather data from the target population, while the entire study took about seven
months.
Data Processing
Statistical Package for Social Science (SPSS) version 23.0 was utilised to code, classify, computerize, tabulate,
and analyze the data. Percentages and frequency tables were also used to display the results. Chi-square
analysis was utilized to test for associations. Pregnant women's attitudes regarding seeking healthcare were
assessed using a dichotomous scale.
Ethical Clearance/Permission/Consent
The University of Port Harcourt Research Ethics Committee granted permission to carry out the study.
Confidentiality was guaranteed to study participants, and the data they submitted was used exclusively for the
study. No one not directly involved in this study was given access to the provided information. Before the
study was conducted, participants gave their informed consent after being fully informed about the procedures
involved. Participants were allowed to freely withdraw from the research at will without facing any
consequences.
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Response Rate/Completeness of Data
A 94.43% response rate was obtained from the 341 questionnaires that were distributed, of which 322 were
returned and properly completed. These were utilized in the study.
Socio-Demographic Characteristics
The sociodemographic characteristics of the respondents in the studied population sample are variables like
age, ethnicity, marital status, occupation, religion, occupation of spouse, educational qualification, educational
qualification of spouse, family setting, place of residence, age at marriage, total number of pregnancies ever
had, total number of live births, mode of delivery of previous pregnancies, place of childbirth, income level
and income level of spouse.
Majority (62.1%) of the participants were within the age range of 20 to 34years old, most (92.9%) of them are
married, 78.6% of them are Yorubas, 78.6% of them also are Christians, 56.5% of them are self-employed
while 59.3% of them had self-employed spouses, 151(46.9%) of the respondents had tertiary education as their
educational qualification while 51.6% of them had spouses with tertiary educational qualification, most
(84.8%) of the respondents belong to a monogamous family setting, majority (67.7%) of the respondents are
residents of rural communities, majority (75.2%) of the participants got married within age range of 20 to
34years, 113 (35.1%) of the participants have been pregnant three times, most (72%) of the participants have
had live births within the range of 1 - 4 children, majority (80.7%) of the respondents delivered the previous
pregnancies by themselves and in the hospital (59.9%), 37.3% of them earn within the range of ₦100,000 -
<₦250,000 monthly, while 37.3% of their spouses earn from ₦250,000 and above monthly likewise.
Table 1: Frequency Distribution Showing Respondents’ Socio-Demographic Characteristics
Variables
Frequencies
Percentages
Age
20
6.2
200
62.1
102
31.7
322
100.0
Marital Status
21
6.5
299
92.9
2
0.6
322
100.0
Ethnicity
253
78.6
54
16.8
6
1.9
9
2.8
322
100.0
Religion
253
78.6
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66
20.5
2
.6
1
0.3
322
100.0
Occupation
22
6.8
101
31.4
17
5.3
182
56.5
322
100.0
Spousal Occupation
14
4.3
108
33.5
9
2.9
191
59.3
322
100.0
Educational Status
70
21.7
97
30.1
151
46.9
4
1.2
322
100.0
Spousal Educational
Status
59
18.3
80
24.8
166
51.6
17
5.3
322
100.0
Family Status
273
84.8
49
15.2
322
100.0
Place of Residence
218
67.7
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104
32.3
322
100.0
Age at Marriage
75
23.3
242
75.2
5
1.6
322
100.0
Total number of
pregnancies ever had
10
3.1
90
28.0
113
35.1
59
18.3
43
13.4
5
1.6
2
0.6
322
100.0
No of live births
25
7.8
232
72.0
65
20.2
322
100.0
Mode of delivery for
previous pregnancies
260
80.7
61
19.0
1
0.3
322
100.0
Place of childbirth
47
14.6
193
59.9
75
23.3
7
2.2
322
100.0
Monthly Income level
57
17.7
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87
27.0
120
37.3
58
18.0
322
100.0
Monthly Income level
of spouse:
40
12.4
75
23.3
87
27.0
120
37.3
322
100.0
Study Findings – Tables/Figures And Narratives That Cover The Research Questions/ Objectives
Awareness of Antenatal Services
Most of the participants agreed to the following statements: “have heard of antenatal care services” (94.4%);
“visit the health facility for antenatal care” (82.6%); “have a birth preparedness plan for their recent birth/this
pregnancy” (85.4%); “receive at least 2 doses of Tetanus Toxoid vaccine in pregnancy” (85.4%); “knows that
the remaining doses of Tetanus Toxoid vaccine should be completed even after delivery of that pregnancy”
(59.3%); “were administered folic acid tablets in pregnancy” (84.8%); “had any of the following
tests/examinations during pregnancy - Weight, Height, Blood Pressure, Abdominal examination, Blood test for
HIV & Hepatitis B, Blood group & genotype, Sickle Cell, Thyroid test, Hemoglobin Test, Urine test,
Ultrasonography (92.2%); “aware of transport services for emergency delivery around them” (57.5%); “know
of antenatal services such as treatment of malaria, nutritional health education, prevention of communicable
disease” (50.3%); “know that should visit the antenatal clinic for minimum of 8 times in pregnancy” (52.2%);
know of any free or subsidized antenatal services in their area” (82.9%).
However, majority of the respondents said no to the following statements: “Heath workers visit them at home
during pregnancy & after childbirth” (82.65%); “had any cause for any medical complaints in this pregnancy”
(66.5%); “experience at least 1 of the following symptoms/complications in pregnancy - Bleeding per
vaginam, Chills & Fever, Pains in the lower abdomen, Headache, Oedema, Excess vomiting, High Blood
Pressure (61.2%); “experience any of the following delivery complications in the past - Preterm labor, Heavy
bleeding, prolonged labor, Drainage of liquor, Delayed placental delivery, seizures, Fever, Difficult delivery,
Weakness, Baby with cord round the neck” (68.9%); “aware of screening services for diseases before first
pregnancy” (73.6%).
Table 2: Awareness of Antenatal Services
S/N
YES F (%)
NO F (%)
1.
Have you ever heard of antenatal care services?
304 (94.4%)
18 (5.6%)
2.
Do you visit the health facility for antenatal care?
266 (82.6%)
56 (17.4%)
3.
Do you have a birth preparedness plan for your recent birth/this
pregnancy?
275 (85.4%)
47 (14.6%)
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4.
Did you receive at least 2 doses of tetanus toxoid vaccine in pregnancy?
275 (85.4%)
47 (14.6%)
5.
Do you know that you should complete the remaining doses of Tetanus
Toxoid vaccine even after delivery of that pregnancy?
191 (59.3%)
131(40.7%)
6.
Did Heath workers visit you at home during pregnancy & after childbirth
56 (17.4%)
266 (82.65)
7.
Were you administered folic acid tablets in pregnancy?
273 (84.8%)
49 (15.2%)
8.
Did you have any of the following tests/examinations during pregnancy?
Please select the ones that pertains to you
- Weight, Height, Blood Pressure
- Abdominal examination,
- Blood test for HIV & Hepatitis B, Blood group & genotype, Sickle Cell,
Thyroid test, Hemoglobin Test
- Urine test
- Ultrasonography
297 (92.2%)
25 (7.8%)
9.
Have you had any cause for any medical complaints in this pregnancy?
108 (33.5%)
214 (66.5%)
10.
If yes, was it attended to to your satisfaction?
102 (31.7%)
220 (68.3%)
11.
Did you experience at least 1 of the following symptoms/complications in
pregnancy?
- Bleeding per vaginam, Chills & Fever, Pains in the lower abdomen,
Headache, Oedema, Excess vomiting, High Blood Pressure.
125 (38.85)
197 (61.2%)
12.
Are you aware of transport services for emergency delivery around you?
185 (57.5%)
137 (42.5%)
13.
Did you experience any of the following delivery complications in the
past?
- Preterm labor, Heavy bleeding, prolonged labor, Drainage of liquor,
Delayed placental delivery, seizures, Fever, Difficult delivery, Weakness,
Baby with cord round the neck.
100 (31.1%)
222 (68.9%)
14.
Are you aware of screening services for diseases before your first
pregnancy?
85 (26.4%)
237 (73.6%)
15.
Do you know of the following antenatal services such as: Treatment of
malaria, nutritional health education, prevention of communicable
disease.
162 (50.3%)
160 (49.7%)
16.
Do you know that you should visit the antenatal clinic for minimum of 8
times in pregnancy?
168 (52.2%)
154 (47.8%)
17.
Do you know of any free or subsidized antenatal services in your area?
267 (82.9%)
55 (17.1%)
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Health Seeking Behaviour of Pregnant Women
Most (82.9%) of the participants visits the antenatal clinic for their recent birth/pregnancy, 78.9% used health
facility for their recent birth/pregnancy, 74.8% delivered recent childbirth in the hospital, 67.4% planned to
deliver this pregnancy in the hospital, 51.9% usually start antenatal care as soon as they confirm pregnancy,
65.8% takes all medications as prescribed during pregnancy, 87.9% carry out all tests/examinations as
recommended in pregnancy, 65.2% reports any complication experienced in pregnancy promptly, 73.3%
reports delivery complications in good time, 71.7% took to all preventive measures taught during pregnancy.
However, 25.2% of the respondents who did not deliver recent childbirth in the hospital, claimed to deliver in
faith homes, some in their houses, and others with the Herbalist/Traditional Birth Attendant; 68% do not start
antenatal clinic during the third trimester of pregnancy, 73% do not prefer their church faith homes or
Traditional Birth Attendants to the hospital Midwives, 67.4% did not take up any screening for diseases before
their first pregnancy.
Table 3: Health Seeking Behaviour of Pregnant Women
S/N
YES F (%)
NO F (%)
1.
Did you visit the antenatal clinic for your recent
birth/pregnancy?
267 (82.9%)
55 (17.1%)
2.
Did you see use the health facility for your recent
birth/pregnancy?
254 (78.9%)
68 (21.1)
3.
Did you deliver recent childbirth in the hospital?
241 (74.8%)
81 (25.2%)
4.
If No, where? _____________
3 (0.9%)
319 (99.1)
5.
Did you plan to deliver this pregnancy in the hospital?
217 (67.4%)
105 (32.6%)
6.
I usually start Antenatal care as soon as I confirm myself
pregnant
167 (51.9%)
155 (48.1%)
7.
I start antenatal clinic during the third trimester of my
pregnancy
103 (32%)
219 (68%)
8.
I prefer my church faith homes or Traditional Birth Attendants
to the hospital Midwives.
87 (27%)
235 (73%)
9.
I took all medications as prescribed during pregnancy
212 (65.8%)
110 (34.2%)
10.
Did you carry out all tests/examinations as recommended to
you in pregnancy?
283 (87.9%)
39 (12.2%)
11.
Did you report any complication experienced in pregnancy
promptly?
210 (65.2%)
112 (34.8%)
12.
Did you report the delivery complications in good time?
236 (73.3%)
86 (26.7%)
13.
Did you take up any screening for diseases before your first
pregnancy?
105 (32.6%)
217 (67.4%)
14.
Did you take to all preventive measures taught during
pregnancy?
231 (71.7%)
91 (28.3%)
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Attitude of Pregnant Women Towards Utilization of Antenatal Services
It was found out that 57.8% do not consider pregnancy as a risky event, 64% do not think antenatal care should
be initiated in the first pregnancy trimester, 66.1% do not have mixed feelings about their pregnancy nor feel
reluctant to use antenatal care services,74.5% admitted that they are pregnant, 70.5% do not feel overwhelmed
and were ready for motherhood, 84.5% were not afraid, 69.3% had the pregnancy planned, 77.3% agreed that
there is so much to do for them at the antenatal clinics, 78.3% disagreed that becoming pregnant is a typical
life event in which women can take care of themselves, and so should always go to the hospital whether well
or unwell, 86.6% trusted the doctors and the midwives, 91.6% do not feel judged and stigmatized by
healthcare professionals, 83.2% disagreed that healthcare professionals are just task-oriented, they possess
empathy and treat one with respect, 74.8% disagreed that only the rich people get the best attention, and the
poor are neglected, 79.5% had their opinions usually regarded by the health professionals; attending the
antenatal clinic is not a waste of time for 53.4%, 72.7% do not have issues with the hospital referral services,
74.8% do not have their antenatal appointments clash with other commitments, 79.5% do not feel discouraged
not seeing the same healthcare worker at every visit.
On the other hand, 66.6% of the respondents see attending every antenatal clinic as compulsory, even if there
are no complaints, 74.2% think pregnancy cannot be booked anytime the woman pleases
Table 4: Attitude of Pregnant Women Towards Utilization of Antenatal Services
S/N
YES F (%)
NO F (%)
1.
I consider pregnancy as a risky event
136 (42.2%)
186 (57.8%)
2
I think ANC should be initiated in the first trimester of pregnancy.
116 (36%)
206 (64%)
3
Attending every antenatal clinic is not compulsory if there are no
complaints
108 (33.45%)
214 (66.6)
4
I think pregnancy can be booked anytime the woman pleases
83 (25.8%)
239 (74.2%)
5
I usually have mixed feelings about my pregnancy making me feel
reluctant to use antenatal care services
109 (33.9%)
213 (66.1%)
6
I do not admit that I am pregnant
82 (25.5%)
240 (74.5%)
7
I feel overwhelmed and not ready for motherhood
95 (29.5%)
227 (70.5%)
8
I am afraid
50 (15.5%)
272 (84.5%)
9
My pregnancy is unplanned
99 (30.7%)
223 (69.3%)
10
There is no much to do for us at the antenatal clinics
73 (22.7%)
249 (77.3%)
11
Pregnancy is a normal life event, women can take care of themselves,
and so should only go to the hospital when feeling unwell
70 (21.7%)
252 (78.3%)
12
I do not trust the doctors and the midwives
43 (13.4%)
279 (86.6%)
13
I feel judged and stigmatized by healthcare professionals
27 (8.4%)
295 (91.6%)
14
The healthcare professionals are just task oriented; they lack empathy
and do not treat one with respect
54 (16.8%)
268 (83.2%)
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15
Only the rich people get the best attention, and the poor are neglected
81 (25.2%)
241 (74.8%)
16
My opinion is usually not regarded by the health professionals
66 (20.5%)
256 (79.5%)
17
Attending the antenatal clinic is a waste of time
150 (46.6%)
172 (53.4%)
18
There are issues with the hospital referral services
88 (27.3%)
234 (72.7%)
19
My antenatal appointments clashes with my other commitments
81 (25.2%)
241 (74.8%)
20
Not seeing the same healthcare worker at every visit discourages me
66 (20.5%)
256 (79.5%)
Factors Affecting Utilization of Healthcare Facilities by Pregnant Women.
A fair percentage (50.9%) of the respondents have full autonomy to take decision as it pertains to their health,
50.9% had good road network to the health facility, 72% have a personal means of transportation, 89.1% do
not need to take permission from their husband before using any health facility, 97.2% are usually willing to go
to the health facility alone, 89.8% disagreed that antenatal clinic is only for those having complications in
pregnancy/with childbirth, 77.2% disagreed that those who attend antenatal clinic usually dies, 89.1% are
satisfied with the services of the antenatal clinics, Cost of antenatal services is affordable for 96.9%, 74.8%
have their husband support them going to the hospital for antenatal care, 90.4% were pleased with the service
of the health facility when they complained of a complication in pregnancy.
However, 58.1% do not want the pregnancy, and 60.2% had the health facility too far from their residence.
Table 5: Factors Affecting Utilization of Healthcare Facilities by Pregnant Women.
S/N
YES F (%)
NO F (%)
1.
I do not have full autonomy to take decision as it pertains to my
health
158 (49.1%)
1640.9%)
2.
The pregnancy is not wanted
187 (58.1%)
135 (41.9%)
2
Road network to the health facility is bad
158 (49.1%)
164 (50.9%)
3
The health facility is too far from my residence
194 (60.2%)
128 (39.8%)
4
I do not have a personal means of transportation.
90 (28%)
232 (72%)
5
I must obtain permission from my husband to use any health
facility
35 (10.9%)
287 (89.1%)
6
I am usually unwilling to visit the health facility alone.
9 (2.8%)
313 (97.2%)
7
Antenatal clinic is only for those having complications in
pregnancy/with childbirth
33 (10.2%)
289 (89.8%)
8
Those who attend antenatal clinic usually dies
73 (22.7%)
249 (77.2%)
9
I am usually not satisfied with the services of the antenatal clinics
35 (10.9%)
287 (89.1%)
10
Cost of antenatal services is not affordable
10 (3.1%)
312 (96.9%)
11
In my culture, our pregnancies do not go to the hospital.
187 (58.1%)
135 (41.9%)
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12
My husband does not support me going to the hospital for antenatal
care.
81 (25.2%)
241 (74.8%)
13
I was not pleased with the service of the health facility when I
complained of a complication in pregnancy.
31 (9.6%)
291 (90.4%)
RESULTS – MAX 5 (TABLES AND/OR FIGURES) WITH 750 WORDS NARRATIVE
Table 6: Awareness level of respondents Generally, the respondents have a good awareness (57.1%) of
antenatal services.
Awareness_CAT
Frequency
Percentage
Valid Percentage
Cumulative Percentage
Valid
Poor awareness
138
42.9
42.9
42.9
Good awareness
184
57.1
57.1
100.0
Total
322
100.0
100.0
Table 7: Health seeking behaviour of respondents
Generally, the respondents have a good health seeking behaviour (57.8%).
Healthseek_CAT
Frequency
Percentage
Valid
Percentage
Cumulative
Percentage
Valid
Poor Health seeking behaviour
136
42.2
42.2
42.2
Good Health seeking behaviour
186
57.8
57.8
100.0
Total
322
100.0
100.0
Table 8: Attitude of participants to antenatal services
Overall, the respondents have a poor attitude (53.4%) towards antenatal services
Attitude_CAT
Frequency
Percentage
Valid Percentage
Cumulative Percentage
Valid
poor attitude
172
53.4
53.4
53.4
Good attitude
150
46.6
46.6
100.0
Total
322
100.0
100.0
Hypothesis
H
0
: There is no statistically significant association between sociodemographic data (Age, education level and
income) and health seeking behaviour of pregnant women in Osun State.
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Result: The p-value (0.001) derived is lesser than the critical value for this study, hence there is statistically
significant association between sociodemographic data (Age, education level and income) and health seeking
behaviour of pregnant women in Osun State.
Table 9: Association between sociodemographic data (Age, education level and income) and health seeking
behaviour of pregnant women in Osun State using chi square
Variables
Health seeking behaviour
ꭓ2
p-value
Poor 136 (42.2%)
Good 186 (57.8%)
Age (years)
<20
20-34
35-49
16 (80)
74 (37)
46 (45.1)
4 (20)
126 (63)
56 (54.9)
14.9
0.001
Educational Status
Primary
57 (81.4)
13 (18.6)
58.23
<0.001
Secondary
32 (33)
65 (67)
Tertiary
46 (30.5)
105 (69.5)
None
1 (25)
3 (75)
Income
<50,000 naira
18 (31.6)
39 (68.4)
19.9
<0.001
50,000 - 100,000 naira
26 (29.9)
61 (70.1)
100,000 - 249,999 naira
55 (45.8)
65 (54.2)
≥250,000
37 (63.8)
21 (36.2)
H
0
: There is no statistically significant association between sociodemographic data (Age, education level and
income) with attitude of pregnant women in Osun State.
Result: The p-values (0.267, 0.309) derived is greater than the critical value for this study, hence there is no
statistically significant association between sociodemographic data (Age and level of education) and attitude of
pregnant women in Osun State, however, there is statistically significant association between income level and
attitude of pregnant women in Osun State (p value< 0.045).
Table 10: Association between sociodemographic data (Age, level of education and income) with attitude of
pregnant women in Osun State, using chi square
Variables
Attitude
ꭓ2
p-value
Poor
172 (53.4%)
Good
150 (46.6%)
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Age (years)
<20
20-34
35-49
11 (55)
100 (50)
61 (59.8)
9 (45)
100 (50)
41 (40.2)
2.6
0.267
Educational Status
Primary
44 (62.9)
26 (37.1)
3.6
0.309
Secondary
47 (48.5)
50 (51.5)
Tertiary
79 (52.3)
72 (47.7)
None
2 (50)
2 (50)
Income
<50,000 naira
30 (52.6)
27 (47.4)
8.0
0.045
50,000 - 100,000 naira
36 (41.4)
51 (58.6)
100,000 - 249,999 naira
73 (60.8)
47 (39.2)
≥250,000
33 (56.9)
25 (43.1)
DISCUSSION
Sociodemographic profile of respondents
According to this study findings, the most of the participants are married, between the ages of 20 and 34, live
in rural areas, have had live births between the ages of 1 and 4, and the majority of them recently gave birth in
a hospital. This is comparable to the findings of Fagbamigbe & Idemudia, (2015), who found that the majority
of their respondents were married, between the ages of 20 and 29, lived primarily in rural areas, and had given
birth to up to four children. According to Adelekan, (2024), the bulk of her participants were from low-income
rural homes without formal schooling.
Additionally, this research showed that the most of the participants are Yoruba (from south-western Nigeria),
have completed college, even with their husbands, and earn between ₦100,000 and ₦250,000 per month, with
their spouses earning even more. This contrasts with the results of Fagbamigbe and Idemudia, (2015), who
found that the majority of participants were from the northeastern region of Nigeria, had only completed
secondary school as their greatest level of education, and were classified as economically disadvantaged. This
indicates that individuals who are Yoruba, financially secure, and well-educated are very likely to use and
receive antenatal care. However, the study also revealed that access to prenatal care was more difficult for
women in North-Eastern Nigeria who had lower economic standing and levels of education. Given that
maternal healthcare utilization is greatly impacted by characteristics including education, income, and cultural
diversity, this highlights the necessity for particular health initiatives. Instead of using a one-size-fits-all
strategy, policies might be customized to accommodate the particular difficulties faced by each location.
Awareness of Antenatal Services
The results of this study, which examined pregnant women awareness of antenatal care in Osun State,
indicated that majority of them are aware of these services. The results of a hospital-based study on
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Knowledge, Attitude, and Practice (KAP) on Antenatal Care Among Pregnant Women and its Association with
Sociodemographic Factors by Bashir et al., (2023) are comparable to this. He discovered that these pregnant
women knew a lot about antenatal care. Additionally, this is in line with the results of a 2019 cross-sectional
study by Gebremariam et al. titled Level of Knowledge, Attitude, and Practice of Pregnant Women on
Antenatal Care at Amatere Health Center, Massawa, Eritrea (first published January 24, 2023). The majority of
the women in this survey demonstrated a positive attitude and good understanding regarding prenatal care.
Nwabueze et al., (2023) study, "Assessing Focused Antenatal Care (FANC) Awareness and Utilization Among
Pregnant Women in Enugu State, Nigeria: A Cross-Sectional Survey," contrasts with this finding. Due to the
respondents' poor educational attainment, he discovered that only 7.3% of them knew well about the
components of focused prenatal care.
Health seeking behaviour of Pregnant Women
The findings of this study indicate that a significant majority of pregnant women in Osun State demonstrate
fairly good health‑seeking behavior, particularly in accessing antenatal care (ANC) services. Although, when
benchmarked against the 2016 WHO guideline advocating a minimum of eight ANC contacts, local adherence
remains inconsistent. While a 2021 national survey found substantial variation across Nigeria, with Osun State
achieving one of the highest eight‑visit compliance rates at 80.2 %, the national average remains low at 20%,
indicating room for improvement. Moreover, only around 9.9 % of women across Sub‑Saharan Africa fulfill
the eight‑contact standard (BioMed Central, 2024), underscoring systemic challenges regionally.
By comparison, cross-sectional research from Kancheepuram District, Tamil Nadu (Gopalakrishnan et al.,
2019), highlighted a critical information gap: many rural women were unaware of danger signs in pregnancy,
leading to poor decisions regarding healthcare utilization. Similarly, Mazharul et al., (2018) in Bangladesh
identified low compliance with WHO recommendations for maternal care including antenatal, delivery, and
postnatal services reflecting reluctance or inability to seek appropriate medical attention.
Yet, the sub‑optimal satisfaction levels reported point to persistent quality gaps. WHO emphasizes that
respectful, empathetic, and high‑quality ANC including coverage of danger‑sign counseling, nutrition
screening, and mental‑health support is essential. Addressing long waiting times, improving staff patient
communication, and reinforcing community health education could help bridge this gap.
So, while pregnant women in Osun State are fairly proactive in seeking antenatal services and engage at higher
levels than many regional and global peers, continuous efforts particularly in service quality and adopting
WHO’s full eight‑contact model will be essential to attain sustainable maternal health outcomes.
Attitude of Pregnant Women Towards Utilization of Antenatal Services
The findings of this study revealed that a significant proportion of pregnant women in Osun State exhibited a
generally negative attitude toward the utilization of antenatal care services, despite an acceptable level of
awareness. This outcome is concerning, as a negative attitude can undermine the effectiveness of maternal
health programs and reduce compliance with recommended antenatal visits, potentially placing both maternal
and fetal health at risk.
This finding contrasts sharply with the results of a recent hospital-based study by Bashir et al., (2023), which
assessed the Knowledge, Attitude, and Practice (KAP) of pregnant women toward antenatal care and its
association with sociodemographic factors. The study reported a predominantly positive attitude among
pregnant women toward antenatal care services, suggesting that women in that setting appreciated the
importance and benefits of ANC for healthy pregnancy outcomes. This divergence may reflect contextual
differences in population characteristics, health system engagement strategies, or cultural perceptions of
maternal healthcare.
Similarly, a cross-sectional study by Gebremariam et al., (2019), conducted at Amatere Health Centre in
Massawa, Eritrea and published in 2023, found that the majority of women surveyed had a positive attitude
toward prenatal care. The study emphasized that positive maternal attitudes were strongly linked to effective
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health education, community sensitization, and previous positive experiences with healthcare providers. The
contrast between these findings and the present study suggests that while awareness may be widespread in
Osun State, it does not necessarily translate into favorable attitudes or proactive health behaviors.
Several factors may contribute to the negative attitudes observed in this study. These may include past
experiences of poor service delivery, long waiting times, perceived provider disrespect, financial constraints,
cultural beliefs, or misconceptions about the necessity of frequent antenatal visits. It is also possible that
although women are aware of antenatal services, their motivation to use these services consistently may be
influenced by personal beliefs, peer influence, or lack of emotional support from partners or family.
The discrepancy between knowledge and attitude found in this study underscores the importance of addressing
not only informational gaps but also the behavioral and emotional determinants of health-seeking behavior. As
such, health promotion programs should not only focus on raising awareness but also on reshaping attitudes
through community engagement, testimonials from satisfied service users, improved patient-provider
relationships, and psychosocial support initiatives.
Factors Influencing Utilization of Health Care Facilities Among Pregnant Women
This study highlights several key motivating factors that positively influence pregnant women in Osun State to
seek antenatal care (ANC). Notably, spousal support, personal mobility, dependable transportation
infrastructure, and autonomy in healthcare decisions emerged as significant enablers. This result underscore
the role of family backing and self‐determination in facilitating healthcare utilization.
Attitudinally, respondents exhibited favorable perceptions of ANC, recognizing it as universal and pivotal for
reducing maternal mortality. These positive views appear reinforced by the implementation of the Osun Health
Insurance Scheme, which has reduced out‑of‑pocket expenses for prenatal visits. However, satisfaction levels
are inconsistent due to issues like prolonged wait times and occasional disrespectful provider conduct.
Despite these enablers, significant obstacles remain. Unintended pregnancies reported by 58.1% of the
respondents were associated with reduced ANC uptake, suggesting reluctance or stigma play roles in health-
seeking avoidance. Geographic barriers also persisted, in that women living more than 5 km from health
facilities were significantly less likely to attend ANC. These findings echo those of Fagbamigbe and Idemudia,
(2015), who identified socio-cultural detachment, financial limitations, and infrastructure deficits as major
barriers in Nigeria.
National data from 2012 indicate that women in the wealthiest quintile were over five times more likely to use
ANC adequately compared to their poorest counterparts, reinforcing the critical interplay between
socioeconomic status and ANC utilization. The results emphasize the pivotal roles of social, infrastructural,
and economic enablers such as autonomy, transportation, cost, and positive ANC perceptions in boosting
maternal awareness and healthcare-seeking behavior. However, unintended pregnancies and geographical
constraints continue to pose notable barriers. Aligning policy efforts with contextual elements from coverage
schemes to digital outreach and family-based programs will be essential for strengthening ANC uptake and
achieving sustainable maternal health improvements in Osun State.
Influence of sociodemographic factors on awareness of ANC and health-seeking behavior
This study highlights the significant role of socio-demographic characteristics (such as age, parity, education,
occupation, marital status and income level) in shaping awareness of antenatal services and health-seeking
behaviour among pregnant women in Osun State.
Age being an important determinant was seen as younger women, particularly adolescents and those below 20
years, demonstrated lower awareness and poorer utilization of antenatal services, largely due to inexperience,
limited autonomy, and restricted access to information. In contrast, older women showed higher awareness and
greater health-seeking behaviour, possibly due to accumulated maternal experience and heightened perception
of pregnancy-related risks (NDHS, 2018; WHO, 2016).
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Parity also influenced utilization patterns with first-time mothers (primigravidae) often had limited initial
awareness but showed high motivation to seek care once informed, driven by concerns about complications.
Multiparous women, however, though more knowledgeable from previous pregnancies, sometimes
underutilized antenatal services, reflecting a degree of overconfidence based on prior uncomplicated births
(Tessema et al., 2023).
Educational attainment emerged as one of the strongest predictors. Women with secondary or tertiary
education were more likely to be knowledgeable about antenatal care, interpret health messages correctly, and
seek timely care. Conversely, women with no or low educational attainment exhibited misconceptions, poor
risk perception, and delays in accessing formal health services, consistent with findings from other sub-
Saharan African contexts (Nwabueze et al., 2023; Bashir et al., 2023).
Occupation and economic independence influenced both awareness and service utilization. Women engaged in
stable, formal employment had greater financial capacity to afford consultations, transportation, and associated
costs of care. Those unemployed or in low-paying informal work faced significant barriers, often delaying or
forgoing care despite awareness of its benefits (Latunji & Akinyemi, 2018).
Marital status was another key determinant in that, married women reported higher awareness and better
health-seeking behaviour, supported by spousal encouragement, financial provision, and joint decision-making.
By contrast, unmarried, divorced, or widowed women were more vulnerable to poor health-seeking behaviour,
largely due to inadequate financial resources, stigma, and limited social support networks (Gebremariam et al.,
2023).
Finally, income level was strongly associated with both awareness and utilization because, women in higher
income brackets accessed care more consistently, often at higher-quality facilities, while those from low-
income households faced affordability challenges, leading to delayed initiation of care or reliance on
traditional birth attendants and informal providers (El-Khatib et al., 2020; Fagbamigbe et al., 2021).
Taken together, these findings underscores the complex interplay between socio-demographic characteristics
and maternal health outcomes. While education, income, and marital stability act as enablers of awareness and
utilization, barriers such as poverty, low literacy, early age at pregnancy, and lack of spousal support continue
to hinder progress. Addressing these disparities requires context-specific interventions, including health
education campaigns, economic empowerment programmes for women, and community-based support
systems, in order to improve antenatal care awareness and health-seeking behaviour in Nigeria.
CONCLUSION
The results of this research showed that most of the participants are aware of antenatal services, have good
health seeking behaviour, but poor attitude towards their health. This result being just fair, reveals that there is
still need to improve the awareness and health seeking behaviours of women that are pregnant. This study also
identified factors affecting their use of antenatal services, of which a considerable number of these factors are
quite commendable, apart from the fact that the pregnancies are not wanted and, that the health facility is quite
far from their place of residence. This then calls for need to educate the community about family planning,
debunking misconceptions about it, in order to prevent unwanted pregnancies which could lead to poor attitude
to health. There could also be need to allocate medical practitioners to the rural areas with appreciable
renumeration, in order to make healthcare accessible & available to the residents in the remote areas. The
hypotheses tested in this study revealed that there is statistically significant association between
sociodemographic data (Age, education level and income) and health seeking behaviour of pregnant women in
Osun State (p-value 0.001). Likewise, there is no statistically significant association between
sociodemographic data (Age and level of education with p-values 0.267 and 0.309 respectively) and attitude of
pregnant women in Osun State, however, there is statistically significant association between income level and
attitude of pregnant women in Osun State (p value< 0.045).
To translate these findings into practice, several actionable recommendations are proposed:
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- First, strengthening health education programmes at the community and primary healthcare levels is
critical for reinforcing awareness and shaping positive attitudes. Leveraging mass media platforms and
local community leaders will also help in dispelling misconceptions, especially around family planning,
while broadening the reach of health messages.
- Second, subsidizing or incenticizing antenatal care services can reduce financial barriers, particularly
for low-income women, thereby promoting equitable access.
- Third, targeted policies should ensure the equitable distribution of healthcare providers, particularly in
rural areas, with adequate remuneration to encourage retention.
- Finally, training healthcare providers to improve service quality and ensure friendliness toward
pregnant women will help foster trust, reduce negative perceptions, and improve overall utilization.
Although this study was limited to Osun State and excluded women with severe medical conditions, its
findings provide important insights for designing context-specific interventions. Addressing the socio-
demographic barriers and implementing the above recommendations could significantly enhance antenatal care
utilization and contribute to improved maternal and neonatal health outcomes in Nigeria.
ACKNOWLEDGEMENT OF SUPPORT AND FUNDING
My supervisors Prof. Cosmos Enyindah and Dr. (Mrs.) Margaret Akpan
Entire staff and management of Africa Centre of Excellence, Public Health and Toxicological Research (ACE-
PUTOR) headed by Prof. Daprim Ogaji
Entire Nursing Division, headed by Prof. Faith Diorgu,
My Lecturer, Dr. Sunday J. Ayamolowo
My husband, Mr. Ajayi Babatunde Babasola
Entire Department of Nursing Science, Redeemer’s University, Ede, Osun State headed by Dr. (Mrs.) D. F.
Onisile
My parents (Pastor & Mrs. S. A. Bamidele), siblings and in-laws far.
My friends, neighbours, and professional colleagues among whom are Adejumo Bosede Oluwatosin, Laogun
Olapeju Abiola.
Declaration of conflict of interest
I, Ajayi Ifeoluwa Grace, hereby declare that there is no conflict of interest regarding the conduct, findings or
publication of this dissertation titled “Awareness of Antenatal Services and Health Seeking Behaviour Among
Pregnant Women in Osun State.” I affirm that the research was carried out independently and objectively,
without any financial, personal, or professional influence or bias that could have affected the integrity of the
study. No affiliations or relationships exist that could be perceived to influence the outcomes of this work.
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