Supply and demand barriers to PHC maternal care services uptake: qualitative and behavioural insights from Gombe State, Nigeria

Abstract

Background

Several factors influence maternal morbidity and mortality in northeast Nigeria, and maternal care-seeking behaviour at primary healthcare facilities is a critical factor. This study, rooted in the Social Ecological Model (SEM) of behaviour change, investigated the structural and demand-side cognitive barriers that limit antenatal and family planning care-seeking behaviour among households in Gombe State, Nigeria.

Method

Qualitative in-depth interviews, each lasting 60–70 min, were conducted with 56 respondents, including mothers/expectant mothers (n = 15), their household decision-makers/spouses (n = 16), community leaders (n = 16), and primary healthcare centre (PHC) service providers and volunteers (n = 9). The qualitative instrument was developed and analysed based on four core elements of the SEM: intrapersonal, interpersonal, institutional, and community-level factors of behaviour. The study was conducted in Dukku, a rural local government area (LGA), and Yamaltu Deba, a peri-urban LGA.

Results

The findings indicate that the direct and indirect costs of care, service quality, and PHC proximity were the main supply-side and institutional-level factors. Most of the demand-side barriers were associated with individual (poor salience), relational (limited spousal support), and community-level (traditional maternal practices) factors of the SEM model. Optimism bias, overconfidence bias, and present bias are some demand-side psychological barriers that impede maternal care uptake. Similarly, supply-side barriers, such as poor quality of care, can significantly undermine individual and community-level demand for PHC-based maternal care.

Conclusion

The SEM model offers a comprehensive framework for understanding the complex, multi-layered factors influencing care-seeking behaviours toward antenatal care and family planning. The findings show that although relational and community-level barriers are prominent barriers to care-seeking, they are all interlinked and are fuelled by a broad scope of institutional-level barriers.