RELIGIOUS AND SOCIO-DEMOGRAPHIC FACTORS INFLUENCING 
UTILIZATION OF ANTENATAL CARE SERVICES IN ILESA, OSUN STATE, 
NIGERIA 
  
 
 
 
 
By  
 
 
Mary Olaitan, AYANLEKE 
B. Ed (ABU, Zaria) M. Ed, M. Sc (Ibadan) 
Matric. No: 64561 
 
 
 
 
 
A thesis in the Department of Sociology  
Submitted to the Faculty of the Social Sciences  
in partial fulfilment of the requirements  
for the degree of 
 
 
 
 DOCTOR OF PHILOSOPHY 
of the 
UNIVERSITY OF IBADAN, NIGERIA 
 
 
 
 
 
 
 
 
 
 
April, 2015  
 
 
 
 
 
 
 
 
CERTIFICATION 
 
 
I certify that this work was carried out by AYANLEKE, Mary Olaitan under my 
supervision in the Department of Sociology, University of Ibadan, Nigeria. 
 
 
 
 
 
Signature...............................................                        Date.........................................                
 
Dr. O. O. Omololu,  
B.Sc (Calabar); MSc; Ph.D (Ibadan) 
Department of Sociology, 
University of Ibadan, 
Ibadan, Nigeria. 
 
 
ii 
 
 
 
 
DEDICATION 
 
 
 
This work is dedicated 
 
to the glory of God Almighty who has brought me, a poor soul, from the dung hill, and 
has made me sit with princes 
 
and  
 
 
to my late parents and mentors Mr. and Mrs. David Atoyebi Ifawole;  and Chief Oyedeji 
Ifawole; all of whom afforded me the solid foundation for this educational programme. 
May you find favour with the Almighty on that great Day. 
iii 
 
 
 
ACKNOWLEDGEMENTS 
I give all the glory and praise to God Almighty, who has counted me worthy of 
His love and favour.  
I am deeply grateful to my former supervisor, late Professor E. A. Oke, for his 
assistance, guidance and support during this work. I am grateful to him for inspiration 
and help. May his gentle soul find eternal rest. I am indebted to my current supervisor, 
Doctor O.O. Omololu, for his kindness to take up this work. The Almighty God will meet 
you at the very point of your need. 
I sincerely appreciate Professors O. A. Olutayo and S.A. Ajayi as well as Dr. E. E. 
Okafor for their invaluable encouragement. They stood by me when the times were 
hardest. I also appreciate the contributions of Professors U. Isiugo-Abanihe, A. S. Jegede 
and O. M. Obono. I am grateful to Drs. E. E. Nwokocha, R. A. Okunola, O. A. 
Omobowale, A. A. Akinwale, K. K. Salami and S. A. Ajayi for their invaluable 
contributions and constructive criticisms. I appreciate all the lecturers and postgraduate 
students in the department. 
My thanks go to Pastor and Dr (Mrs) Abiodun and Pastor and Dr. (Mrs) Falade 
for their support and encouragement. I had to move permanently to the Abioduns‘ house 
to complete this job. Dr. Adegoke of the Institute of Education, University of Ibadan, is 
much appreciated.  
I am indebted to Pastors G. O. Eso, Ogundipe, Olaleye, Abiola, Abimbola, 
Alawiye, Olowookere, Adegoke, Ariyo, Yinka Ojo, Alabi and Dr Ayoola and their 
families for their innumerable supports and prayers. I appreciate the contributions of Dr 
(Mrs) T. M. Ajayi, Dr (Mrs) V.O. Agboola and Dr. (Rev) J. L. Olajide, Rev. and Mrs 
Atoyebi, Emma, Favour, Jerry boy, my twin sister, Mrs M.O Osadare, Mr Opafunso and 
my colleagues at work. I am indebted to the Deeper Life Family in Ilesa.   
I am also grateful to the staff of all the maternity centres, faith homes and 
Obafemi Awolowo University Teaching Hospital, Ilesa. I appreciate all pregnant women 
and their husbands and others who participated in the interviews. 
I cannot conclude this acknowledgement without appreciating Mrs. Olowookere, 
Alawiye and Oladele for helping in the collection of data. 
iv 
 
 
 
Finally my gratitude goes to my husband, Surveyor M.A. Ayanleke; my lovely 
boys: Toluwase, Oluwatobi, Toluwanimi; and my precious jewel, MoyinOluwa, for their 
prayers, physical and emotional supports. I appreciate all others too numerous to mention 
one by one that contributed in one way or the other to the success of this work. God bless 
you all. I pray that you will all find favour in your time of need. 
Ayanleke M. O. 
April, 2015 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
v 
 
 
 
TABLE OF CONTENT 
                             Page 
Title Page  i 
Certification  ii 
Dedication  iii 
Acknowledgements         iii 
Table of Content  v 
List of Figures          vii 
List of Pictures          viii 
List of Tables          ix 
Acronyms          x 
Abstract  
         xvii 
1. CHAPTER ONE: INTRODUCTION     
   
1.1 Background to the Study          1 
1.2 Statement of the Problem       3 
1.3 Objectives of the Study       7 
1.4 Significance of the Study        8 
1.5 The Study Setting        9 
1.5.1 Ethnographic Detail       9 
1.5.2 Geographical Information          9 
1.5.3 Historical Background      10 
1.5.4 The People         10 
1.5.5 Political Organisations      11 
1.5.6 Economy        13 
1.5.7 Socialization        14 
1.5.8 Health Institutions       14 
1.5.9 Religious Belief System      15 
1.5.10 The Oke-Ooye Holy Ghost Revival     17 
1.6 Definitions of Concepts       26 
   
vi 
 
 
 
CHAPTER TWO:  LITERATURE REVIEW AND THEORETICAL  
 FRAMEWORK 
2.1 Literature Review        28  
 2.1.1  Perceptions of pregnant women on aetiology of pregnancy  
Complications        28  
 2.1.2  Religious belief systems and pregnant women‘s health seeking  
Behaviour        30 
 2.1.3  Faith clinics / Faith based birth attendants (FBBAs)   34 
2.1.4  Reasons for extensive patronage of traditional birth attendants 
 (TBAs)        36 
2.1.5  Utilization of antenatal care services     38 
 2.1.6  Social Factors that influence decision on pregnancy care  41 
2. 1.7  Influences of demographic factors on care during pregnancy 52 
2.1.8  Adherence of women to hospital‘s instructions and prescription 57 
2.1.9  Adherence to hospital regimes in developed world   60 
2.1.10 Adherence to hospital regimes in African countries   60 
2.1.11  Adherence to hospital regimes in Nigeria    62 
2.1.12  Husbands‘ and significant others‘ roles in decision making and 
 health care in pregnancy      63 
 2.2. Theoretical Framework       69 
  2.2.1      Functionalist Theory       69 
  2.2.2      Health Belief Model       71 
 2.3 Conceptual Framework       76 
 2.4 Explanation of the Conceptual Framework     77                                                                                 
CHAPTER THREE:   METHODOLOGY 
3.1 Research Design        79  
3.2 Study Population        80 
3.3 Sampling Techniques        81 
 
vii 
 
 
 
3.4 Research Instruments        82  
 3.4.1 Survey instruments       82 
 3.4.2 Key informants Interview      82 
 3.4.3 In-depth Interviews (IDIs)      83 
3.5 Data Collection Process       84 
3.6 Ethical Issues         84 
3.7 Method of Data Analysis       85 
3.8 Limitations to the Study       85 
CHAPTER FOUR:  DATA PRESENTATION, ANALYSIS AND DISCUSSION 
4.1 Socio-economic and Demographic Profile of the Respondents  87 
 4.2.1 Age of the Respondents      87 
 4.2.2 Marital Status        88 
 4.2.3 Educational Qualifications of Respondents and their  
  Husbands/Partners       89 
 4.2.4 Income of the Respondents      93 
 4.2.5 Marriage Type       95 
 4.2.6 Religious affiliation       96 
 4.2.7 Percentage Distribution of Demographic Characteristics of  
  Qualitative Respondents      98 
 4.2.8 Percentage Distribution of Religion and Educational Qualification  
  of Qualitative Respondents      99 
4.3 Perceptions of Pregnant Women on Aetiology of Pregnancy-   
  Related Complications      100 
 4.3.1a Pregnant Women‘s Aetiology of Pregnancy Complications  101 
 4.3.1b Drug Abuse as a cause of Pregnancy Complication   108 
 4.3.1c Influence of Perception of Witches and Wizards as a  
  Cause of Complications on Place Sought for Pregnancy Care 109 
 
viii 
 
 
 
4.3.1d Influence of Perception of Adultery as a Cause of Complications  
 on Place Sought for Pregnancy Care     110   
4.3.2 Perceived Signs and Symptoms of Pregnancy Complications  112 
 4.3.2a Perception of Haemorrhage as a Symptom of Pregnancy  
  Complications        113 
 4.3.2b Perception of Labour of more than 12 hours as a Symptom  
  of Pregnancy Complication      114 
 4.3.2c Perception of High Fever as a Symptom of Pregnancy  
  Complications        115 
 4.3.2d Perception of Swollen Legs as a Symptom of Pregnancy  
  Complications        116 
4.3.3 Perceived Means to Avoid Pregnancy Complications   118 
 4.3.4a Perceived Treatment of Haemorrhage    119 
 4.3.4b Perceived Treatment of Placental Previa and Breech Presentation 120 
4.4.  Influence of Religion on Pregnancy Care     124 
 4.4.1 Reported Cases of Malevolent Spirits‘ Activities in Pregnancies 
  care          126 
 4.4.2 Respondents‘ Religious Affiliation and Places Sought for delivery 130 
 4.4.3 Pattern of Referrals of Pregnancy Complications   132 
 4.4.4 Modes of avoiding complications in faith birth homes  134 
 4.4.5 Maternal Mortality recorded at OAUTH Ilesa from 2005-2008 149 
  4.4.6 Influence of Denomination on Places Respondents Hoped to 
  Deliver their Current pregnancies     150 
 4.4.7 Influence of Denomination on Places Respondents  
  Delivered their last pregnancies     151 
4.5 Factors that Influence Decision on Care during Pregnancy   154
 4.5.1 Influence of formal education on place of Pregnancy Care  154 
  4.5.2 Influence of formal education on knowledge of convulsion as a 
    symptom of  pregnancy complication    155 
 
 
ix 
 
 
 
 4.5.3 Influence of formal education on perception of breech baby as a 
   sign of Pregnancy complications      156
 4.5.4 Respondents‘ level of income on perceived place to treat pregnancy 
   complications         157 
4.6 Adherence of pregnant women to care providers‘ prescriptions and basic  
 instructions         159 
  4.6.1a Adherence to focused antenatal clinic (FANC)  160 
  4.6.1b Respondents‘ access to, Utilisation and places sought  
for antenatal clinic service     162 
  4.6.1c Age of Pregancy at First ANC Attendance   163  
  4.6.2a Adherence to immunisation regimes    164 
   4.6.2b Religious affiliation and number of immunisations taken 165 
   4.6.3 Respondents‘ reasons for non-adherence to regimes  166 
   4.6.4 Adherence to FANC attendance by marital status  167 
   4.6.5 Influence of Religious Affiliation and Places Respondents 
    Attended for Pregnancy Care    171 
   4.6.6    Adherence to FANC attendance by Number of Pregnancy 172 
   4.6.7 Influence of Denomination on Places Christians Patronized 
    For Pregnancy Care      173 
  4.6.8 Adherence to food, sleep and exercise regimes among  
women during pregnancy      173 
   4.6.9 Adherence to drug administration    177 
4.7 Men‘s roles in caring for the health of pregnant women   180 
4.7.1 Men‘s role in pregnancy care      180 
4.7.2 Influence of the Respondents‘ Marital Status on Payment for 
   Delivery Materials       183 
4.7.3 Husband‘s roles at delivery       187 
4.7.4 Influence of Marital Status on Other Assistance Husbands/Partners 
Rendered in Pregnancy      194 
4.7.5 Discussion         198 
 
 
x 
 
 
 
CHAPTER FIVE: SUMMARY, CONCLUSIONS AND RECOMMENDATIONS 
5.1 Introduction         207 
5.2 Summary of Findings        208 
5.2.1 Influence of Socio-demographic Factors on Decision on Care  
during Pregnancy        208 
5.2.2 Women‘s Perception of Aetiology of Pregnancy Complications  209 
5.2.3 Influence of Religious Belief System on Pregnancy Care  211 
5.2.4 Adherence of Pregnant Women to Basic Instructions  212 
5.2.5 Men‘s Roles in Pregnancy Care      213 
5.3 Conclusion         215 
5.4 Recommendations        216 
REFERNCES         218 
APPENDICES         233 
 
 
 
 
  
xi 
 
 
 
LIST OF FIGURES 
 
No    Title       Page 
1.  Map of Ilesa, South Western Nigeria          25 
2. Conceptual framework on pregnant women‘s health-seeking behaviour  76 
       
LIST OF PICTURES 
 
1. Pregnant women during prayer meeting in a Church   137 
2. Pregnant women kneeling for prayer in a faith home      140 
3. Picture of a setting in ANC at a private hospital        170 
    
xii 
 
 
 
LIST OF TABLES 
No     Title               Page 
 
Table 4.1 Percentage Distribution of Age of Respondents   88 
Table 4.2  Percentage Distribution of Respondents‘ Marital Status  89 
Table 4.3 Percentage Distribution of Respondents‘ and Partner/Husbands‘ 
  Qualification and Occupation      92 
Table 4.4 Percentage Distribution of Respondents‘ Monthly Income  93 
Table 4.5 Percentage Distribution of Respondents by Type of Marriage 96 
Table 4.6 Religious Affiliation of Respondents     97 
Table 4.7  Percentage Distribution of Demographic Ages and Sex of 
   Qualitative Respondents      99 
Table 4.8  Percentage Distribution of Demographic Religion and  
  Educational Qualification of Qualitative Respondents  100 
Table 4.9  Perception of Respondents on Aetiology of Pregnancy  
  Complications        101 
Table 4.10  Influence of Number of Pregnancies on Perception of Women‗s  
  Physique of as a Cause of Complication     104 
Table 4.11  Influence of Number of Pregnancies on Perception of Infection as  
   Cause of Complication      105  
Table 4.12  Influence of Perception of Witches and Wizards as 
 Causes of Complications on Place Sought for Pregnancy Care  110 
 
Table4. 13 Influence of Perception of Adultery as a Cause of Complications  
  on Place Sought for Pregnancy Care     111 
 
Table 4.14:  Distribution of Causes of Maternal Mortality Recorded at  
OAUTH Ilesa from 2005-2008     112 
 
Table 4.15  Perceived Sign and Symptoms of Pregnancy Complication  113 
 
xiii 
 
 
 
Table 4.16  Perception of haemorrhage as a Symptom of Complications 
   and Place Sought for Pregnancy Care    114 
Table 4.17 Influence of Perception of High Fever as a Symptom of  
  Complication on Places Sought for Pregnancy Care   115 
 
Table4.18 Perception of Labour of more than 12 hours as a Symptom of  
  Pregnancy Complications       116  
 
Table 4.19 Perception of Swollen Legs as Symptom of Pregnancy  
 Complications        117 
Table 4.20 Percentage Distribution of Respondents‘ Perception of  
   Treatment of Haemorrhage      119 
Table 4.21 Religious affiliation and Places Where Respondents had their  
  last Babies        130 
Table 4.22 Religious Affiliation and Where Respondents Hoped To  
  Deliver their Current Pregnancies     131  
Table 4.23 Influence of denomination on Places Respondents Delivered their 
 Last Pregnancies       151 
 
Table 4.24 Influence of denomination on Places Respondents Hoped to  
Deliver their Current Pregnancies     152 
 
Table 4.25 Distribution of Types of Deliveries at OAUTH, Ilesa from  
 2005 – 2008        153 
Table4. 26: Influence of Formal Educational on Place of Pregnancy Care 155 
Table 4.27 Influence of Formal Education on Knowledge of  
Convulsion as a Symptom of Pregnancy Complication  156 
Table 28:  Influence of Formal Education on Perception of Breech Baby as        
                     Pregnancy Complications      157 
Table 4.29: Influence of Respondents‘ Monthly Income on Choice of Place  
 to Treat Complications      159 
Table 4.30:  Adherence to Focused Ante-natal Care    161 
Table 4.31:  Percentage Distribution of Respondents Access to, Utilization  
 and Places Respondents Sought for Antenatal Clinic Service 162 
 
xiv 
 
 
 
Table 4.32: Age of Pregnancy at First ANC Attendance    164 
Table 4.33: Percentage Distribution of the Respondents‘ Adherence to 
Immunisation Regimes      165 
Table 4.34: Religious Affiliation and Number of Immunisation Taken  166 
Table 35: Percentage Distribution of the Respondents‘ Reasons for  
 Non-Adherence to Regimes      167 
Table 4.36:  Marital Status and Attendance at ANC    168 
Table 4.37: Influence of Religious Affiliation and Places Respondents  
Attended for Pregnancy care      172  
Table 4.38:  Number of Pregnancy and Antenatal Attendance   172 
Table 4.39: Influence of Denominations on Places Christians patronized for  
Pregnancy care       173 
Table 4.40  Adherence to Sleep and Food Regimes    175 
Table 4.41:  Drug Administration and Utilization     177 
Table 4.42:  Adherence to Drug Prescription and Number of Pregnancies 179  
Table 4.43: Percentage of Distribution of Husbands‘ Roles and  
 Decision-Making Patterns      182 
      
Table 4.44: Influence of the Respondents‘ Marital Status on Payment for  
Delivery Materials       183 
Table 4. 45:  Percentage Distribution of Husband‘s Roles at Delivery  187 
Table 4.46:  Assistance Rendered by Husbands and Number of Pregnancy 194 
Table 4.47: Other Assistance Husbands/ Partners Rendered in Pregnancy 195 
 
 
 
 
 
 
xv 
 
 
 
ACRONYMS 
 
ANC          Ante Natal Clinic 
C.S.             Caesarean Section 
FBBA(s)     Faith Based Birth Attendant (s) 
FBBHs         Faith Based Birth Homes 
HBM           Health Belief Model 
IDI(s)          In-depth Interviews 
MM             Maternal Mortality 
TBA(s)        Traditional Birth Attendant(s) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
xvi 
 
 
 
 
ABSTRACT 
 
Inadequate access to Ante-Natal Care (ANC) services is one of the factors responsible 
for high maternal and infant mortalities in Nigeria. Studies have focused on clinical 
determinants of pregnancy outcomes with little attention paid to belief systems and 
characteristic features of pregnant women who utilise ANC in spite of the potential role 
of religious beliefs system on pregnant women‘s choice of health care services. This 
study, therefore, examined the influence of belief systems and socio-demographic 
characteristics of pregnant women on utilisation of ANC services in Ilesa, Osun State.  
 
Functionalist Theory and Health Belief Model (HBM) were used. Multistage sampling 
technique was used to select 500 pregnant women at household level (50), faith homes 
(225) and health centres (225). Ilesa was purposefully selected because of the 
preponderance of Faith Based Birth Homes (FBBH). Questionnaire was utilised to 
obtain quantitative data on socio-demographic characteristics, perception of aetiology of 
pregnancy complications, influence of religious beliefs, adherence to care givers‘ 
prescriptions and husbands' roles in pregnancy care. Qualitative data were collected 
through non-participant observation of 20 sessions of ANC and prayer meetings. In 
addition, 12 In-Depth Interviews (IDIs) were conducted in each FBBH and orthodox 
health care institution. Quantitative data were analysed using descriptive and Chi-Square 
statistics at p< 0.05. Ethnographic summary was used to analyse qualitative data. 
 
Respondents‘ age was 29.5 + 5years, 86.6% were Christians, 74.6% were married and 
30.6% had tertiary education. About 80% attended ANC; and of this, 24.6% had their 
last babies in FBBH while 11.8% delivered at home. Less than 40.0% completed 
minimum requirements of four ANC visits. Only 51.6% had ante-natal ultra sound 
evaluations, 37.6% took two shots of tetanus toxoid while 18.2% refused any form of 
immunization as a result of religious belief. Adultery (43.8%) and activities of witches 
and wizards (41.6%) were perceived as causes of pregnancy complications. There was 
no significant relationship between religious affiliation and place of delivery. Decision 
making on utilisation of ANC services reflected dominant gender structure as 61.9% of 
respondents reported that husbands determined the choice of place of delivery. There 
xvii 
 
 
 
was no significant relationship between demographic characteristics of pregnant women 
and ANC utilisation; age (t= .649), marital status (t=1.038), education (t= -.356) and 
income (t= -.356) were not significantly related to ANC utilisation. Majority of the IDIs 
revealed that respondents perceived pregnancy processes and outcomes as more spiritual 
than medical. Praying, confessions of sins, application of anointing-oil and spiritual 
baths were perceived as efficacious for warding off evil forces. The ANC providers in 
FBBH reported that many women could not afford delivery materials thereby causing 
some husbands to abscond on the day of delivery.  
 
Faith Based Birth Homes enjoyed more patronage than orthodox birth homes. Therefore, 
there is need for supportive supervision of FBBH by health professionals. 
 
Key words: Ante-Natal, Faith Based Birth Homes, Religious Beliefs, Pregnant Women 
 
Word count: 472 
 
xviii 
 
 
 
CHAPTER ONE 
INTRODUCTION 
1.1 Background to the study  
Religion permeates all aspects of Africans‘ life. Mbiti (1978) observes that 
religion extends and influences every aspects of Africans‘ living. Africans are said to be 
notoriously religious. Religion is the way of life in traditional African society as there are 
inextricable connection between religion and culture in Africa (Mbiti, 1978). They were 
naturally born into religion and grew up formulating ideas, beliefs and customs that were 
religiously based to regulate their daily living.  
The Ijesa, like all the Yoruba people, from pre-colonial times, believe in one 
Supreme Being (God) who created the universe. They believe in the existence of 
divinities that are believed to emanate from the Supreme Being. They believe that the 
divinities are ministers of God- the Supreme Being. When there are outbreaks of 
diseases, the divinities are believed to cause them.  Olode or Soponna, for example is 
believed to be the divinity of small pox and Osoyin is the divinity of healing. When 
diseases break out, diviners and witch-doctors are employed to curb them. Idowu (1973) 
states that ―diviners in Africa are believed to be under possession of the spirits when they 
engage in divination and witch-doctors claim that they are chosen by sprits, taught 
medicine by the spirits and guarded in their profession of diagnosis and healing by the 
spirits‖. According to Idowu (1973) as quoted by Jacobs (1977) ―the key notes of the 
Yoruba is in their religion... ―full responsibilities of all affairs of life belong to the Deity 
and their own part is to do as they are ordered through the priests and diviners and that at 
every stage of life, man is in the hands of the Deities‖. As a result, religion also 
influences maternal and child health. It influences their health seeking behaviour in 
pregnancy care and delivery. 
Belief in witches, wizards, sorcery and malevolent spirits prevail. These spirits are 
believed to cause diseases, barrenness, as well as infant and maternal mortality. Among 
1 
                                                                                
 
the Ijesa, many rituals are connected with child birth. Sons are preferred to daughters. To 
be childless is a reproach and barren women would do anything to ensure fertility. 
Statistics have shown that more than half a million women die every year during 
pregnancy-related complications, ninety nine per cent of which occur in sub-Sahara 
Africa and South Asia alone (Freedman and Maine, 1993; Population Reference Bureau, 
2000; Azub, 2011; Adebayo, 2013). Developing nations of Sub-Saharan Africa has one 
of the highest Maternal Mortality Ratio (MMR) of 900 per 100,000 live births while 
South Asia has 470.  India has the highest Maternal Mortality (MM) 117,000 per 100,000 
live births in the world. Nigeria follows after with 54,000 per 100,000 live births. Global 
estimates are 428 and 400 for 1990 and 2005 respectively. Global decline from 1990- 
2005 is only 5.4% with an annual decrease of less than 0.1% in Sub Sahara Africa. Africa 
hosts majority of the 68 countries that are currently off track in achieving Millennium 
Development Goals (MDGs). These figures do not include many rural women, who for 
various reasons, do not go to hospital. A basic indicator of national development is the 
health status of its population and women‘s health is a critical area, which reflects 
national health standards and this is basic to women‘s advancement (Federal Ministry of 
Health (FMOH), 2007). World Health Organization (WHO, 1978) defines health as ‗a 
state of complete physical, mental and social wellbeing and not merely the absence of 
disease or infirmity.‘ It defines reproductive health as ‗a state of physical, mental and 
social wellbeing in all matters of reproduction and not merely the absence of diseases or 
infirmities in pregnancy status and outcome, abortion and sexual health.‘ The health of 
the people contributes to better quality of life and sustained social and economic 
development.  Maternal mortality is an important indicator of the standard of health in 
different countries. Infant and maternal health are basic indicators of national 
development but both are high in Nigeria (Akinlembola and Oguntimehin, 2006; Nigeria 
Demographic and Health Survey (NDHS) 2003; 2008). Federal Ministry of Health (2006) 
observes that Nigeria contributes about 10 percent of the world‘s global burden of 
maternal mortality. The Nigerian scenario remains among the worst in the developing 
countries. Nigeria Maternal Mortality Ratio (MMR) is 100 times worse than 
industrialized societies (NDHS, 2008).  
2 
                                                                                
 
Pregnancy and child bearing sustains any society. Pregnant women are supposed 
to be the healthiest patients in the hospital, but pregnancy condition places a woman in a 
state where she constantly needs medical care because it alters the physical condition of 
the body system. If this stage is not properly managed, it makes the body susceptible to 
diseases owing to low level of body immunity. This necessitates adequate care of a 
woman‘s pregnancy in order to enhance a successful outcome. Adequate antenatal care 
would result in considerable reduction in maternal and child deaths. Every pregnant 
woman desires good life and health for herself and her baby. Therefore, she will likely 
seek means to make herself and the baby healthy. To promote maternal and child health, 
the health of the women must be well managed.  
Health management is an action taken by an individual to remain healthy or 
prevent illness; or the action she takes to regain her health when she falls sick (Mechanic, 
1962). Health care of a pregnant woman may include all the actions she takes from 
conception to six weeks after delivery to ensure safe delivery and sound health for herself 
and the baby; such as: pregnancy tests, antenatal treatment, immunisation  when due, 
adherence to routine drugs, exercise, rest and diet prescriptions. Health care for pregnant 
women includes all actions taken by the woman, significant others, and healthcare 
providers to make or mar the pregnancy. Studies have shown that poor hygiene, 
malnutrition, and Human Immunodeficiency Virus (HIV) status as well as lack of 
appropriate care often increase the risk of serious complications in minor ailments in 
pregnancy, but proper management will reduce these risks. 
 
1.2 Statement of the problem  
In any culture, child birth is a thing of joy, but reproductive health problems 
account for more than one third of the burden of diseases in women (Mbizvo, (1996); 
NDHS (2008). Ebhuomhan (2008) and Dada (2008) claim that in Nigeria, an estimated 
54,000 maternal mortality (MM) occur per annum due to pregnancy-related problems. 
This translates as one woman dying every 30 minutes; and for every death, there are about 
twenty other women who suffer from diseases, disabilities, or physical damage that 
impede their health for life (Dada, 2008). Unsafe abortions, complications of pregnancy 
3 
                                                                                
 
and childbirth thus remain serious causes of death and morbidity among Nigerian women 
(Ladipo, 1989). Most data on maternal morbidity and mortality in Nigeria are derived 
from hospital statistics. They are not a representative sample, as many women die at home 
or on the way to hospital unreported.  
The foregoing discussion implies that there are 54,000 cases of widowers, 
motherless babies, bereaved parents and relations. Every year, Nigeria records 1.5 million 
women in agony of maternal morbidity and many remain so for the rest of their lives 
(World Health Development Report, 1995 and Dada, 2008). Maternal mortality in Nigeria 
ranges from 800-1000 per 100,000 live births (Akinlembola et al. 2006 and Awosiyan, 
2009). The chairman of the National Population Commission (NPC), once disclosed at a 
press conference in commemoration of the 2012 World Population Day that the Nigerian 
maternal mortality (MMR) ratio was 545 per 100,000 live births. The MMR in Nigeria 
shows a disparity between the regions and the rural areas. The north east and the north 
west have 1349 and 1025 per 100,000 live births, respectively, making the region eight 
times higher than the south west region. Rural areas have 828 per 100,000 live births as 
against 351 per 100,000 live births in urban areas. This is due to poor health during 
pregnancy as well as poor obstetric care. The north is predominantly rural, and less than 
31 percent of pregnant women are delivered by skilled health personnel (NDHS, 2008).  
 An African woman‘s life-time risk of dying from pregnancy complications is 
about 1:15 while the risk in industrialized world ranges from 1:4,000 to 1:10,000 (Roth 
and Mbizo, 2001 and Azuh, 2011). In Asia, the ratio is 1:105, that of Europe is 1:1895 
and that of North America is 1:3750 (Azuh, 2011; Abdoulaye, 2006). Among Nigerian 
women of reproductive age, 1:18 die due to pregnancy-related complications; while in 
Bosnia and Herzegovina 1:29,000 dies (Population Reference Bureau, 2005 and WFFC 
MDGs Table 2007). In Nigeria, maternal mortality ratio is estimated at 1:98 per live 
births; still one of the highest in the world (WFFC MDGs Table, 2007). Data from 
Federal Ministry of Health (FMOH) showed an increment in level of MM since Safe 
Motherhood Initiative was launched in Nigeria in 1990. 
Causes of maternal death in developing world include haemorrhage, infection, 
toxaemia and obstructed labour, and illicit abortion (WHO, 1999; United Nations Fund 
4 
                                                                                
 
for Population Activities (UNFPA) 2001). Adebayo, (2013) asserts that there are five 
major causes of maternal death: haemorrhage (25%), infection (15%), eclampsia (12%), 
obstructed labour (8%) and unsafe abortions (13%).  These deaths and disabilities could 
be prevented or reduced if pregnancies are managed appropriately. Adebayo, (2013) 
states, that these deaths are preventable, with simple prophylactic measure and timely 
diagnostic measures, as well as treatment of pregnancy complications. Statistics revealed 
that 2-3 million women develop preventable disabilities, such as severe anaemia, 
incontinence, uterine prolapsed, damage of the reproductive organs or nervous system, 
chronic pain, and infertility (Asghar, 1999 and UNFPA 2001). In Nigeria, complications 
arising from pregnancy and childbirth are leading causes of disabilities and deaths among 
women. The incidence of maternal mortality is estimated at 15 per 1000 live births, 
making the country one of the highest on the African continent World Health 
Development Report, (1995); and WHO, (2001); (Population Reference Bureau, (2005)). 
Throughout the world, the death of mothers from pregnancy and child birth has become a 
source of worry and concern, particularly in Nigeria, that has been rated first among poor 
countries on maternal mortality ratio and least safe nation on matters relating to maternal 
and infant welfare (Adelani, 2009). WHO (2006) notes that MM ratio in Benin Republic 
was 859, Gambia and Ghana 540, Liberia 760, Nigeria 800, and Sierra Leone 2000 
(Adelani, 2009). Nigeria‘s case is even worse than those of Gambia and Ghana and war-
torn Liberia.  
 Maternal mortality and maternal morbidity are critical priority problems that 
demand recognition and concern by all, including policy makers and health 
administrators. When women are pregnant, their health status becomes complicated. 
Inappropriate and incorrect treatment or even lack of appropriate and timely interventions 
may result in maternal deaths. The Nigerian government has been taking some steps to 
reduce this trend. One of such is the proposed compulsory one-year national service for 
all newly qualified midwives to enable service spread of antenatal care (ANC) and 
delivery across the country. World leaders adopted the Millennium Development Goal 
(MDG) number five to improve maternal health and reduce maternal mortality by 75% by 
the year 2015. In line with this goal, Nigeria in the National Reproductive Health Policy 
set the goal of reducing MM by half within ten years (Federal Ministry of Health, 2001). 
5 
                                                                                
 
This is the year for the fulfilment of the Millennium Development Goal MDGs (2015), 
there are still high maternal deaths in the country, and there is no clear evidence that 
Nigeria has yet achieved any remarkable improvement. Harrison (2012) avers that 
evidence has shown that, at the current rate of progress, Nigeria will not achieve the 
Millennium Development Goals (MDGs) before 2040. 
 However, these deaths place a significant burden on the health system of women 
and families. Many studies have attributed this challenge to the state of health of pregnant 
women, poor delivery process, poor antenatal and postnatal care utilisation of available 
health care services, as well as distance of health facilities (NPC, 2000; 2004; Azuh, 
2011). Aniebube and Aniebube (2010) studied the attitude of pregnant women to a new 
antenatal care model with four antenatal visits (focused antenatal care) in Enugu, Nigeria. 
Only 20.3% of the parturient desired a change to the new model. Ibeh (2008) investigated 
maternal mortality index in Anambra State, Nigeria and attributed high maternal 
mortality to poor socio-economic development, weak health care system, low socio-
economic status of women, as well as socio-cultural barriers to care utilisation. He found 
that about 99.7 percent of women in the locality attended antenatal clinics, with 92.3 
percent of them making 4 or more visits before delivery. Okonofua, et al. (1992) 
investigated risk factors that affect maternal mortality in Ile-Ife, Nigeria and found that 
maternal deaths involved young women of poor socio-economic status. Their study 
revealed lack of prenatal care among all women in their sample. 
   There are various health actions that pregnant women can take to manage their 
health and that of their foetus. These include regular attendance at antenatal clinics 
(ANC), taking prescribed drugs, resting, as well as eating balanced diet. A major issue 
that this study investigated is whether or not pregnant women in Ilesa took appropriate 
health actions to ensure safe delivery. Among the numerous factors that were investigated 
was the influence of religious belief system on choice of care. This factor has not been 
well investigated. This was the focus of this research, as the health needs of these women 
require a holistic approach.  
 Though Ilesa was privileged as early as 1913 to host a Western medical centre 
established by the Methodist Mission; and more hospitals, maternity centres, and clinics 
6 
                                                                                
 
have been established, do these translate to utilization? There are sixteen government 
maternity centres, a general hospital, a teaching hospital as well as numerous privately 
owned hospitals and maternities that are all close to the people. The people do not have to 
travel more than one kilometre or spend more than fifty naira (₦50.00) to get to the 
nearest hospital or maternity centre. In fact, the maternity centres are mostly within 
walking distance to the residences of the citizens. Are pregnant women patronizing them? 
What are the factors that determine whether or not a pregnant woman will seek health 
assistance from any of these places? Are there advantages in proximity of pregnant 
women to the health-care services available? These problems generate further questions. 
How do social and demographic factors influence decision on care during pregnancy? 
What is the perception of pregnant women on aetiology of pregnancy-related 
complications? How does religious belief system influence pregnant women‘s health-
seeking behaviour? Among women that patronize hospitals, do pregnant women adhere 
to basic instructions and prescriptions? What roles do men play in caring for the health of 
pregnant women?  
 
1.3 Objectives of the study  
 The study investigated pregnancy care in Ilesa Osun State, Nigeria with the 
assumption that spiritual and socio-demographic variables are determinants of health-
seeking behaviours. The general objective of the study was to examine pregnancy care 
among women in Ilesa, Osun State. The specific objectives were to:  
1.   Examine pregnant women‘s perception of aetiology of pregnancy complications. 
2.  Explore the influence of religious belief systems on pregnant women‘s health-
seeking behaviour. 
3.  Examine social and demographic factors that influence decision on care during 
pregnancy.  
4.  Investigate adherence of pregnant women to care providers‘ prescriptions and 
basic instructions. 
5.  Identify men‘s role in caring for the health of pregnant women. 
7 
                                                                                
 
1.4  Significance of the study 
 In Northern Nigeria, about 2,100 women die per 100,000 live births. This figure 
does not give a perfect picture, as more women die quietly at home unreported. Almost 
half of infant deaths in Nigeria results from poor care at the time of delivery and labour 
(Dada, 2008). As many as 300 million women, more than a quarter of all adult women, 
suffer from short-or long-term illnesses related to pregnancy or child birth. A recent 
survey conducted by the National Democratic Health Survey has it that 12,000 women 
develop Vesico Vaginal Fistula (VVF) every year in Nigeria. Fistulae-holes in the birth 
canal allow leakages of urine or faeces from the bladder or rectum or both, making the 
affected women permanently incontinent. Most of these young girls have been abandoned 
by loved ones and society because of the stench that oozes from their bodies. Because of 
their condition, they are treated like lepers, or outcast (Leadership, 2011). Between 
500,000 and 1 million women live with it and become social outcasts, turned out by 
husbands and families.   
 Maternal mortality accounts for 36% of the female reproductive age group. 
Maternal mortality is four times higher in poor villages than in developed ones (Yola, 
2012). WHO (1998) statistics reveal that 1,600 women die daily from pregnancy 
complications and 50 million women suffer maternal morbidity. At least, 18 million of 
these cases are long-term and crippling. Fortunately, maternal deaths are not mere 
misfortune or unavoidable but can be prevented, through interventions that are known to 
be cost-effective and within the reach of developing countries. These deaths should not 
be allowed to continue. All that is needed is strong political commitment. Government, 
internal agencies, non-governmental organizations (NGOs) and other partners need to 
make concerted efforts to achieve this. 
 In addition to these, most of the studies on pregnancy care have been 
predominantly on antenatal care attendance, accessibility and availability. There are other 
factors such as perception of aetiology of disease, religion, and husband‘s role in 
decision-making in obstetric and general maternal care that have great influence on 
pregnancy care. These are the gaps this study tried to fill. 
8 
                                                                                
 
 A reduction in maternal mortality (MM) and morbidity would greatly reduce cases 
of widowers, motherless babies, bereaved parents and relations as well as orphans and 
vulnerable children.  This will also reduce agonies of the 1.5 million Nigerian women in 
danger of maternal morbidity (World Health Development Report, 1995; Population 
Reference Bureau, 2005; Dada, 2008). Furthermore, as maternal mortality and maternal 
morbidity happen when these women are economically productive, a reduction in them 
would enable the women to contribute to the economic growth of their families, in 
particular, and their country, in general. Those in morbid conditions will be able to enjoy 
healthy lives. 
 
1.5  Study setting 
1.5.1  Ethnographic details 
  This section focuses on ethnographic details of Ilesa in Osun State, Nigeria. The 
geographic and historical development, pre-colonial and post-colonial political 
organizations, health institutions, and religion are discussed in details.    
 
1.5.2  Geographical information  
 The study was conducted in Ilesa, Osun State. Osun State has thirty LGAs. Ilesa 
was one LGA until 1996 when that LGA was divided into two (Ilesa East and Ilesa West). 
The headquarters of Ilesa East is at Iyemogun Road, Ilesa, while that of Ilesa West is at 
Aladie, at the outskirts along Osogbo Road, located on a large expanse of land. The 
population of Osun State was 3,416,959. The population of both local government areas 
was 212,225. The female population in both LGAs was 106,519 (2006 Population and 
Housing Census). The two LGAs lie within the rain forest belt, north east of the 
0 1 
Greenwich and 7 30 North of the Equator (Adeyekun, 2000; Adefila, 2004;). Both LGAs 
are urban. They have an annual mean rainfall of about 60 inches and are endowed with 
fertile farmlands. Ilesa has about eight months (March to November) of rainfall. 
Abundance of rainfall encourages breeding of mosquitoes that makes pregnant women in 
study area susceptible to malaria. However, it allows fruits and vegetables to be grown in 
abundance. This makes it possible for pregnant women to eat them and avoid anaemia. A 
9 
                                                                                
 
popular saying in Ilesa is “e suun han f‟ogede se laalede Ijesa eye lee je.‖ (Bananas and 
plantains are so many in Ijesa land; birds feed on them). 
 The LGAs are situated on hills ranging from 1200 to 1300 feet above the sea level 
with a landmass of about 250 sq kilometres (Adefila, 2004). Imo hill housed the former 
colonial masters and was the headquarters of North Eastern Yoruba Division. The LGAs 
are blessed with large-scale deposits of gold. They are blessed with beautiful landscape 
with projecting hills which range from 1200 to 1300 feet above the sea level, while some 
areas are relatively plain. They share boundaries with Oriade, Atakunmosa East and 
Atakunmosa West, and Obokun LGAs.  
 
1.5.3 Historical background 
 The study covered a part of Ijesa land in Osun State of Nigeria. One of his sons was 
believed to have established the Owa Omiran dynasty in Ilesa between 1150 and 1255AD 
(Adeyekun, 2000). Prior to the 11th century, there were loose and scattered settlements of 
people in Erin-Oke, Imesi-Ile, Ipole, Igbadae, Erin-Ijesa and Ibokun, but little was known 
about them until this prince came and overran the communities. The legendary Prince 
Owa Ajibogun left Ile-Ife to conquer and settle there. He was believed to have stayed in 
different places at Ilowa and Ilugbin before other subsequent Owas shifted the capital to 
the present Ilesa – meaning ‗Ile ti a sa‘ (the land of the selected people) (Adeyekun, 
2000). The colonial imperialists came and overran Ilesa between 1902 and 1920. Ilesa 
was later made the headquarters of Yoruba North Eastern District.  
 
1.5.4  The people 
 The major inhabitants of Ilesa are the Ijesa-speaking people. They are a sub-group 
of the Yoruba ethnic group and claim descent from the legendary Yoruba ancestor, 
Oduduwa. The Ijesa people are men of valour (Fatubarin, 2008). They have aversion for 
passivity, mediocrity and cheating. They have travelled far and wide. It is believed among 
the people that wherever Ijesa people cannot succeed, no one else can succeed there 
(Fatubarin, 2008). The people believe in themselves and would not want to depend on 
others for their sustenance. The statement ‗Meeje lowo re ni‘ (you are not feeding me) is 
10 
                                                                                
 
very common among the people. Adeyekun, (2000) states that ‗Ijesa are hard working, 
straight forward and progressive‘; each Ilesa person (man and woman alike) wants to 
make it in life without recourse to a friend or relation. Begging is frowned at and is 
uncommon in Ilesa, as in other towns. The people accommodate settlers from other parts 
of the country. Town planning in the community dates back to early ages. The people 
embrace self-help projects. 
 
1.5.5  Political organisations 
      Prior to the colonial era, Owa Obokun was the paramount ruler. He ruled supreme 
over Ijesaland. He reigned through a complex hierarchy of traditional rulers/chiefs (Elus 
and Aaroes).  He communicated orders, directives and advice to the grassroots through 
these chiefs. Communication followed the same route upward to the Owa. He was the 
political head and power radiated from his palace through the chiefs to the citizens 
(Adeyekun, 2000). However, with the invasion of the Europeans, his power and grip over 
the citizens was eroded. The colonial masters did this by humiliating the reigning Owa-
Obokun Atayero by arraigning him before the colonial court for collecting poll tax from 
his subjects. Next to Owa are a number of traditional chiefs who individually and 
collectively advice him on issues. Confidential matters are reserved for closet advisers 
while the less confidential and less intricate are for council of chiefs. This history reveals 
the patriarchal nature of Ilesa. Most political posts were held by men and so were 
important decisions.  
 For administrative purpose, there are three distinct chieftaincy groups─Obanla 
(leader), Ogboni of Ibokun, Ogboni of Ijebu-Jesa, Ogboni of Ipole, and Oba Odo of Ilesa. 
In strictly Ilesa affairs, the Ogboni of Ibokun and Ijebu-Jesa were excluded.  
 At Ilesa, there are three chieftains (Agbanla) one of which is hereditary, while the 
others (Obanla and Oba Odo) are attained. Achievements are more important to the 
people than names. Anyone who holds a position of authority must be ready to perform. 
The Ogbonis of Ilesa advise the Owa on severe matters. The Ogbonis of Ilesa include the 
Iwole or Aare (high chiefs). Aare advises the king. The leader of this group is the Odole 
Risawe. The group forms the inner caucus and frontline advisers to the Owa (Adeyekun, 
11 
                                                                                
 
2000). The Elegbe are war lords that defend the monarch and Ijesa territory. The leader is 
Lejoka; other members are Loro and Lejofi. They were always ready to take war alerts 
from Owa. However, in peace times, their prowess is now depicted at annual festival of 
Ogun and Iwude Ogun.  Loro doubles as Aare and as Elegbe. He was Owa‘s 
representative in the military. In palace affairs, the Loro acts more as Elegbe. In tribute or 
fees sharing, he shares from both groups. In both groups, only the Loro is hereditary, 
while the Lejoka and Lejofi are attained titles. The decision of Owa and the high chiefs 
are passed to the citizens down the hierarchy of chiefs to the Loriomos, who are chosen 
quarters‘ heads or leaders. 
 Next to these two are the lesser chiefs Aare Odo or Elegbe Odo, who are of lower 
order. The lesser chiefs include Lukinran, Risikin, Sorundi, Salosi, Sawe, Lodifi, Losara 
and Lokoyi. The upper layer of the lower group produces quarter heads who effectively 
administer various quarters of Ilesa. Another group of chiefs that are consulted in craft, 
medical or spiritual affairs are grouped as Alapokurudu (palace chiefs), babalawo 
(diviners) isegun (Physician) aworo (priest). At the lower levels, women are not left out of 
the administration in Ilesa. Titled women chiefs are Yeyerisa, (the women leader), Risa 
Arise, Yeye Saloro, Yeyedole, Yeye Segbua and Yeye Bajimo. These are women‘s 
mouthpiece in the palace. Their views are sought and respected in women‘s affairs, 
markets, and cleanliness of the town, parenthood and reception of visitors. All women‘s 
titles are achieved. This could explain why the women are hard working.  
 The colonial masters, in 1952, reformed the Native Administration (NA). This 
produced more representatives (Ijesa Representative Council). This was known as Ijesa 
Divisional Council, which was split into Ijesa Northern and Southern District Councils. 
Ilesa was the headquarters of North East Yoruba Divisional Council during the colonial 
imperialism (Adeyekun, 2000). The Northern District Council became Obokun and 
Oriade LGAs, while Ijesa Southern District Council became Ilesa and Atakunmosa 
LGAs. In November (1996), Ilesa and Atakunmosa were further split into Ilesa East and 
Ilesa West; and Atakunmosa East and Atakunmosa West.  
 
 
12 
                                                                                
 
1.5.6  Economy  
 Farming is the occupation of about 60% of the working population. The land is 
fertile which helps in cultivating food crops, various types of fruits and cash crops. The 
Ijesa are known for trade and merchandise. They are foremost among businessmen; they 
are industrious, adventurous, enlightened and prayerful (Fatubarin 2008). They started the 
local hire purchase and credit system known as ‗Osomalo‘ (I will be in squatting position) 
derived from the way they collected outstanding debts from their customers. They 
introduced ‗buy-now-and-pay-later‘. They are scattered in many places, plying their 
trades among various tribes. They supplied soldiers‘ needs during wars at Congo and 
Biafra. They are bold and tread where others fear to tread. They introduced ‗ready-made 
dresses‘ to the people ‗Ijesa gba mi ode kaaro‘ (Ijesa safe me from ridicule, there is a 
function to be attended the next day). These are dresses already sewn to different patterns 
and sizes. This was the forerunner of the modern-day ready-made clothes. Prior to this 
time, when people bought clothes, they gave to tailors who took some time to get them 
sewn. 
 They produce of eni oree, eni ewele and eni ateka. These are different types of 
quality mats that predated the modern-day rugs and carpets (Fatubarin 2008). They 
produce and market kolanuts. This is why they are called Ijesa Osere, Onile Obi─Ijesa 
whose land grows kolanuts in abundance (Fatubarin 2008). Ilesa is one of the leading 
commercial centres in Osun State, and its inhabitants are known to be very frugal in 
spending money. The Ijesa people surpassed most other communities and set the pace that 
people always say jocularly, that if an Ijesa man goes to the university to read Economics 
or Business, he has gone there for a postgraduate study because he already knew enough 
for a first degree in any of these courses by daily interaction (Fatubarin 2008). 
Commercial activities are boosted with the presence of many banks - First Bank, Union 
Bank, Mainstreet Bank, First City Monument Bank, Wema Bank, IBTC Bank, GT Bank, 
Zenith Bank, Access Bank and Oceanic Bank, to mention but a few.  
 Many Ijesa women are also traders. They engage in various finance-generating 
activities that make them fairly financially independent. The women have control over 
their income and may not necessarily give such to their husbands. The husband may 
13 
                                                                                
 
borrow money from the wife when he is financially hard up, with the understanding that 
he will pay back when he is able. If he refuses to pay back, he cannot force his wife to 
help him out during another financial crisis. 
 
1.5.7  Socialization 
 With the coming of Christian missionaries and introduction of Christianity, formal 
education started in Ilesa. The first primary school, St. John‘s School Iloro, Ilesa, was 
established in 1888 and in 1900 another school, Holy Trinity School, Omofe, Ilesa, was 
established. In 1934 and 1954, Ilesa Grammar School and Obokun High School were 
established respectively. As a result of early introduction of formal education, the Ijesa 
people are fairly literate. As at the time of writing this theses, Ilesa has fifty-two Primary 
Schools, twenty-two Secondary Schools, a College of Education and a College of Health 
Technology, one Federal  Science and Technical College, one Science School and a 
Special School for the handicapped.  
  
1.5.8  Health Institutions 
 The Methodist Church Mission first introduced orthodox medical system to Ilesa 
in 1913 (about one hundred years ago), and was known as Wesley Guild Hospital, now 
part of Obafemi Awolowo University Teaching Hospital (OAUTH). It is located in Ilesa 
East Local Government Area. Wesley Guild Hospital provides primary, secondary as well 
as tertiary healthcare and referral services for the population in Ilesa and adjoining areas. 
It served as the last stop for medical cases in the hinterland of the then Western Region 
(Fatubarin, 2008). It provides tertiary health care with highly specialized services 
provided by modern diagnostic equipment. It serves as referrals for Osun, Ekiti, Ondo, 
and Kwara States. No patient in labour is refused admission here, whether booked or 
unbooked, referred, complicated or otherwise. 
 Ilesa West has a state general hospital. The two local government areas have 
twenty health centres and posts; fourteen of which take deliveries. The delivery centres 
are Ajanaku, Isokun, Oke-Iyin, Ilaje, Aragan, Irebami, Idasa, Egbe-Idi, Ayetoro, Irojo, 
Oke-Oye, Imo, Ijamo, and Igbaye. Each of them takes an average of 7.44 births per 
14 
                                                                                
 
month. Antenatal attendance at the health centres averages 38.88 per month.  OAUTH 
takes average antenatal attendance of 232.2 per month, while State General Hospital takes 
an average of 26.75 deliveries per month (delivery records from these maternities and 
hospital). In addition to the above, there are numerous private hospitals and maternity 
centres. Doctors and nurses and, sometimes, ward aids, run them; some of them are 
retired while others are still in government service.    
 
1.5.9 Religious belief system 
To attempt a definition of religion would be a herculean task because of its scope 
and diversity. Many people have made several attempts but their definition have been 
greatly criticized because of the shortcomings. Joseph (2015) views religion as 
―absolutely a matter of faith and a belief in the existence of a Supreme Being‖ (Olorun, 
Olodumare Atererekari aaye). Religion according to him has two obligations: ―the 
acknowledgement of the supremacy of God and the adoration and worship of that God.‖ 
Prior to the advent of Christianity and Islam, Ilesa predominantly practiced 
Traditional religion. There was the worship of Olodumare the Almighty God through the 
mediums of Ifa (god of divination) ogun (god of iron) and other deities. The Ijesa also 
believe in immortality of the soul. They believe in the spirits of the ancestors which can 
be evoked for blessing and to avert dangers. Rituals and ceremonies are observed in 
remembrance of them to ensure their continuous watch over the living members of the 
community. In Ilesa, there are annual Egungun and Iwude festivals on 26 of December to 
commemorate this belief. Those who have embraced Christianity do elaborate burial, 
outing and remembrance services for the departed. Fifty, forty, thirty, twenty and ten 
years‘ remembrance ceremonies are common. Sometimes the people that organized them 
were not yet born or were babies at the time the individual died.  
One is not sure of definite time Christianity came to Africa but, from the earliest 
period, its presence had been there. However, it is certain that the first sets of 
st
missionaries landed in Nigeria on 1  April 1842. When they came, they established 
schools, built hospitals and clinics and several paramedical institutions (Idowu, 2007) but 
the work of these missionaries did not address ―to reality of evil and malevolent forces as 
embodied by force of witchcraft and sorcery‖ (Idowu, 2007). The result was that some 
15 
                                                                                
 
would openly profess Christianity but secret consult witch-doctors and fortune-tellers for 
protection. The missionaries requested its adherents to renounce all cult practices and use 
of charms, amulets and other cultic protective materials to take part in its sacrament but 
did not give the natives alternative by exposing them to the power of the gospel that 
could banish these forces. 
Then in 1918, there was a deadly influenza epidemic and economic depression 
which killed over 250,000 people in southwest Nigeria (Adewale, 1986). This led to the 
closure of many mission churches to avoid further spread of the epidemics. Many of the 
Yoruba Christians were disappointed in these mission Churches that were helpless in the 
face of disaster. They started prayer and healing fellowship to check the outbreak. 
Odubanjo, a member of the prayer cell, came across the Sword of the Spirit a publication 
of The Faith Tabernacle in America, which influenced him greatly. The publication 
emphasised the power of prayer alone to heal and to provide for worldly needs and 
condemned the use of any medicine whatsoever (Idowu, 2007). This belief made the 
group to be at loggerheads with the Anglican Church. The group faced a lot of 
persecution from the church and was forced out of St. Saviour Anglican Church. At the 
same time, one Sophia Odulami claimed she had divine direction to use particular rainfall 
water for healing. She was persuaded to join the prayer cell. The group became Diamond 
nd
Society, which had its first meeting on Jan. 22  1922 (Idowu, 2007). This group 
emphasized the important role of prayers in the face of adversity. It was the habits of this 
people to pray several times in a day for revival in land. They observed hours of prayers 
and vigils. Odubanjo a member of the group had started another chapter of the prayer cell 
in Lagos, which was named Faith Tabernacle, after a group in America. Not long after 
this, many chapters of this prayer cell sprang up in various parts of Nigeria, including 
Ilesa. This was what led to the birth of prophetic healing movement in several parts of 
Africa, particularly the Aladura movement in western Nigeria. This was a platform for 
the Oke Ooye revival of 1930. Leaders of this movement were former members of St. 
Saviour Anglican Church, Ijebu Ode.  
Christianity was introduced to Ilesa between 1867 and 1874 when Owa 
Oweweniye invited the Reverend C. A. Gollman and other white missionaries. They 
preached and got many people converted to Christianity. Between 1845 and 1893 Owa 
16 
                                                                                
 
Obokun Bepo Agunloye (the paramount ruler t that time) stopped the practice of human 
sacrifice in Ilesa (Adeyekun, 2000).  
 
1.5.10 The Oke-Ooye Holy Ghost Revival 
The Oke Ooye Revival was born in answer to the prayer of these people. Three 
separate angelic visitations were experienced by the leaders (Babatope J.A. Daniel 
Orekoya and Joseph Ayo Babalola) of these prayer cells. 
On the 9th of October, 1928, Joseph Ayo Babalola, while fasting, claimed to have 
received divine call to leave his trade for spiritual assignment. He was anointed for the 
work and received three gifts with spiritual symbolism: 
a. Bell –symbolising prayers, to bless and to call people to prayers; to drive out 
hosts of darkness and invite heavenly hosts to the meeting. 
b. Staff –symbolising authority and power over all the forces of darkness and 
evil. 
c. Bottle of water, which is symbolic of the curative and healing power of the 
Holy Spirit through the medium of water (Idowu, 2007), 
In his ministry, he sanctified water to cure the sick and his authority to deliver those 
oppressed by the enemy. Divine healing was paramount in his entire message from town 
to town. He thought the people to desist from the use of herbs and all native medicines 
but to trust in the Lord for healing. When he visited his home at Ilofa to preach, many 
people rose against him and refused to repent and three hundred people died of smallpox 
epidemic. The people that remained alive began to come to Babalola for prayers to be 
cured. A prayer group soon emerged from the Anglican Church at Ilofa. Those who 
spoke in tongues were eventually excommunicated from the church (Idowu, 2007). As 
Babalola continued his preaching, prayer and miracles attended his prayers and his fame 
spread to the hearing of members of Faith Tabernacle, who invited him to their meetings. 
He eventually joined this group and was baptised. 
On July 9th 1930, the leadership of Faith Tabernacle met to discuss a 24-point 
agenda on doctrinal issues in Ilesa. Paramount on the agenda were: 
 Whether polygamists should be baptized in the church. 
 Whether the name of Jesus alone was sufficient and adequate for healing. 
17 
                                                                                
 
As they were deliberating on the second issue, a dead boy John Obi Ogundipe was 
brought to the meeting and Babalola resuscitated /restored him back to life with the name 
of Jesus. News of this miracle reverberated all over Nigeria and beyond, as newspapers 
carried the stories of this revival. Many that were sick found their ways to Oke Ooye and 
received their healing. Before long, the great Oke Ooye revival began it led to the birth of 
two main Apostolic Churches. Idowu (2007) views this as beginning of modern 
Pentecostalism and real power evangelism and gospel in Nigeria. For the next two 
months, crowd continued to increase from all walks of life and towns to Ilesa that no hall 
could be found to accommodate them. The sick, the barren and even corpses were 
brought for prayers.  
Not long, Joseph Ayo Babalola, at 24, suddenly found himself at the centre of a 
great revival which no religious leader in Nigeria ever experienced. It was the first 
indigenous Holy Ghost Revival in the West Africa sub-region. Idowu (2007) claims that 
Joseph Ayo Babalola could be regarded as father of Pentecostalism in Nigeria. According 
to him, Oke Ooye marked the high point of spiritual regeneration, the centre of religion 
and moral transformation for the people of Nigeria. In this revival, Jesus only was the 
point of attraction. All seekers were directed at Him. Babalola pointed all seekers to look 
at Jesus and believe in Him but they should forsake their idols. Babalola reported that he 
did everything according to the leading of the Holy Spirit. Witches, wizards, juju priests, 
witch-doctors and other fetish practitioners were said to have submitted their powers 
under this great revival. Many people received the Holy Spirit with the evidence of 
speaking in tongues and impossibilities were made possible. Several people that were 
kilometres outside Oke Ooye were touched with the wave of revival, some in their farms, 
homes and places of work. Some of such people were responsible for the revivals in their 
different towns and villages. They heard voices while working on their farms kilometres 
away to go to Babalola at Oke Ooye. Such men included Toro Owo, who started the 
revival at Ipagun and Igbara Oke; Joshua Ojo, at Ijero-Ekiti; and Peter Adewuyi of Efon 
Alaaye (Idowu, 2007). 
The Oke Ooye revival was for both physical and spiritual healing. It was for 
healing souls that were disfigured by sins and the devil, and body ravaged by sickness 
and diseases (Idowu, 2007). Many people that were afflicted and suffering under the 
18 
                                                                                
 
yokes and torments of witchcraft and satanic power were said to be liberated, freed and 
healed. Witches, witch-doctors and sorcerers submitted the instruments they used to 
torment and afflict their victims and confessed their sins publicly. Barren women and 
impotent men had their children and the people‘s trades prospered. Lost people retraced 
their ways to their families and many that ran away because of witches and wizards were 
said to have returned to their families. The blind saw, the deaf heard and the dumb spoke 
and myriads of afflictions were dealt with (Idowu, 2007).  
Prior to the 1930 revival, traditional worship had strong association with fetish, 
magic and occultism. The magicians, sorcerers and witch-doctors held sway. The occult 
and secret societies were in control and had their ways. There was no alternative power to 
challenge or revoke their sentences or decrees. Christians and others lived with fear, 
witches and wizards were believed to torment their victims without respite. Charms and 
traditional medicine were utilized by some Christians until this revival when the Lord 
demonstrated to all His power over charms, idols and shrines. A mythological tree was 
set on fire in front of Owa‟s palace and there was no evil repercussion that followed; 
rather there was mass conversion of traditional worshippers, and juju and Ifa (god of 
divinity) priests to Christianity. In many places Babalola visited, he entered forbidden 
forests and removed their altars without any consequences. These people confessed that 
Babalola operated with higher power. They surrendered their charms and heaps of images 
and occult materials for burning.  
At Oke-Ooye, divine judgement came upon the unrepentant and evil ones. There 
were only two options- confession of sins for the penitent and death for the unrepentant. 
Those that died were: 
 Those who had done wickedly in the past 
 Those that went back to idolatry after being healed by the power of God 
 Those who came to test the power of God. 
Many of the sicknesses that were brought to Oke-Ooye were perceived as having their 
roots in the spiritual world and were enforced by forces of darkness. Therefore, they 
could not be helped by medical science but were delivered at the revival. Those who were 
afflicted and drank the ‗water of life‘ vomited strange objects and were delivered. Long-
standing problems and battles were won as God intervened in the affairs of men. 
19 
                                                                                
 
 The Oke-Ooye revival was not attached to any denomination, Anglicans, Baptist, 
Methodists, Muslims and traditional religious members met at Oke-Ooye. But after some 
time, Babalola said he saw a vision that as he was catching fishes, others were throwing 
the fishes back to the river. He interpreted that to mean that there was a need to establish 
a church to put his converts in. This was what led to the establishment of Christ Apostolic 
Church and The Apostolic Church. Babalola emphasized divine healing as the power of 
God to heal as well as the need to renounce idolatry and turn to the Living God. Omi Iye 
(water of life) characterised this revival. From the day of his commission, Babalola 
claimed he was called of God to sanctify water for the healing of all ailments of the 
people. Participant at this revival brought bottles of water which Babalola prayed on and 
sanctified in the name of Jesus for people to drink and birth with. Rigorous and ceaseless 
prayers were said night and day to bring the power of God down. Many instant miracles 
happened thereafter. Almost a century after this revival, rigorous prayers are still being 
said in FBBHs to draw the hand of God for supernatural intervention in their affairs. In 
some of the churches, healing and deliverances were the major reasons for attending the 
revival and many people came to give testimonies of their deliverance. Many people 
claimed they had been to the hospitals and traditional healers but it was prayers of faith 
that delivered them. This practice continued and was transferred to the Faith-Based Birth 
Homes.  The faith homes have special days (usually Wednesdays or Fridays) set apart for 
prayers and healing purposes. These spiritual healing homes also serve as clinics and 
maternity for pregnant women. A common song at the revival is: 
Jesu Olomi Iye re Omi Iye 
Omi Iye, iye re o Omi Iye 
Babalola Olomi Iye Reo 
Omi Iye. Mo ti sonuu o wa mi ri 
Omi Iye, iye reo Omi Iye 
Meaning 
  Jesus, the giver of living water is here.  
  I was lost he sought me.  
  Babalola is here with this life-giving water. 
Before this revival, the majority of Ijesa people were in Traditional Religions while, 
Christianity was in the minority. However, after this revival, the balance tilted in favour 
of Christianity. One of the greatest impacts of this revival was massive conversion to 
20 
                                                                                
 
Christianity, particularly the Pentecostal Aladura group. This had altered the socio-
religious balance of Yoruba land permanently (Idowu, 2007), especially in Ilesa, the seat 
of the revival. Ilesa is still predominantly Christian.  This revival greatly increased 
conversion to Christianity so much that, as of the time of this research, most of Ijesa 
people are Christians, mainly in the CAC and other Aladura churches. This revival made 
Christianity relevant to the local people who used to see Christianity as white man‘s 
religion. According to Idowu (2007), Christianity did not emphasize ―enough spirituality 
in a spiritually active and alive culture... in the battle of the gods, missionary operations 
were done with blunt scalpel‖ This might be why the areas of Yoruba land that were 
evangelised by missionaries are now predominantly Muslims while those that were 
evangelised by Africans are predominantly Christians. 
Prior to this revival, conversion and genuine encounter with Jesus was not the 
condition for conversion to Christianity but desire to benefit from mission education, 
health programmes, and get employment from the Colonial government (Idowu, 2007). 
Further the revival swelled up the existing Churches; they found it difficult to 
cope with the new converts. Life was said to be better for the generality of the people, as 
they lived at peace with each other. Many wicked people were said to be converted to 
Christianity and lots of charms that were used to perpetrate evil were burnt. These helped 
to liberate the people. The revival whetted people‘s appetite for education so as to be able 
to read the Bible and sing the hymns.  
Idowu (2007) notes that 2,000 copies of Yoruba books and pamphlets of A B D 
(Yoruba alphabets) were sold in Ilesa alone in September 1930. This provided the 
background for Awolowo‘s free education of the 1950s. From the time of this revival 
people gave themselves to regular attendance at prayer meetings, vigils, Bible study and 
church service. During the course of the revival, many left the hospitals to receive divine 
healing, The Wesley Guild Hospital that had about five hundred patients had four to five 
left; others had run to Oke-Ooye for divine healing. It got to the point that Doctors were 
thrown out of jobs. The doctors complained to the District Officer of lack of patronage. 
The District Officer summoned Bablola to his office and queried him on the content of 
his water. People came with bottles of water to revival grounds and Bablola prayed on 
them. They carried this home for drinking, bathing and applying to any area of their 
21 
                                                                                
 
bodies needing healing. Almost a century after this revival, members of CAC, Aladura 
Churches and pregnant women still carry kegs of water to their churches for prayers. The 
water is believed to have the same healing efficacy as the time of Babalola. 
Churches have been categorised into groups; churches that have Western origin, 
like Catholic, Anglican, and Salvation Army are Orthodox Churches. African 
Independent Churches (AICs) are those that emerged within the Mission Orthodox 
churches from the 1920s. They are also known as Indigenous Church Movement or 
Aladura and African Indigenous Churches. They are self-supporting and do not depend 
on missionaries abroad for financial and spiritual assistance. These were churches that 
were founded by Africans for Africa.  
In traditional religion, women serve as priestesses, medicine women and seers; 
they are also used in antenatal and child care. In Ilesa women are trained as traditional 
healer and doctors. They also take deliveries. They are Iya abiye and agbomola (women 
who ensure safe delivery for mother and child). After the Oke- Ooye revival, converted 
women continued these services in the churches. Some women even became church 
founders. 
Prior to the introduction of orthodox medicine, traditional medicine was the 
dominant medical system available for millions of Africans (Abdullahi, 2011). It is the 
oldest form of health care available. WHO (2000) defines traditional medicines ―as the 
total knowledge, skills, practical based on theories, beliefs and experiences indigenous to 
different cultures whether explicable or not used in maintaining of health as well as the 
prevention, diagnosis, improvement or treatment of   mental illness. Healers are 
addressed as babalawo, onisegun and adahunse. They do not merely treat diseases in 
patients but also attempt to ensure the social and emotional equilibrium of the patience 
based on the community rules and relationship (Hillenbrand, 2005, quoted in Abdullahi, 
(2011). Traditional healers ―act as intermediaries between the visible and invisible 
worlds...and determine the spirit which is at work and how to bring the sick back to 
harmony‖. 
Ijesa land is also blessed with many other religious leaders whose religious 
activities have taken them to enviable heights. Late Canon Akinyemi was among the 
frontline Anglican religious leaders. George Vincent Agbebi was among the first 
22 
                                                                                
 
missionaries that came to Ilesa. His efforts with Reverend David Hinderer laid the 
foundation of Anglican Communion. Bishop John Falope was the first Anglican Bishop 
of Ilesa Diocese and Most Rev. Timothy Abimbola Akinnigbagbe was the first Diocesan 
Bishop of Ifaki. He was commissioned a Priest and a Deacon. He was the Archbishop of 
Ilesa. Late Apostle Timothy Obadere, founder of World Souls Evangelical Mission 
(WOSEM) and world Evangelist of a version of the C.A.C. Among the present-day 
Christian religious leaders are Pastors W.F. Kumuyi of the Deeper Life Bible Church, 
from Erin-Ijesa; S. K. Abiara of Agbala Itura, from Erinmo; E.A. Adeboye of the 
Redeemed Christian Church of God, from Ifewara; and Apostle Fakeye of the C & S 
Church Movement Ayo ni o.  
Ilesa is the capital of Ijesaland. The inhabitant regard it as a citadel of the 
Christian faith, ‗the place where God dwells‘ and the present-day new Jerusalem. The 
Ijesas‘ show of deep affection for God is epitomized by their patronage of many religious 
houses and mountains for prayer, revivals, vigils, early morning evangelists and prayer 
warriors. 
In fact, almost every four houses have a church auditorium, whether small or big, 
and because of the people‘s religious inclination, there are many religious birth houses 
attached to these churches. Some women who attend these churches patronize their birth 
houses and invite their pregnant friends to do same. Some Christian denominations in 
Ilesa are Christ Apostolic Church (CAC), The Apostolic Church (TAC), Anglican 
Church, Methodist Church, Christ Trumpeters‘ Church, The Redeemed Christian Church 
and Deeper Life Bible Church. There are numerous Cherubim and Seraphim and 
Celestial Churches. The Ijesa see themselves as beloved of God (Fatubarin, 2008).  The 
Ijesa women are very religious; many churches in Ilesa have more women than men. 
Many women are oludasile (church founders). 
The CAC has nine birth houses with an average of five deliveries per month per 
house (C.A.C. FBBAs, 2009). The Apostolic Church also has a birth house attached to its 
Mission at Irojo Headquarters Church with an average of four deliveries per month. All 
of the religious birth houses have antenatal days and clinics. The CAC runs antenatal 
clinics on Wednesdays, with average of 30 pregnant women in attendance in each birth 
house. The Holy Ghost Fire Church also has a birth house within her compound. Other 
23 
                                                                                
 
churches that run birth houses are The Redeemed Christian Church, Christ‘s Trumpeters‘ 
Church, Cherubim and Seraphim and Celestial Churches. Some of these churches were 
established on the threshold of divine healing and efficacy of prayers without medication. 
This belief system is transferred to their birth houses. Emphasis is laid on the pregnant 
women believing in the efficacy of prayer and hygienic lifestyle. A lot of time is devoted 
to prayers for safe delivery and against known and unknown enemies during their 
antenatal clinics. Traditional birth attendants and home-based obstetric care were not 
easily identified in the local government areas. This study, therefore, focused on care-
seeking in Western hospitals and faith homes.  
Some of the maternity centres the researcher selected had been established as 
early as the 1940s; pregnant women have found them trustworthy. Women that were born 
in some of them go there to give birth to their children. One of the conditions for 
selecting a care giver is that s/he must have taken deliveries for more than ten years and 
has good patronage, taking at least two deliveries per month, but the male Faith-based 
birth attendants (FBBAs) do not fulfil the condition of two deliveries per month although 
they must have fulfilled the required condition of ten years and above. One of the male 
FBBAs had started taking delivery since 1993 and claimed he had taken more than 
twenty deliveries, including twins and triplets. His educational qualification was JSS 2. 
He is an itinerant CAC/FBBA. He claimed that he specialised in complicated cases. The 
other male FBBA completed secondary school. He was the founder of a Cherubim and 
Seraphim Church. The rest were female FBBAs from various Pentecostal churches. The 
two male FBBAs were purposively selected because they were rare and the only ones that 
could be identified. 
 
 
 
 
 
24 
                                                                                
 
 
Figure 2: Map of Ilesa, South Western Nigeria 
SOURCE: Microsoft Encarta 2008 © 1993-2007 Microsoft Corporation 
25 
                                                                                
 
 
1.6  Definitions of concepts  
1.6.1  Health care is the totality of all that a woman and significant others do from 
conception to six weeks after delivery, to ensure sound health for the pregnant woman 
and her baby. This includes pregnancy test to confirm that the woman is actually 
pregnant; regular antenatal attendance; and adhering to drug regimes, immunisations, 
exercise and food prescriptions, as well as other instructions given. 
1.6.2  Pregnant women: women who were pregnant at the time of study. All the 
respondents were pregnant as at the time of study. 
1.6.3  Primigravidals (Prim) women who were pregnant for the first time. 
1.6.4  Multigravidals were women with second to fourth conceptions. 
1.6.5  Grand multigravidals were women with fifth and subsequent pregnancies. 
1.6.6  Booked pregnant women were women who had attended a minimum of four 
antenatal clinics and have done all the recommended tests and taken all the needed 
immunisations. 
1.6.7  Unbooked pregnant women were women who did not adhere to therapy stated 
above. Such women registered only in case there was a complication. They neither took 
immunisation nor attend ante-natal clinics. Some took only one immunisation and did not 
show up for the rest, while others did not take immunisation at all for religious reasons. 
Some of them just appeared on the day of delivery because there was a complication 
where they intended to deliver. 
1.6.8  Caregivers were those who assisted pregnant women in hospitals and faith 
houses: nurses, doctors and faith-based birth attendants (FBBAs). 
1.6.9  Maternal mortality is death of a woman while pregnant or within 42 days of 
termination of the pregnancy, irrespective of the duration or site of the pregnancy or from 
any cause related to the pregnancy, or aggravated by the pregnancy itself or its 
management but not from accidents (WHO, 1978). 
26 
                                                                                
 
1.6.10  Ijesa people are a sub-group of the Yoruba people of South-West Nigeria. Ijesa is 
the spoken dialect of the people. They are in the south-eastern part of Osun State. 
Generally, Ijesa women are hard-working and the majority of them engage in one 
business or the other. Most of the the Ijesa women are traders and one assumes they can 
attend, pay hospital bills and take health decisions.  
1.6.11 Focused Antenatal Clinics (FANC) refers to help sought and obtained by 
pregnant women during conception till 42 days after delivery. It is aimed at producing 
healthy mother and baby. WHO recommends at least four FANC visits at 16 weeks, 24-
28 weeks, 32 weeks and 36 weeks. It emphasises quality of visits rather than number of 
visits. 
1.6.12 Morbidity is disease condition aggravated by pregnancy condition, such as Vesico 
Vaginal Fistula (VVF), arthritis and pregnancy induced high-blood pressure. 
1.6.13 Eclampsia refers to pregnancy induced high blood pressure which leads to 
convulsion and coma. It is defined as sustained diastolic blood pressure of 90 mmHg or 
more (Emdex, 2008/09). 
1.6.14 Trimester is division of pregnancy period into three equal parts of three  months 
each. The first three months (1-3months) of pregnancy is referred to as the first trimester, 
4-6 months second trimester and 7-9 months third trimester. The first trimester of 
pregnancy is usually associated with vomiting, tiredness and general weakness of the 
body. During the second trimester, the woman is generally healthy and her body has 
adjusted to the pregnancy state.  
1.6.15  Religion is the people‘s believe in Supreme Being and the people‘s trust in Him 
in pregnancy care. 
1.6.16  Social demography has to do with pregnant women‘s characteristics such as age, 
economy, and their influences on pregnancy care  
1.6.17  Antenatal care services are care received in orthodox care centres. 
1.6.18 Singles means pregnant women who were never married: teenagers and single 
mothers 
 
27 
                                                                                
 
 
 
CHAPTER TWO 
LITERATURE REVIEW AND THEORETICAL FRAMEWORK 
2.1  Literature Review 
2.1.1  Perceptions of pregnant women on aetiology of pregnancy complications   
 Pregnancy is the means by which man or animals prevent their races from 
extinction. Fishcer‘s (2002) study in Ghana revealed that pregnancy is perceived to be a 
gift from God and it is in his plan; and so, no woman should avoid it. In every culture, 
childbirth is a thing of joy that calls for celebrations. However, health-related conditions 
threaten the joy associated with childbirth and this is having negative effects on Nigeria 
among other nations (Adelani, 2009). Every pregnancy and labour ought to be normal 
and expected to end well, but in reality, things go wrong that about 5-15 per cent of 
pregnancies experience major complications, which require medical intervention at 
referral health care level (Fatusi and Ijadunola, 2003). They end in inevitable abortions or 
special cares have to be given to carry such babies to term.  For instance, among African 
women, 640-1100 women die for each 100,000 live births (FMOH, 2007; WHO, 2004; 
2006). This translates as one woman dying every ten minutes and about 54,000 maternal 
deaths annually in Nigeria alone (NPC, 2001; Nigerian Health Review (NHR), 2006). It 
should be possible to detect these complications early and correct them if women receive 
adequate antenatal and postnatal cares. Perception of aetiology of pregnancy 
complications involves a group of people‘s belief about causes and treatment of 
pregnancy complications. How a group perceived pregnancy problems will affect the care 
they seek. Perception of aetiology of diseases will affect their health care-seeking 
behaviour in pregnancy. Many people perceive pregnancy complications from the 
religious point of view. They lay much emphasis on religious and supernatural forces. 
This perception will affect pregnancy care. If people have extensive belief in witchcraft 
and supernatural causation of disease or influence in other spheres of life, they may 
prefer delivering their babies in prayer houses and faith clinics to delivering them in 
28 
                                                                                
 
orthodox medical homes. Asuquo, Ottong, Olaniran and Duke (1992) assert that rural 
communities in Cross River State of Nigeria associate post-partum haemorrhage to 
witchcraft, supernatural forces, adultery, reincarnation, and the character of the woman; 
and believe that only prayers, sacrifices, and confessions could save the life of the 
woman. 
 From the scientific point of view, however, there are various causes of pregnancy 
complications. These could be biological and / or social. Some biological causes of 
pregnancy complications include age of the woman and parity of pregnancy. Studies have 
revealed that MM increases with age and parity. MM is relatively high at young ages less 
than 18 but lowest at 20-29 therefore, the safety age for parturition is 20- 29. MM 
increases as maternal age increases. 
o Women aged 17years and under as well as women aged 35years and older run the 
pregnancy risk of MM 3-4 times greater than those within 20-25 age brackets 
(Chase 1977, reported in Chattopadhyay et al. 1983). Young maternal ages has 
been associated with obstructed labour, pre-eclampsia and narrow pelvis while 
older women are at greater risk of haemorrhage, pregnancy-induced hypertension 
and uterine prolapsed and post-partum haemorrhage. Women having first births 
have also being found to be at higher risk than second and third births (WHO, 
USAID)    
o Women having their fifth or subsequent pregnancies run the risks of MM 3 times 
greater than women within 20-25 age brackets (WHO Statistics Annals 1973- 
1976).  
To avoid complications of all sorts, women should avoid pregnancies before age 18 and 
after 34 years. 
 The following are some of the biological symptoms of pregnancy complications: 
o haemorrhage, swelling face and legs 
o Excessive vomiting, rashes on vulva, offensive discharge, sudden lower 
abdominal pains, weakness, anaemia, dizziness, fever, shivering attacks, 
infections, painful and frequent urination, thick vaginal discharge, high blood 
pressure, convulsion and excessive weight gain.  
29 
                                                                                
 
The study of Pembe et al. (2009) in Tanzania revealed that women had low awareness of 
obstetric complication signs. Half of the respondents were not aware of any sign of 
complication. Only one in four women recognized haemorrhage as pregnancy complication, 
while only 1.5% of them realized that prolonged labour was a complication. Only 18% 
perceived retained placenta as complication. However, in Pempe‘s study, she found that 
knowledge of complication increased by age and parity. This may be related to their 
experience and number of ANC attendance. Primigravidals (prim) were less aware of 
complication signals. She recommended that prim need more counselling sessions and health 
education, stressing introduction of safe motherhood to girls in school before they get 
pregnant to improve awareness of danger signs.  
 Fishcher‘s (2002) study revealed that, when complications and infertility occur, 
they are attributed to witchcraft and demons, and that solution was to appeal to a god of 
fertility. She reported that, when the babies eventually arrived, the infertile woman must 
return with sheep and goat to fulfil her pledge. Infertility was also perceived as 
punishment for disobeying God and remedy was in fervent prayers, fasting, repentance 
and drinking ‗blessed water.‘ Herbs were given to nourish the mother and the child. 
Energetic and fervent prayers said to God for protection and safe deliveries were 
regarded as ‗main medicine.‘ It was believed that intuitive knowledge during prayer 
sessions had a great potential of revealing the sexes of the unborn baby. The respondents 
perceived infertility was attributed to stomach ache, and women were encouraged to 
praise God for their healing.  
 
2. 1. 2 Religious belief systems and pregnant women’s health seeking behaviour 
Religion is seen from different angles. Some view it from the fear of creation 
angle, as a result of viewing the vastness of universe and the one who maintains it (Ekeke 
and Ekeopara, 2010). The second school of thought is that Africans saw their limitation 
and weakness in the face of death, calamities, earthquakes and other things that are 
beyond their control and see that the Supreme Being can be drawn to help through 
appeasement and sacrifice. Africans feel they need this great power to assist in their 
experiences and powerlessness. God is real to Africans as a real personal entity whose 
30 
                                                                                
 
help can be sought in times of trouble, one who is able to protect all people(Ekeke and 
Ekeopara, 2010).  
To Anti (n.d.) however, religion is the beliefs and practices associated with the 
supernatural which embraces a code, a creed and a cult. The creed deals with the 
philosophy, beliefs or faith of the people. The code has to do with the ethical dimension, 
while the cult focuses on the rituals ceremonies of the religion. 
  In Yoruba belief, the Supreme Being, Olodumare is believed to be the Chief and 
King. He is superlative in worth, permanent, unchanging and reliable. To the Yoruba he 
is equally Olorun the owner of heaven and earth-- the author of all living. He is Kabio osi 
(He that cannot be queried or challenged). He has no equal and no image is attributed to 
Him. The Ijesa believe in this mighty God. 
Culture is perceived as a way of life of members of a society; the collective ideas 
and habits which they learn, share and transmit from generation to generation. It includes 
the belief systems, rules, values, and principles, which a group of people have inherited 
from their predecessors, through which they have come to illustrate how they live and do 
whatever they do (Haralambos and Holborn, 2008). Traditional African religion like 
culture extends to affect every aspect of Africans‘ live. Religion plays a dominant role in 
the way a woman perceives and cares for her pregnancy as well as prepares for her 
delivery. Each culture has its own values, beliefs and practices with regard to pregnancy 
and birth. Various definitions have been given by different schools of thought to religion. 
 From Functionalist perspective, religion is to meet society‘s needs of social 
solidarity. Hamilton cited in Haralambos and Holborn (2008), argue that religion can 
have greater hold on the individual than the society. Malinowski (1954), also cited in 
Haralambos and Holborn (2008) views religion as reinforcing social norms and values 
and promoting social solidarity. Malinowski (1954) identifies situations of emotional 
stress that threaten social solidarity as the concerns of religion. Such anxiety and tension-
provoking crisis of life, like marriage, childbirth and death are examples of emotions that 
disrupt social life. Malinowski argues that ‗deaths...are perhaps the main sources of 
religious belief‘. He found rituals attached to tension and anxiety-provoking situations 
and uncertainty, such as fishing in open sea.  
31 
                                                                                
 
 To the pregnant women, the possibility of MM is emotionally stressful; they may 
attend religious activities to reduce anxiety and provide confidence in pregnancy and 
delivery. Parsons (1964) cited in Haralambos and Holborn (2008) also sees religion as a 
mechanism for adjustment and coping with the unknown and uncertainty as well as 
uncontrollable factors that can threaten a successful outcome. Religion provides a means 
of adjusting and coming to terms with such a situation through rituals to act as ‗a tonic of 
self confidence.‘ The function of religion is to provide meaning to events that are 
frustrating and contradictory. The religion of an individual affects all aspects of his life 
including childbearing.  
Belief system is significant in all aspects of pregnancy care and decision on 
contraceptive utilization. The religion of a group of people plays a dominant role in their 
health care. Some religious groups will not seek orthodox caregiver help for some 
symptoms and some believe in divine health and healing and are against blood 
transfusion and deliveries through Caesarean Section (CS).  Adams (1987) avers that 
religious beliefs affect the health care practices of the Amish in America. He found that 
religious and cultural practices of the Amish resulted in health care beliefs and practices 
that were different from the dominant American culture. For instance, the Amish are 
excluded from health insurance schemes and have different perceptions of health and 
illness; do not practise birth control; do not take immunisations nor prenatal care and use 
a variety of traditional and non-traditional health care providers. Fishcer‘s (2002) study in 
Ghana revealed that, in contraceptive use, his respondents sought clearance from their 
religious leaders. Traditional priests provided certain herbs for contraception. 
A people‘s concept of health and disease influence utilization of health care 
facilities and the type of help sought in pregnancy. Individuals with low social status 
often perceive illness and disease from pre-natural and supernatural points of view and 
are not naturally disposed to the use of Western medical facilities. Western medicine, on 
the other hand, does not recognize the role of supernatural powers in health problems. 
However, when therapeutic management of signs and symptoms of a disease becomes 
ineffective, supernatural powers are often thought to be responsible (Jegede, 2010). The 
low income people often perceive some diseases as being mystical, resulting from the 
neglects of the gods, broken taboos or ritual errors (Centre for Gender and Social Policy, 
32 
                                                                                
 
2002). Sacrifices and rituals are made to appease the offended gods. Rituals may involve 
slaughtering animals, and preparing special food items at road junctions. Pregnancy 
complications such as haemorrhage, is usually attributed to mystical causes (Centre for 
Gender and Social Policy, 2002; Jegede 2010).   
For religious reasons, as well as to prevent pre-marital sex and promiscuity, some 
Nigerian societies practise girl-child marriage. These girls are married out at tender ages 
before they are physically and emotionally mature. This is because parents prefer to send 
their daughters as virgins to their prospective husbands to avoid promiscuities so that the 
girl is ‗safely delivered‘ to her husband in ‗pure state‘ (Erinosho, 2006). Early marriage 
predisposes the girls to high pregnancy-related complications, such as severe anaemia, 
pregnancy-induced high blood pressure, VVF and high mortality rate (Erinosho, 2006). 
In predominantly Muslim areas, a girl-child is given out in marriage after the first 
menarche. This practice promotes early childbearing with its attendant consequences 
(Adelani, 2009). When girls below 18 years get pregnant and are delivered of babies, 
they may suffer irreparable damage. Such girls have small pelvic girdles, which may not 
allow passage of babies, and this might result in prolonged labour. The babies may die 
and the mothers become infected. If they survive, holes may be created in their bladders 
and rectums, which will cause them to leak and be smelly. These girls are sent back to 
their parents who, in turn, often discard them because of their condition. Thousands of 
such women are abandoned and rejected. To repair the damage costs time and money. 
This situation could be avoided if men would refuse to put girls under 18 years in the 
family way as it could be their first and last pregnancies (Ransom-Kuti, 1990). 
The practice of early marriage and the purdah system in Islam expose women to 
risk, as women having difficult labour cannot be taken out of the homes without the 
express permission of their husbands. This custom can cause serious delay in getting a 
woman with complication to hospital. Purdah also restricts women from receiving advice 
from other women. This will affect women‘s perception and knowledge of pregnancy 
complications. 
When girls marry early, as a result of religious obligation, all life‘s major 
decisions are taken for them by their fathers and later by their husbands. Early marriage 
33 
                                                                                
 
also exposes the girls to sexual networking when their spouses cannot satisfy their 
economic needs. The girls tend to have sex for financial gains. This also predisposes 
them to sexually transmitted diseases and HIV/AIDS. Early marriage leads to a cycle of 
poverty. The girls have not been able to learn any trade to fend for themselves and their 
children. Such children become poor, their children are poor, and the cycle of poverty 
continues to widen. 
Kisekka et al. (1992) found that religious barrier is responsible for 29 percent of 
his respondents‘ non-deliveries in hospital. Many of their respondents saw maternal 
mortality and childbirth complications as the will of Allah, which must be taken calmly. 
They note that women have aversion to exposing their nakedness to male health workers, 
(doctors inclusive) because these are ―strange men gazing at their nakedness‖. This may 
probably be because Kisekka‘s respondents were Muslims and their religion prohibits 
close, direct social and physical contact between males and females.  Among the 
respondents of Afsana and Rashid (2001) were women who were not comfortable to open 
their bodies to either female or male health workers. This category of women preferred to 
deliver at home with the assistance of older women. 
 
2. 1. 3  Faith clinics / Faith based birth attendants (FBBAs) 
 These are churches that hinge their therapy on the efficacy of prayers and 
confession of sin(s) (Erinosho, 1989). They believe that sin is the cause of man‘s sorrow, 
sickness and disease. When a man sincerely confesses his sin(s), he is emotionally, 
psychologically, and spiritually relieved. His guilt is removed and he becomes free from 
guilt. When he prays or is prayed for, God heals him supernaturally. Levin (2001) 
investigated how knowledge of various aspects of religiousness contributes to 
determining health and well-being. He argues that religious affiliations and frequencies of 
attendance at religious services are associated with long living and good health. There are 
observable behaviour patterns that promote health in religious houses as a result of high 
level of social support that accompanies being religious. Members provide emotional and 
prayer supports that help the sick to recover from ill health.  
34 
                                                                                
 
 Similar to Fishcer‘s study in Ghana, many Nigerians believe that pregnancy and 
childbirth are supernatural events that need the interventions of God. The Yoruba for 
instance, believe that children are gifts from God, and that faith-based midwives are in a 
position to assist in prayers during the supernatural processes of pregnancy and childbirth 
(Adekunle, 2001). When diseases and illnesses defy medical cure and hospital 
investigations prove fruitless, many Nigerians believe that prayers have to be made for 
cure to be achieved. There are belief systems that attribute birth complications to 
supernatural forces. Witches and wizards are blamed for obstetric emergencies. Many 
women believe that prayers made in faith homes protect them and ward off the power of 
witches and wizards; as a result, some pregnant women prefer faith delivery sessions to 
orthodox medical care. Some religious and traditional sects do not utilize orthodox 
medicine at all but depend only on the efficacy of prayers while some combine the two.  
Some religious groups, like Jehovah‘s Witnesses refuse transfusion of blood in 
complicated labour especially haemorrhage. Asuquo et al. (1992) aver that, when 
postpartum haemorrhage occurs among some rural communities in Cross Rivers State of 
Nigeria, a spiritualist is sent for or the affected woman is taken to the prayer house 
because the women believe that everything is possible with prayers. 
However, religious homes have also been associated with high maternal deaths 
and morbidity. Owolabi, Oyo State Commissioner for Health in 2009, shut all mission 
houses in the state because he claimed that 36,000 women die annually from avoidable 
complications before and after delivery in the hands of unqualified personnel in mission 
houses. But pregnant women and significant others perceive faith homes as efficacious. 
Currently, there are various health-care delivery systems for pregnant women in Nigeria 
namely: traditional birth attendants (TBAs), faith clinics/houses, community based and 
orthodox Western medicine. In Ilesa, faith clinics and western medicine are the most 
prevalent. Medical personnel regard faith based homes as traditional birth attendants 
(TBAs). 
 
 
 
35 
                                                                                
 
2.1.4  Reasons for extensive patronage of traditional birth attendants (TBAs) 
TBAs are usually females that are elderly who acquired their skills generally by 
delivering babies themselves or by working with other TBAs (Eades, Brace, Osei and 
Laguardia, 1993). Their skills and experience are locally recognized and respected 
(Muazu, 1992; Adekunle, 2001). They usually reside in the community, and this makes 
them easily accessible to women and so they take deliveries of 60-80% of births. They 
regard their practice as God‘s gift. Nigeria, like other developing countries, makes 
extensive use of TBAs during pregnancy and labour. This is partly because child delivery 
is regarded as a social event, rather than a medical one. TBAs serve special roles in 
primary health care delivery. If appropriately trained and supervised, they can play extra 
roles in immunisation, family planning education and contraceptive distribution as well 
as diagnose for referrals of complications. They help to take simple midwifery to women 
in their homes and reduce congestion in hospitals. Their services are not as costly as 
institutionalized maternity services, just as payment can be waived or postponed to a 
more convenient time.  
According to Leedam (1985), TBAs performed an estimated 70-90 percent of 
deliveries in African countries in 1974. The proportion of births attended by TBAs in 
rural areas is greater than that of urban areas; In rural areas, the TBAs are probably the 
only available health care providers (Eades, et al. 1993). The proportion of births 
attended by TBAs in North East, North West and North Central Nigeria is far greater than 
that in the other geographical zones (NDHS, 2003). Various reasons have been adduced 
for the extensive use of TBAs in Nigeria which include: cultural beliefs and practices, 
proximity and convenience of accessing places of delivery, costs of services, treatment 
and handling of pregnant women, especially in labour and delivery. Population Reference 
Bureau (2005) posits that only 35 per cent of Nigerians have access to modern medical 
services, while the other 65 per cent employ the services of traditional healers. Many 
women still acknowledge the skills of modern hospitals in handling complications than 
the TBAs; yet, they believe in the expertise of TBAs in other aspects of childbirth 
(Muazu, 1992). They claimed they felt comfortable because the TBAs are part of them 
and know what is required and what they expects from them.  
36 
                                                                                
 
 O‘Mahony and Steinberg (1995) assert that two-thirds of rural South African 
women deliver at home with the aid of TBAs. Population Reference Bureau (2005) 
report notes that only 35 per cent of Nigerian women are delivered by skilled personnel. 
Ekanem et al. (1975) observe that many women still prefer TBAs even where trained 
midwives and physicians are available because of the TBAs‘ experience, kindness, skills, 
and interest in the welfare of the baby. Williams and Yumkela‘s (1986) study revealed 
that 85% of mothers preferred TBAs because they were more easily accessible, more 
friendly, and kinder during delivery, and their chages were less expensive than those of 
hospital deliveries. TBAs are believed to have special rituals and religious roles to play in 
pregnancy (Adekunle, 2001).  
The TBAs not only take deliveries, but they also treat women‘s diseases, 
disorders and infertility, threatening abortions and deformities; they also do spiritual 
healing (Eades et al., 1993). They employ natural methods and manipulation. The TBAs 
provide antenatal and postnatal services as well as medicine for some childhood ailments. 
They provide herbal treatment and nutritional advice for pregnant women to prevent 
problems, stimulate foetal growth, and hasten labour (Muazu, 1992; Eades et al, 1993). 
They assist to keep the woman in a squatting position, hold her hands and massage her 
back while contractions are on.  They encourage the woman not to shout or push too hard 
to avoid tears. When tears occur, they treat the injury with hot water (Muazu, 1992). At 
deliveries, the TBAs cut the umbilical cord, bath mother and child Such umbilical cords 
are cut with razor blade, knife or even palm fronds. These could be sources of infection 
for mother and child, as some of the equipment are not sterilised. In Muazu‘s study, the 
TBAs took care of the mother and the baby for a week, washing their clothes and bathing 
for them (Muazu, 1992). They still have contact with both mother and child weeks after 
delivery; and give advice on breastfeeding and mother‘s nutrition (Eades et al. 1993). 
When women who are delivered at home experience complications, many TBAs 
refer such complications to hospitals (Muazu, 1992; Eades et al, 1993). But many of the 
TBAs reported that the women do not go to hospital owing to financial and transport 
limitations as well as disrespect and painful treatment from hospital personnel (Muazu, 
1992). Akpala, (1994) suggests the need to urgently train more TBAs in obstetric services 
37 
                                                                                
 
such as antenatal care, risk detection, referral conduction, delivery under septic condition 
and postnatal care to reduce maternal mortality and morbidity.  
WHO had recognized the need since the early 1970s and encouraged countries to 
evolve training programmes for the TBAs. Countries that have been involved in this 
training have increased and the impact has been drastic reduction in maternal and infant 
mortality (Greenwood, Bradley, Byass, Greenwood, Snow, Bennet and Hatib-N‘jie, 
1990). There are general proposals to adapt some practices of one health care provider to 
the other, especially Western medicine to traditional indigenous midwifery, so that the 
advantages in both may be enjoyed. This may reduce the negative aspects of indigenous 
medicine. The major problem, however, is that traditional and Western medicines do not 
have common concepts. They are based on different philosophies and their integration 
may be difficult (Jegede, 2002). 
To reduce the then high maternal mortality rates in areas served by the TBAs, the 
Bayalu Rural Development Society in India carried out community-based projects with 
farm families in Indian State of Karnataka. Women groups selected TBAs for training 
and pressured health authorities to provide gynaecological services and regular visits by 
auxiliary midwives. The project evaluations showed that participants were more likely to 
have at least three antenatal visits and to have trained personnel attend to them during 
childbirth than non-participants. Participants were more likely to indicate that they had 
the right to make decisions and move freely outside the home. 
 
2.1.5  Utilization of antenatal care services 
Home deliveries have been the pattern of deliveries since human existence. The 
first idea of midwives occurred in Exodus Chapter 2 of The Full Life Study Bible, King 
James Version (1992) where it was written that Egyptian midwives attended to Israelite 
women. With the introduction of orthodox medicine to Europe, delivery shifted from 
home to hospitals. As utilization of orthodox medicine increased in Europe, so decreased 
maternal mortality from over 1,000 per 100,000 live births in the 18th century to 10 per 
100,000 births in 1989 (Royston and Armstrong, 1989) and 13 per 100,000 live births in 
U.S.A. Western medical service was introduced to Africa, Nigeria in particular, via the 
38 
                                                                                
 
colonial administrators and missionaries around 1906. It was extended to Ilesa (the study 
area), Shagamu and Ado-Ekiti in 1913 (Fatunbarin, 2008). This service was later spread 
to other parts of Nigeria.  
Fatusi and Ijadunola, (2003) argue that less than one third of public-sector 
facilities meet comprehensive essential obstetric care standard. This makes it difficult for 
these facilities to take care of referral needs of the people. In developed countries, regular 
enquiries are made to eliminate available risk factors, and this has brought maternal 
mortality to negligible level. A woman‘s risk of dying from pregnancy and childbirth in 
developed countries is 1 in 7,300; while that of sub-Saharan Africa is 1 in 22 (United 
Nations Development Programme (UNDP), 2010). Maternal mortality ratio (MMR) in 
developing countries is 10 times higher than that in developed countries and national 
statistics in these countries are rare and inaccurate, as analysis of MM is based on 
experiences in individual hospitals. Estimated MMR in different communities in Nigeria 
is as follows:  
Rural Areas         -    828  
Urban Areas        -     351 
South West         -       165 
South East          -       286 
North-West          -     1025 
North-East        -        1549 per 100,000 live births.  
While the estimate for the nation is 840 (NDHS, 2008; Limwattanawon, 
Targcharoensatthien, and Smiak, 2011, Unicef,  USAID n.d.).   
Haemorrhage and hypertensive disorders account for the largest proportion of 
these maternal deaths (Okonfua, 2012). Haemorrhage is believed to account for 34% of 
MM; infection 17%; pregnancy induced hypertension 11%; obstructed labour 11%; 
abortion 11%, eclampsia 11%; malaria 11%; and anaemia 11% (Salama, 2008). Mothers 
with severe anaemia are predisposed to increased risks of maternal death, stillbirth and 
neo-natal death and their infants are at increased risks of low birth weight, premature 
death and/or cognitive impairment (Tinker and Ransom, 2002). Anaemia also predisposes 
39 
                                                                                
 
babies to be born prematurely as well as increases their chance of dying before their first 
birthdays. 
One in every five African women has a risk of losing a newborn child during her 
life time (Graham, 1991; Sindiga, Chacha and Kanunah, 1995; WHO, UNICEF, UNFPA, 
2001). Most of these deaths are preventable if appropriate health measures are taken. 
Such measures include antibiotics for infections, caesarean sections for obstructed labour, 
blood transfusion and oxytocic drugs for haemorrhage, sedatives and other drugs for 
eclampsia.  Other preventive measures include better health care during pregnancy, 
delivery and post-partum period; antenatal care, providing initiated HIV testing and 
counselling, skilled attendance at delivery, emergency obstetric care and family planning 
(Salama, 2008). When these measures cut across and integrate the home, community, 
outreach and facility-based services, these interventions can have multiple benefits for 
mothers, children and communities in which they live (Salama, 2008). Unfortunately, 
such treatments are not available to many women for cultural, social, religious, and 
economic reasons. 
In many pregnancy complications, there are not early warning signals that an 
emergency may occur. Complications do occur at dying minutes when they are least 
expected. Some of the women who survive become chronically ill and eventually die 
from conditions such as diabetes and infectious hepatitis (Paul, 1993; Dada, 2008). It is 
not only imperative to save mothers‘ lives, but it is also a sound investment that benefits 
the families, the communities, and countries (Wardlaw, 2008).  
The hospital authorities expect pregnant women to adhere to certain conditions. A 
pregnant woman is expected to come for booking after missing two consecutive 
menstruations that is about eighth or tenth week of pregnancy. She is expected to attend 
ANC at least four times: one at first trimester, one at second trimester and twice at the 
third trimester, and adhere to all the tests and immunisation schedules.  
Health workers recommend a maximum of five doses of tetanus toxoid injection 
for a lifetime vaccination. The first dose at first contact, the second after four weeks, the 
third six months and the fourth and fifth doses one year interval. An unimmunized 
pregnant woman must take at least two doses each within 4 weeks and the third six 
40 
                                                                                
 
months after. Women that do not attend ANC early may not be able to take more than 
one or two. NDHS (2003) reported that almost half of their respondents did not receive 
any tetanus toxoid injection. Only 20-40% of pregnant women in northern Nigeria 
received two or more immunizations, compared with 62.7% in the South. Women that 
utilize ANC are faced with the problem of financing materials that the hospital authorities 
expect them to purchase. Women who attend ANC are supposed to book with two 
thousand and five hundred naira for the first booking and one thousand and eight hundred 
naira for subsequent pregnancies. These costs cover tests of retroviral, hepatitis, blood 
group, ultra sound, genotype, urine and packed cell volume (PCV) as well as other 
measurements, like blood pressure, weight and height.  
When women attend ANC, health talks on appropriate diet, personal hygiene, 
what to expect in, and preparation for labour, breastfeeding; care of the baby (appropriate 
way to bathe the baby) are given. Such talks also include: indication of pregnancy 
complications, what to do when labour sets in, and indication for surgery as well as 
postnatal check up. Following health talk are pelvic and abdominal palpation, and 
prescription of appropriate routine drugs. During the course of booking and subsequent 
antenatal attendance, the midwives or nurses check for danger signs like swollen feet, 
face, and body.  
   
2.1.6 Social Factors that influence decision on pregnancy care 
 Different studies have laid emphasis on minimum travel distance to increase 
utilization of health-care services. Federal Ministry of Health (1988) and Jegede (2002) 
noted that women would want to utilize clinics near their homes because of travel time 
and transport cost. Most Nigerians do not want to travel more than 5 kilometres on foot to 
receive health care service. Okafor (1982) argues that the cost of travel has serious 
implications for location and utilization of health care services, as most people want to 
spend less on transport. Proximity, high income, and participation in occupation are 
important determinants of utilization of health care delivery services. Logistic problems, 
such as availability of transport and good roads, are some of the factors that influence 
health management of pregnant women. In Ilesa, there are no problems of transport 
41 
                                                                                
 
because the health care facilities are within walking distance to all citizens. The question 
is whether or not women make adequate use of these facilities. 
 According to Jegede (2002), Nigeria has a ratio of one health facility to about 10 
rural communities. The majority of women with prolonged labour complications in many 
hospitals are patients from remote rural areas. Safe Motherhood Progress Report from 
Guinea Bissau on maternal mortality revealed that half of maternal deaths occurred 
among illiterate women who were 10 kilometres away from health care centres or 
hospitals who had no antenatal care and were delivered at home (WHO, 1978). Ilesa has 
many health centres within reach. But do the pregnant women make use of these 
facilities?  
 Audu-Airede, (2000), reports that the introduction of users‘ fees has been found to 
lead to increased MM in many places in Nigeria especially in University of Nigeria 
Teaching Hospital, Enugu; where MM ratio was said to have increased by about 600% 
since 1987 when users‘ fee was introduced in government-owned hospitals. Antenatal 
care, hospital delivery and emergency obstetric care have become inaccessible to many 
Nigerians. Some women come to hospital as a last resort only when complications have 
set in and mother is, perhaps, on death road (Audu-Airede, 2000). Kaufman (2002) found 
that Chinese women knew the importance of hospital deliveries but still delivered at 
home because of users‘ fees. Less than six percent of women delivered in hospitals, while 
the other deliveries took place at home attended by a relative or a friend. In Ejia China, 
pregnant women perceive quality of local services too poor and birth attendants 
inadequate and, because they could not afford hospital bills, they usually deliver at home, 
attended by a friend or a member of the family.  
 High fertility rate is another issue in maternal mortality. Women are subjected to 
repeat childbearing at short intervals, either to satisfy their husbands' quest for a large 
family size or as a means of adjusting to the very high infant morbidity and mortality on 
the continent. The situation is exacerbated by cultural beliefs and practices and poor 
medical delivery system that hinder access and use of hospital facilities during 
emergencies (Ajiboye and Adebayo, 2012). This is compounded by other harmful 
traditional practices, such as female genital mutilations. Average fertility rate in Nigeria 
42 
                                                                                
 
is 6.0. In northern Nigeria, fertility rate is 6.6 and in the South fertility rate is 5.5. Early 
childbearing is partly responsible for this high fertility rate in Northern Nigeria. For 
instance, 21% of girls have given birth by age 15.  
Birth spacing affects the health of mother and child. Women who give birth when 
they are too young or too old or have babies too closely spaced are at risk of birth 
complications and infant mortality. For instance, a newborn baby that is less than 24 
months younger than the next older siblings is 2.2 times more likely to die than one that 
arrives after 36 months.  Women with high parity are at high risk of maternal mortality 
and their newborn children are at increased risk of death (Tinker and Ransom, 2002). 
Women above 35 years and those who had more than four pregnancies are known to be at 
increased risk of maternal mortality and morbidity. So, in the interest of their health, 
women should not have children when they are above 35 and should not have more than 
4 pregnancies.  
Women bear the greatest brunt of physical labour at home and farm, and this 
brings about premature aging. Frequent pregnancies reduce women‘s resistance to illness 
and fatigue, yet they are pressed into numerous pregnancies such that, by 50 or 55 years, 
they are disabled by arthritis and hypertension. High MM is a result of low status of 
women and low coverage of health care services (Ransome-Kuti, 1990). 
Cultural patterns are important because they lead to an understanding of factors 
underlying disease patterns in a community. These cultural patterns give insight into 
people‘s values, knowledge of and attitude to health and disease. Oke (1995) notes that 
socio-cultural factors affect utilization of medical facilities as well as predispose an 
individual to accepting or rejecting utilization of medical facilities. Jegede (1998; 2010) 
claims that, the culture of a particular group of people, at specific periods of time, always 
influences their ways of living in that society. 
In addition, much less value is placed on the female child than the male. The 
female child is less nourished and given less formal education. When resources are 
scarce, the girl child‘s education is stepped down to give place to the boys. When 
sickness strikes in a family, the girl is withdrawn from school to take care of the sick. 
Many parents still arrange child marriage for their girls. This result in early pregnancies, 
43 
                                                                                
 
with its attendant complications like Vesico-Vagina Fistula (VVF), prolonged labour and 
anaemia. Females are exposed to genital cutting. Male child preference encourages high 
fertility and maternal mortality. Desire to bear sons will make women anxious to bear 
children without proper spacing. A woman will go in for as many pregnancies as possible 
in order to have a male child who will secure her right to inheritance in her husband‘s 
house. Studies in India revealed stronger preference for sons than daughters. 
According to Onwudiegwu, (1997) and CGSPS, (2002) with the worsening 
economic situation in Nigeria, the health status of Nigerians would be the worse for it. 
Deepening economic crisis has worsened poverty level, resulting in increased 
promiscuity, prostitution, adolescent sexual experiences and unwanted pregnancies, 
HIV/AIDS, and unsafe abortion (Audu-Airede, 2000). Effective use of family planning 
methods at this time can contribute to improved maternal and newborn health by helping 
women to avoid pregnancy when the risk of poor outcome is high (Ayongwa, 2006).  
Limwattranon et al. (2011) report that most African leaders failed to allocate to 
health 15% of their national annual budget, as they committed themselves in 2001. The 
percentage of allocated is far below WHO‘s estimate to health at any given year. The 
resources available are allocated to infrastructures and VVF. A situation where there is 
misallocation of available resources to infrastructures and VVF while women with 
prolonged labour cannot afford emergency CS is not good enough. Cost of transportation, 
travel time, condition of the road or distance, aggravated by incessant shortage of 
petroleum products, result in high cost of transportation to take women with emergency 
obstetric complications to the hospital. This is also complicated by drivers‘ unwillingness 
to have their vehicles soiled with blood. All these result in delay in reaching facilities.  
Social elements, such as gender inequalities and social class are basic determining 
elements of health. Oke (1995) avers that some diseases are occasioned by poor diet, 
clothing, and housing that are direct effects of cultural origin.  Adekoya (2012) found 
strong but inverse relationship between socio- cultural factors and choice of health care. 
The result of his study revealed that the culture of patriarchy, income and where one 
resides are determinants of when one commences care and the choice of health providers. 
44 
                                                                                
 
Mubiru ba (Mak) (2012) asserts that women‘s social definitions and perception 
about pregnancy influence ANC-seeking behaviour patterns. Women with positive 
perspectives towards pregnancy seek ANC. To such women, pregnancy provides joy, 
happiness, and pride, promotes social status, and safeguards marriages. It is an avenue to 
access love, care, support and gifts. On the other hand, women with negative perception 
do not seek ANC. They perceive pregnancy as misery, sadness, pain, suffering, 
regrettable and uncomfortable experience. Mubiru ba (2012) found that the perception of 
these women were culturally constructed and rooted in their taboos, rituals and practices 
of their communities. These social constructions prevent the women from seeking ANC 
care to avoid bad omen that could harm the pregnancy. Culture, therefore, cannot be 
divorced from the health status of a group of people; poor health is a direct consequence 
of cultural practices (Adelani, 2009). Until and unless some cultural practices are 
modified, most health problems cannot have feasible solutions. Some of these practices 
include food prescriptions and proscriptions, attitude to operative deliveries, ignorance, 
decision-making patterns and ill-equipped hospitals to take care of emergencies.  
Among some societies, balanced meal is preserved until after delivery, when 
relatives are around to see that they eat good meals even though the foetus would have 
been deprived. Among other cultural groups, balanced meals are proscribed for nursing 
mothers until seven or nine days after delivery for baby girls and boys, respectively. 
Some women prefer to reserve their money for expensive clothing, trinkets and elaborate 
naming ceremony rather than make adequate preparation for balanced meals or pay 
medical bills because of cultural factors. Women expect their husbands to provide 
balanced meals and pay medical bills while they spend their money on clothes and 
trinkets. Adelani (2009) avers that most women would not get ready the needed items for 
delivery, probably due to nonchalance, ignorance, and poverty. Therefore, education 
must be structured for women to prioritize safe motherhood.  
Another social factor is attitude to Caesarean Section (CS). Most women expect 
delivery to be normal, but when things go wrong they go to any length to avoid CS. They 
think that unless they have normal delivery, they have reproductive failure and insist on 
trying against medical advice. They deliberately delay permission in the hope that, with 
time, normal delivery will take place. At times, they are lucky and are delivered 
45 
                                                                                
 
normally, but some are not so lucky and, by the time the permission is given, things 
would have gone dangerously bad. When operative delivery is needful, women should 
accept the inevitable to save their lives and their babies.  
Adelani (2009) identifies three types of delay that contribute to poor obstetric 
care, disabilities and deaths. 
1)  Delay in taking decision to seek medical care because of ignorance and inability 
to recognize danger signs of complications and lack of birth preparedness by 
pregnant women and their families. Ignorance occurs when pregnant women and 
significant others are ignorant of early symptoms of pregnancy complications. 
2)  When it becomes obvious that a problem is at hand and the woman decides to 
seek help, she is faced with the problem of decision-making, taking permission 
from an absentee husband, and where to get money. When these obstacles are 
surmounted, the problem of transport between the home and facilities surfaces: 
the woman in a difficult labour may have to trek or be put on a donkey in the 
North or in boat in riverine areas for a long journey to facilities. This delay is 
further aggravated by poor road network, impassable roads, communication gap 
between pregnant women and health care providers, and lack of individual or 
family‘s means of transportation. These can cause serious delay in getting a 
pregnant woman to the hospital. In order to find solutions to transport problems, 
Pate (2012) suggests collaboration with Nigerian Union of Road Transport 
Workers to assist women in need of urgent obstetric care in villages. Pate (2012) 
was of the opinion that maternal and child health will receive a boost as the 
Nigerian Union of Road Transport Workers (NURTW) provide emergency 
services to pregnant women in rural areas in northern Nigeria.  
However, Onwudiegwu (1993) and Adekunle (2001) were of the opinion that 
when the women eventually arrive, they may not receive adequate treatment 
because needed materials to aid delivery may be in short supply; relations of the 
women have to pay large deposit or buy the material themselves. Sometimes, the 
relations have to go back to the villages to get more money. This could be an 
additional 8-10 hours, which may spell death of the mother, the child or both. 
46 
                                                                                
 
This has led to a corresponding increase in the number of pregnancy 
complications and subsequent maternal deaths. 
3)  At the hospital, delay in receiving appropriate care due to delay in access to staff 
and facilities; lack or inadequacy of competent and/or committed hospital 
personnel─ doctors, nurses, and attendants─stare them in the face, as many 
doctors and nurses refuse rural posting (Adelani, 2009).  
There is evidence that pregnant women that needed augmented labour like CS or blood 
transfusion had been delayed to the point of death due to administrative bottlenecks when 
health workers gave priorities to registration and payment than to patients. The causes of 
type three delays may also include unavailability of antenatal, delivery and post-delivery 
cost. Before women reach well-equipped facilities, their conditions would have worsened 
considerably, leading to avoidable MM or maternal morbidity. When the economy is the 
problem, the community should know that government cannot provide everything, and be 
aware of hospital limitations so that they come well prepared when they bring patients to 
avoid unnecessary delays. The community could evolve a financial self-help so that no 
woman is prevented from going to hospital because of lack of funds. 
In addition, a combination of previous unfavourable experiences with health care 
providers; lack or poor supply of consumables and equipment; delay in referral of 
patients as well as lack of essential obstetrics care in facilities can also contribute to type 
3 delay. 
Muazu (1992); Kisekka, Ekwenpu and Olorukoba (1992); Afsans and Rashid 
(2001) note that, women may not be willing to be examined by men or may be reluctant 
to discuss reproductive matters with men. When such women have to discuss with male 
physicians, they may not open up.  
Another cultural practice which militates against utilization of Western obstetric 
care is the inability of the hospitals to accommodate delivery in squatting position 
(normal delivery in hospitals is lying on the back but home deliveries are in squatting 
positions). Further, some hospitals do not bath babies in the first 12 hours of delivery and 
many people believe that babies that are not bathed would have body odour in future. 
This also may militate against hospital delivery. Those who are delivered of babies in 
47 
                                                                                
 
hospitals are eager to be released to go home so that they can quickly bath their babies to 
avoid their babies having such odour. Some hospitals do not allow hot baths for mothers. 
The Hausa believe that exposure to cold after childbirth may lead to ill health. As a result, 
mothers are made to eat hot spices, have very hot baths, and sleep in overheated rooms 
during the first forty days of delivery. Although this practice enhances personal hygiene, 
it results in severe burns and injuries. Severe burns on the breast may make breastfeeding 
impossible. Others may sustain such burns on their private parts. These get infected and 
those who survive have severe scaring and harrowing effects in their private parts that 
make future delivery difficult or impossible (Ekwenpu, 1990). Nwokocha (2006) claims 
that, the Ibani people of Rivers State in Nigeria attach great importance to how the 
placentas of their children are disposed of. Therefore, mishandling of such placentas by 
hospital care providers may hinder patronage. 
There is the cultural practice of post-delivery sexual abstinence for lactating 
mothers, no sexual activities are allowed until the baby is 2½ years old. This practice 
exposes the husbands to polygyny or extra-marital affairs with the attendant exposure to 
HIV/AIDS and other sexually transmitted infections. 
Another cultural practice is ‗Gishiri‟ cuts, a traditional practice among the Hausa 
people of northern Nigeria, in which the birth canal, especially the vagina, is cut with a 
razor blade. This leads to loss of blood and extensive injuries and severe damage to 
adjacent organs, like the bladder and rectum. This may result in Vesco Vaginal Fistula 
(VVF). 
Shehu (1992) identifies polygyny as another cultural factor that affects pregnancy 
care. In a polygynous marriage, the pregnant woman has to share her husband with other 
co-wives. She may not be given any special treatment except she is clearly seen to be 
sick. The diet of a pregnant wife in a polygynous marriage is not different from that of 
other members of the family. She takes of the food provided by the husband for all 
members of the family. This may be inadequate for her and her foetus. Further, the 
ridicule of co-wives may prevent the pregnant woman from seeking help early. This may 
contribute to prolonged labour. There is also the tendency for women (especially in 
polygynous marriages) to compete to have many children so as to produce many males to 
48 
                                                                                
 
enable them to have fair share in the husband‘s property at his demise. Hence, Shehu‘s 
respondents desired as many children as Allah willed regardless of the opinions of 
medical professionals. Cultural practices that encourage childbirth at short intervals and 
multiple pregnancies confer no advantage on women. 
As a result of their belief that pregnancy is a normal process, women in labour in 
Sokoto State of Nigeria are confined to a room by themselves. They are to show bravery 
and will and should not call for help even in prolonged labour. By the time a problem is 
discovered, complications must have set in. Among the Hausa people, pregnancy and 
childbirth of the firstborn must be in modesty, shyness, disguises and secret (Kisekka, et 
al. 1992). The woman is socialized such as not to flaunt her pregnancy; to isolate herself 
and deliver her baby in solitude. She is to show no signs of pain or fear. Even when a 
pregnant girl cries out for help she may not receive it quickly as other co-wives or 
neighbours or traditional birth attendants (TBAs) may believe that she is being lazy and 
has not taken her lessons seriously. Such women are, exposed to high-risk labour. TBAs 
do not even attend to births of first babies; they only come after a woman‘s self-delivery 
to cut the umbilical cord. This frequently contributes to delays in early detection, timely 
diagnosis and assistance in childbirth complications. This is even more so since the first 
babies are delivered when the mother is also a child with less developed pelvic. 
Cultural taboos and superstitions proscribe some food items for pregnant women. 
Such proscriptions are detrimental to the welfare of mothers and babies. Proscribed food 
items include snails, chicken, gizzards, fish, pig, antelope, grasscutter, egg, melon soup, 
groundnuts, sugar, sugarcane, honey, cocoa beverages, banana and mangoes (Wahab, 
2004 and Erinosho, 2006). Yet these food items have abundance of protein, 
carbohydrates, vitamins, fats and minerals that reduce women‘s susceptibility to diseases 
and infections. Diets that have sufficient nutrients and calories are essential to carrying 
pregnancy to term, but many women lack them. Vegetables and fruits are prescribed but 
even then the prescriptions are based on the notion that they cleanse wombs. These food 
taboos are imposed on pregnant women and children when they need them most for 
growth and development of healthy babies.  
49 
                                                                                
 
In many societies, women suffer food discrimination; they have access to food 
only when all males have eaten though they are saddled with the responsibilities of 
preparing them and are overburdened with other household chores (Erinosho, 2006). As a 
result of poor nutrition, women could not combat anaemia, infection and haemorrhage. It 
has been found that maternal weight, especially gestational weight gain, is linked to the 
birth weight of the infant. The nutritional status of pregnant woman is believed to be 
closely related to peri-natal outcome. Poor maternal nutrition has been linked to 
spontaneous abortions, low birth weight, hearing problems, brain damage in children, 
stillbirths and congenital malformation (Erinosho, 2006). Anaemic women are unable to 
withstand even moderate blood loss and so cannot carry babies to term. 
In addition to the burden of pregnancy, the workload of the average Nigerian 
woman is twice that of her male counterpart. She spends hours fetching water, gathering 
sticks and cooking food in addition to farming and the secular work or business. Even 
among the working class, women still run shops/ businesses after the close of their 
official work.  
Among some societies, pregnant woman should avoid sunshine so that evil spirits 
would not destroy the pregnancy. Physical exercises, such as bending of legs, lying 
backwards and walking about, are discouraged because it is believed that the baby‘s cord 
will be entangled around him. In some other societies, excessive exercise is encouraged 
during the third trimester to shorten the labour period. In some societies, pregnant women 
are to carry heavy load to induce smooth and quick labour. Some of these cultural 
practices should be reviewed and adjusted so as not to jeopardize the health of pregnant 
women and babies. 
Other social factors that have affected maternal health care utilization include 
repeated strike actions by hospital personnel for better conditions of service. Incessant 
strikes actions and lock-outs are most common in the teaching hospital in the study area. 
During the course of this study, the teaching hospital chosen for the study was on strike 
four times. Women who booked there for delivery had to make alternative arrangements 
at critical times. Most pregnant women envisage that there will be a strike action at the 
time they are to give birth, so they always book in alternative care-giving centres.  
50 
                                                                                
 
Shehu (1992), in his study in Sokoto State, Nigeria, revealed that the socio-
cultural practice of early marriage is a big factor in maternal mortality. Some women start 
reproduction from as early as 13-14 years and have babies until nature stops them. 
CONNOHPD (1997), in their studies in Kaduna and Katsina States, Nigeria, found that 
the normative age of marriage for girls is 12-15 years, contrary to the minimum accepted 
18years by UNICEF and medical experts. They found that illiteracy was high among 
women because very few of them went beyond primary school, if they ever went to 
school at all. The respondents‘ reasons for giving out the girls early was that girls become 
sexually mature earlier than boys and it will not be correct to watch a girl become big 
while staying in her father‘s house. In their opinion, the appropriate place to grow big is 
in the husband‘s house. Other informants commented that they did not want the girls to 
bring shame to them by getting pregnant outside wedlock or becoming promiscuous. 
They also perceived early marriage as a kind of luck for the girls because delay might 
mean she would lose the opportunity of getting married. They were of the opinion that if 
the girl got married around ages 20-25 she might have lost her virginity.  Most men want 
to catch the girls young. These girls are married to men aged 20-25, or 40-60, majority of 
whom are not virgins themselves. One wonders why a man who is not a virgin will be 
bent on marrying a girl that is a virgin. 
The (2003) Nigeria Demographic Health Survey reported that 30% of Nigerian 
females have begun childbearing by age 18, and by age 20, 40 - 48% of northern 
Nigerian women have begun childbearing. However, studies have shown that neo-natal 
and maternal deaths are lowest among mothers aged 20-29 (NDHS, 1990; 2008). Child 
marriage tends to increase MM in Nigeria as these young adults are not physically and 
emotionally stable for the stress of pregnancy and childbearing (Adelani, 2009). The 
teenage period should be a transitional one in which teenagers grow up and mature, but 
many of them experiment with sex and engage in illegal abortions, which often result in 
life-threatening complications and lots of them die annually as a result of this. It is 
essential to provide accurate and understandable information about sexuality and 
contraception to girls, using culturally acceptable approaches so as to avoid unnecessary 
risks (Adelani, 2009). 
51 
                                                                                
 
Ekwenpu (1990) states that, the best result of childbirth is between 20 and 30 
years where children are spaced evenly between 2½ - 3 years and are not more than 4. If 
girls are allowed to go to school, they would not get married early and they will use the 
time to grow up. Education will be profitable to them to take decisions, seek help, know 
where to get help and have resources to pay for services.  
 
2. 1. 7  Influences of demographic factors on care during pregnancy 
 Economy is an indicating factor in illness and health. The health of a pregnant 
woman depends on her personality and economic backgrounds, as well as who provides 
the finance in health care. The dangers women face in pregnancy and childbirth are 
closely connected to their socio-economic status. Harrison, (2012) notes that, Nigeria‘s 
social, economic and political chaos is the underlying problem militating against safe 
motherhood. Adekoya (2012) reported strong significant but inverse relationship between 
the socio-cultural factors and choice of health care, as well as incongruous relationship 
between the pregnant woman and nursing mother's residence and health care 
consumption.  Oke (1995) avers that upper and lower social classes have different values, 
which influence their health status as well as utilization of health facilities. Younger 
middle-aged people and those who are educated with higher income utilize modern health 
facilities. 
 Thus, there is a great difference between the health care of the poor and that of the 
rich. The literate are prompt to attend the orthodox health care system, as they could 
easily afford it, while the poor and illiterate tend to utilize traditional medicine because 
they could not afford the charges in Western health care (Jinadu, 1998). Erinosho (1977) 
asserts that the literate do not uphold the influence of magic and religion. Even in 
developed countries, the poor die much younger than the rich. Health problems are 
concentrated among the poorest within the poorest countries (WHO, 2001 and Population 
Reference Bureau, 2005).  
 The poor are vulnerable to ill-health and disease because of lack of financial 
resources and balanced diet. The poor have large families that lack nutritious meals, and 
cannot rely on trained health professionals because of users‘ fees. The rich, however, 
52 
                                                                                
 
have smaller, better-nourished families and are better informed on utilization of health 
services and can afford users‘ fees. Women‘s education that favours good health and 
healthy practices is also lacking among the poor, who are also disadvantaged because 
they live in rural and remote areas. They lack clean water, good and safe housing, and 
efficient transportation. Among the poor, there are social norms of early marriage and 
discrimination against women, all of which predispose women to poor health. The poor 
usually receive fewer benefits from the health system than the rich. Governments allocate 
higher health budgets to urban hospitals than the ones in the rural areas where the poor 
reside. One of the respondents in the study of Asuquo et al. (1992), in buttressing the 
impact of economy, said ‗If you do not have money, do not bother to go to the hospital; 
your wife might as well better stay at home and die‘. Professional assistance at delivery is 
critical to maternal health because most childbirth complications cannot be predicted in 
advance, and this is not available to women because of their low social status.  Births to 
women in the richest quintile are nearly five times more likely to be attended by a trained 
professional, such as nurse, doctor or midwife (Population Reference Bureau, 2004).  
 Traditionally, in many societies, family planning is a taboo and continued fertility 
is accepted as evidence of feminism and youth. This results in high fertility rate that can 
cause pregnancy complications. Lack of access to family planning methods or husband‘s 
refusal of the utilization of any of the family planning methods are reasons for high 
fertility rate, coupled with failure to seek modern health management. Population 
Reference Bureau (2005) estimated 5.7 live births per woman for Nigeria. Population 
Reference Bureau (2004), in its studies in 53 countries observes that wealthy women are 
more likely to have less total fertility rate that is, life-time births per woman, less number 
of adolescent deliveries, less children mortality, less percentage of children with stunted 
growth and less percentage of malnourished women. But the rich are likely to have more 
percentage of women using contraceptives, more women with three or more antenatal 
care visits, and more percentage of births attended by medically trained personnel.  
In Benin Republic, for instance, the poor women have 7.2 total fertility rates, 
while the rich within the same country have 3.5. The poor had 198 per 10,000 childhood 
mortality rate, while the rich had 93 per 10,000 (Population Reference Bureau, 2004). 
When we compare this with industrialized countries, this is still high. Fifty-nine percent 
53 
                                                                                
 
of the poor had three or more antenatal attendances, while 92 percent of the rich attended 
three or more antenatal clinics. Trained medical personnel attended to fifty percent of the 
poor at birth, while medical personnel attended to 99 percent of the rich. Only 20 percent 
of the poor women in Bolivia received skilled care at delivery. The story is the same in 
all the 53 countries studied. Therefore, maternal mortality is highest in the world‘s poor 
countries and among the poorest population within every country (Population Reference 
Bureau, 2005). The key finding of Population Reference Bureau, (2004) is the same 
nearly everywhere. Inequality in accessing health care and health status are persistent. 
The poor women and their children face greater health risks and are less likely to use key 
health services than those that are better off. The poor are disadvantaged in nearly all the 
factors that contribute to good health like education, knowledge of health matters, 
nutrition, and use of health services. The wealthy women are nine times more likely to 
have completed secondary education than the poorest in most countries (Population 
Reference Bureau, 2004). The literate are already used to queuing up, registration and 
physical examination, which may be strange to the illiterate. 
Population Reference Bureau (2004) reported that the rich women are more able 
to decide for themselves to seek health care than the poor. In Peru, for instance, only 39 
percent of all the poor can take personal health care decisions. The poor pregnant women 
suffer malnourishment and this makes them susceptible to diseases and poor health. 
Almost a quarter of the newborn ones in the developing world start life with some degree 
of impaired growth and malnourishment. Impaired growth in the womb predisposes 
infants to low birth weight, which may lead such children to early mortality as adult. This 
also predisposes children to other developmental problems such as poor attention and a 
high burden of disease throughout life. Low birth weight may lead to short underweight 
adults. If the baby is a girl, she is likely to have obstructed labour, which is dangerous for 
her and her baby; and the cycle continues (Tinker and Ransom, 2002). Even in poverty-
ridden societies, women suffer the effects of poverty than men because women have 
unequal access to economic opportunities, education and power structure.  
The greatest danger to women‘s health is lack of education. The largest number of 
illiterates in the world is women. Low level of education for women has been said to 
have implications for knowledge, perception, attitude and maternal activities. Bongaarts 
54 
                                                                                
 
(1997) asserts that the higher the woman‘s education, the more likely her knowledge of 
contraceptive methods, and the more likely they are to be independent in decision-
making. NDHS (2003) observes that reproductive health behaviour, contraceptive use, 
and children‘s health are linked to education of household members. The illiterates may 
also find official conduct of orthodox medicine cumbersome. Therefore, giving women 
sound education would liberate them from male dominance and enable them to utilize 
maternal care service. Educating the women would make them knowledgeable about 
antenatal care and detecting early signs of complications. The literature reveals that the 
uneducated bear largest number of children and lose most. They fail to understand simple 
concepts and perform worse in attending ANC owing to economic constraints and 
conflicting advice on efficacy from ancient and modern health care.  
Low level of education for women has been found to have implications for their 
knowledge, perception, attitudes and maternal activities. Bongaarts (1999) cited in 
Nwokocha (2006) asserts that the higher the woman‘s education, the more likely her 
knowledge of contraceptive methods, and the more likely she is independent in decision 
making as regards reproductive health and adoption of birth control. The 2003 NDHS 
observed that reproductive health behaviour, contraceptive use, and children‘s health are 
linked to education of households. A lot of studies have found statistically significant 
relationship between economic status and health. The (2003) NDHS showed that the 
poorest are also least likely than the wealthiest to use basic health services such as 
immunisation, maternity care, and family planning (Population Reference Bureau, 2004). 
Formal education plays a significant role in the use of reproductive health services 
as well as ability to communicate with care providers. Education will increase the value 
people place on their lives and health. This will, in, turn increase utilization of Western 
reproductive health services. Socio-economic elevation and improvement of status as 
well as provision of universal formal education with fertility control will lead to a more 
gradual and sustained decline in the level of maternal deaths in Nigeria. NDHS (2003; 
2008) revealed that the higher the educational attainment of women, the less the number 
of children they desire to have is. Laraia et al. (2006) found that most of the women that 
have problems with food security had lower income, less education and were younger 
than women from food secured homes. 
55 
                                                                                
 
Age has vital social and cultural dimensions. In most Nigerian societies, age is 
power and it connotes authority and superiority. Age is revered, and the aged are seen as 
possessing ability to think and make decisions. The younger persons depend on the 
elderly for taking decisions. Jegede (1998) states that the higher the age, the lower is the 
use of modern health care services. Contraceptive use is highest among married women 
in their 30s and 40s and lowest among 15s-19s. The authority of the aged is also 
noticeable in the roles mothers-in- law play in decision-making in hospital attendance and 
parity. There are cases of mothers and mothers-in-law who insist that their daughters or 
daughters-in-law have more children after the couples have agreed on the number of 
children  they intend to have and one sees their will and decision prevailing. These 
elderly women also play significant roles in deciding health care facilities to be 
patronized. 
Furthermore, gender issue influences reproductive health. Patriarchy makes wives 
depend on their husbands for economic survival and encourages the culture of silence and 
submission in women. Side by side with patriarchy are widowhood rites practices. At the 
demise of the husband, the widow is sometimes shared as part of the man‘s property. She 
is assigned to marry male relation of the husband, an act that increases her exposure to 
sexually transmitted and HIV infections, late pregnancy, haemorrhage, labour 
complications, and death (Centre for Gender and Social Policy Studies, 2002).  
Different studies have revealed that with the worsening economic situation in 
Nigeria, the health status of Nigerians has been the worse for it, and that general health 
indices in Nigeria are worse than that of developed and other developing nations 
(Onwudiegwu, 1997; CGSPS, 2002). Deepening economic crisis has worsened poverty 
level, resulting in increased promiscuity, prostitution, adolescent sexual experiences and 
unwanted pregnancies, HIV/AIDS, and unsafe abortion (Audu-Airede, 2000). Effective 
use of family planning methods at this time can contribute to improved maternal and 
newborn health by helping women to avoid pregnancy when the risk of poor outcome is 
high (Ayongwa, 2006).  
 
 
56 
                                                                                
 
2.1.8  Adherence of women to hospital’s instructions and prescription 
Orthodox Western health care was introduced to Nigeria by both the former 
colonial masters and Christian missions. It consists of primary, secondary and tertiary 
health care centres. Trained doctors and nurses manage them. Availability of skilled care 
during child birth has been critical to maternal and newborn health and survival. It has 
been found to save lives of mother and child. For instance, when a newborn child does 
not cry or breathe despite the stimulation provided, the skilled health attendant can 
provide artificial respiration (Population Reference Bureau, 2004). This health care 
delivery system enjoys the greatest government patronage and funding. This institution 
has been valuable in reducing maternal and child mortality, as adherence to its regimes 
has been found to save lives of mothers and children where such facilities and staff are 
available. However, in Nigeria, WHO‘s numerical targets of 1 doctor to 10,000 patients 
and 15 percent of the annual budget to health are yet to be achieved. Only 6.5 percent of 
Nigeria‘s budget goes to health and, of this, less than 3 percent goes to maternal health 
(Adewuyi and Tsui, 2000; Musibau, 2012). When complications occur, referrals are 
made from the other care givers to hospitals. If the patient arrives early before complete 
damage has been done, such complications could be remedied. Shortages of manpower, 
drugs, and equipment have not allowed this care giver to perform optimally. This is 
further aggravated by low economic level that has hitherto encouraged brain drain in 
medical services. This health service is further plagued with inadequate coverage and 
unreliable infrastructural facilities as well as non-adherence to its regimes.  
Adherence to (or compliance with) a medication regimen is generally defined as 
the extent to which patients take medications as prescribed by their health care providers 
(Bosworth and the National Consumers League n.d.). Adherence to medication usage is 
defined as the proportion of prescribed doses of medication actually taken by a patient 
over a specified period of time. There are patients who do not consume every pill at the 
desired time. Rates of adherence for individual patients are usually reported as the 
percentage of the prescribed doses of the medication actually taken by the patient over a 
specified period (Weisbart, 2012). Some investigators have further refined the definition 
of adherence to include data on dose (taking the prescribed number of pills each day and 
the timing of doses (taking pills within a prescribed period). 
57 
                                                                                
 
WHO () describes adherence has a multidimensional phenomenon determined by 
the interaction of five sets of factors. These dimensions are discussed below.  
 Social/economic: People who have social support from family, friends, or 
caregivers to assist with medication regimens have better adherence to treatment. 
Unstable living environments, limited access to health care, lack of financial 
resources, cost of medication, and burdensome work schedules have all been 
associated with decreased adherence rates.  
 Provider-patient/health care system: The relationship of the doctor-patient is one 
of the most important health care system-related factors impacting adherence. A 
good relationship between the patient and the health care provider, which features 
encouragement and reinforcement from the provider, has a positive impact on 
adherence. Poor or lack of communication concerning the benefits, instructions 
for use, and side effects of medications can also contribute to non-adherence, 
especially in older adults with memory problems.  
 Condition-related: Long-term drug administration for many chronic illnesses and 
adherence to such treatment regimens often decline significantly over time. This 
often happens when patients have few or no symptoms and the absence of them is 
a barrier for people to take their medication. It is important for the patient to 
understand the illness and what will happen if it is not treated.  
 Therapy-related: The complexity of the medication regimen, which includes the 
number of medications and number of daily doses required, duration of therapy, 
therapies that are inconvenient or interfere with a person's lifestyle and side 
effects, have been associated with decreased adherence.  
 Patient-related: Physical impairments and cognitive limitations may increase the 
risk for non-adherence in older adults. Lack of knowledge about the disease and 
why medication is needed, lack of motivation, low self-efficacy, and substance 
abuse are associated with poor medication adherence.  
Adherence rates are typically higher among patients with acute conditions, as compared 
with those with chronic conditions; adherence among patients with chronic conditions is 
58 
                                                                                
 
disappointingly low, dropping most dramatically after the first six months of therapy. 
There is no consensual standard for what constitutes adequate adherence. Some trials 
consider rates of greater than 80 percent to be acceptable, whereas others consider rates 
of greater than 95 percent to be mandatory for adequate adherence. Weisbart, (2012) 
found in responses to a questionnaire, that typical reasons cited by patients for not taking 
their medications included forgetfulness (30 per cent), other priorities (16 per cent), 
decision to omit doses (11 percent), lack of information (9 per cent), and emotional 
factors (7 per cent), and 27 per cent of the respondents did not provide a reason for poor 
adherence to a regimen (www.nejm.org). 
According to the World Health Organization (WHO), non-adherence to the 
medical regimen consists of a major clinical problem in the management of patients with 
chronic illness. Rates of non-adherence with any medication treatment may vary from 
15% to 93%, with an average estimated rate of 50%. In an Australian hospital, 59.1% 
non-adherence was reported among pregnant women with chronic health conditions. 
Non-adherence was not intentional, as many of the women noted that forgetfulness was 
the most common reason. Matsui (2012) argue that non-adherence with medication is a 
common problem in pregnancy. This may have potential consequences as patients may 
not achieve their therapeutic goals. As pregnant women try to keep their underlying 
diseases under control, fear and anxiety regarding the potential harm of the drug on their 
foetus may result in non-adherence.   
Improving adherence enhances patients‘ safety. It is crucial for health 
professionals to assess the patient and foresee the possible causes of non-adherence and 
follow a policy for increasing medication adherence and achieving the best health 
outcome. Adherence to prescribed medication is a key component in management of 
health in patients, the benefits patients derive from medication depend on adherence to 
prescribers‘ instructions. Non-adherence includes: delay in prescription fills, cutting 
dosages and reducing the frequency of administration (Bosworth n.d).  
The care a patient received will determine whether or not the individual will go 
back for further treatment or will eventually utilize the prescription given. The quality of 
interaction between patients and physicians and the emotional impact of interaction may 
59 
                                                                                
 
elicit satisfaction, unhappiness, or anger (Jegede, 2010). These emotions have been found 
to influence adherence to medical regime. When patients are satisfied with the outcome 
of visit to any healthcare delivery centre, they are likely to adhere to recommendations 
and return for follow-up. They are also likely to recommend such for others. But if the 
interaction is poor and the physician is insensitive, clients might be deterred from 
revisiting the physician. 
 
2.1.9.  Adherence to hospital regimes in the developed world 
Bosworth (n.d) asserts that non-adherence to essential medications has grave 
consequences on public health, as it has enormous burden on the world health care 
system. He claims that half of the 3.2 billion annual prescriptions in the United State of 
America are not taken as prescribed. McCharthy, quoted in Bosworth, states that 
approximately 125,000 deaths annually reported in USA are linked to non-adherence to 
medication. Osterberg and Blaschke (2005) aver that between 33 and 66 per cent of 
medication- related hospital admissions are due to poor adherence. The total cost of non-
adherence ranges from $100-300 billion each year. Among patients with chronic 
conditions only 50-60 per cent were found to have adhered to medication as prescribed 
despite the fact that they were aware that the therapy would increase the quality of their 
lives. Osterberg and Blaschke (2005) also reported an average adherence rate of only 43 
to 78 per cent among patients receiving treatment for chronic conditions and about half of 
the patients stopped their medications within six months. Matsui (2012) did a meta-
analysis of 569 studies in London and reported that adherence to medical treatment 
ranged from 4.6% to 100%, with an average of 75.2%. Seriousness of underlying 
conditions did not ensure adherence even when not taking the medication had 
unfavourable disease outcome. 
 
2.1.10  Adherence to hospital regimes in African countries 
Sangare et al. (2011), in their study in Uganda, found that recommended anti-
malarial drug were used according to the guidelines in only 30.1% of all second and third 
trimester episodes. Self-reported malaria was extremely common in this population and 
60 
                                                                                
 
adherence to treatment guidelines for the management of malaria in pregnancy was poor. 
Lugolobi also found that only 32% of HIV patients‘ pregnant women in Uganda adhered 
to ANC attendance. There was no significant difference in the demography of those who 
adhered and those who did not. 
It is clear that the full benefit of the many effective medications that are available 
will be achieved only if patients follow prescribed treatment regimens reasonably closely. 
Wikipedia (2011) notes that a strong percentage of women in Benin received prenatal 
care at some time during their pregnancy. Estimates have indicated that 97% of women 
received prenatal care in 1996 and 88% in 2006. It was estimated that in 2006, 93% of 
women in urban areas and approximately 85% of women in rural areas received prenatal 
care, though rural estimates varied by department. About 61% received the four prenatal 
visits recommended by World Health Organization. Of those women who had prenatal 
consultations, 86% took iron supplements, and only about 45% had any kind of 
nutritional counselling. 
According to Wikipedia (2011), the use of technology in prenatal consultations 
has increased; in 2001, about 8% of women had ultrasound diagnostic tests, while, in 
2006, 21% had the same tests. Further, the recommended two doses of tetanus toxoid 
vaccine were received by only 56% of women in 2006. It is most likely that a woman 
seeking prenatal care will use the services of a midwife for consultations; about 80% of 
these women were found to see a midwife or nurse prenatally.  
The following symptoms were found to motivate women to seek out prenatal 
care; symptoms that prevent the completion of daily tasks; indications of abnormality, 
such as bleeding, pain, or fever; fears of miscarriage; and fears of repeated complications 
seen in prior pregnancies (Wikipedia, 2011). If a woman does not notice any indications 
of complications during early pregnancy, she may opt to wait until late into the second 
trimester or third trimester to seek out prenatal care.  
Barriers to accessing prenatal care include cost and transportation. Women in 
Benin reported that negotiating funds from husbands for prenatal care or associated 
prescriptions can lead to arguments between spouses as well as frustrations between 
patient and provider. In Benin, pregnancy is often a way to gain status and respect in 
one‘s community; therefore, getting pregnant can become more of a pressure from 
61 
                                                                                
 
society than an individual‘s choice. Some women in Benin hinted that pregnancy 
indicated good fortune, but others could not help but express concern about the extra 
costs another child brings. Beninese women also describe pregnancy and birth as a time 
of great vulnerability, and more specifically, as a time 'where life and death converge' 
(Wikipedia, 2011). 
 
2.1. 11 Adherence to hospital regimes in Nigeria 
 Antenatal care has the effect of giving pregnant women the opportunity to have 
any problem detected and treated early. Labour complications are anticipated so that 
when they occur, prompt steps are taken to save the mother and prevent injuries to the 
baby. ANC affords pregnant women opportunities to receive health education on simple 
hygiene, nutrition, care of baby, and other factors responsible for high maternal death. 
Essential obstetric care ensures care for high-risk pregnancy and complications.  
In Nigeria as at 2003, 63% of the women receive ANC and 21% from doctors and 
37% from nurses; only 47% made four minimum recommended number of visits and the 
majority attended only in the second trimester. Among these, only 55% were instructed 
on pregnancy complications; 58% received iron tablets; two thirds had urine and blood 
tests, while only 47% received tetanus toxoid vaccine. Sixty per cent of births occurred at 
home; only one-third of deliveries were attended by skilled attendants; only a small 
proportion received post-partum care (2003 NDHS). About 50 per cent of Nigerians 
received tetanus toxoid injection, while only 57% attended ANC from trained personnel. 
Yahaya and Yahatu (2009) investigated the proportion of women who kept to their 
appointments and found that only 30.7% of the women kept all their appointments. The 
proportion of women who had three visits was 32%. There was no socio-demographic 
difference among those that attended and those who did not attend. Forty one per cent of 
rural and 61% of urban centres received ANC from doctors and 23% from nurses and 
midwives (Giwa- Osagie et al., 1990).  
A factor that may affect adherence to health care system is the attitude of 
orthodox health providers. Strained relations usually occur between the health workers 
and patients; among the health workers themselves for example doctors/nurses; 
62 
                                                                                
 
clerks/patients; and patients/nurses (Jegede, 1998). All these bounce back on the patients. 
However, even where hospitals are available and accessible, the level of adherence of 
pregnant women to instruction would determine their effectiveness. Women attend the 
antenatal clinics only when they have problems, such as bleeding and pains, but when 
such disappear, the women discontinue clinic attendance (Matsui, 2012). Many women 
regard pregnancy and childbirth as natural processes that should not be interfered with. 
Seeking hospital intervention should be a last resort after complications have occurred 
and home management has failed. Many women admitted attending antenatal clinics only 
to register and have a card in case complications occur during childbirth.  
Introduction of user‘s fees also affects the level of adherence of women to 
hospital regime and reduced utilization of antenatal care, hospital delivery and postnatal 
care. A study in Jammu and Kashmir, India revealed that 9% of the respondents 
perceived delivery in health facilities as too exorbitant. To solve this problem, 
community participation was encouraged. Women groups were mobilized to organize 
self-help programmes to raise money to set up small clinics and stock them with drugs 
and raise money for hospital delivery.  
 
2.1.12 Husbands’ and significant others’ roles in decision making and health care in 
pregnancy 
Women are faced with multiple choices to make in childbearing; but women are 
often not allowed decision-making regarding care-seeking during pregnancy, birth or the 
postpartum period. A major factor that inhibits ANC attendance is the role of husbands 
and significant others in pregnancy care. The support and encouragement of these people 
can go a long way to assist pregnant women. Ilesa is patriarchal in nature and the 
husband decides where, when and how his wife goes about pregnancy care. Access to 
ANC, therefore, depends on the socio- economic status of the husband who plays 
dominant roles in taking these decisions. The husbands are regarded as lords, heads and 
masters of their families and, in almost all situations, their decisions are final. In most 
African societies, Ilesa inclusive, men dominate and absolutely control actions and 
interactions in their families in virtually all spheres of social relationships; therefore, 
63 
                                                                                
 
women depend on their husbands and significant others. Barret (1988) views patriarchy 
as a type of household organization in which the father dominates other members of the 
extended kinship and controls economic structure.   
Kisekka et al. (1992), in their studies in Zaria, found that women delay in seeking 
hospital care because they were in purdah and their husbands were in total control of their 
spatial mobility. When a woman is experiencing obstetric complications, the husband‘s 
explicit permission and authority must be sought before she can be transferred to hospital. 
This situation is compounded when the husband travels and cannot be reached on time. 
The women‘s socio-economic status, coupled with a husband‘s access to quick and 
summary divorce by ‗tallah,‘ generates a sense of insecurity and powerlessness which 
makes it very difficult for women to defy or question their husbands‘ decisions even if 
they are detrimental to their own health. CONNOHPD (1997) asserts that men perceive 
divorcing their wives at any time as a right that can be done at will and sometimes they 
do it under the influence of alcohol. When a woman is divorced she has no right to 
anything from the husband and, since early marriage did not allow her access to 
education or apprenticed training, she becomes economically powerless.  
Kisekka et al. (1992) in a study in Sokoto, Nigeria, reported that husbands 
engineered 71.6 percent of those who attended antenatal clinics, as they were the sole 
decision makers in their wives‘ health care. Husband‘s disapproval accounted for non-
attendance in antenatal clinics and not delivering babies in hospitals. In a patriarchal 
society reproductive health that does not involve men would be of little or no impact. 
Studies have identified the need for men‘s involvement in their partner‘s well-being. 
Some areas where men are supposed to contribute to reproductive health include:  
i) planning their families  
ii) supporting contraceptive utilization  
iii) stressing and participating in seeking maternal care 
iv) ensuring nutritional food for their wives during pregnancy  
v) arranging for skill delivery  
vi) avoiding delay in seeking care  
64 
                                                                                
 
vii) helping after baby is born and  
viii) being a responsible father (UNICEF, 1998).  
In the past, women were the target of reproductive health so that there are more family 
planning methods for women than for men. Recently, however, studies on reproductive 
health have shifted to men because more men were found to want larger families than 
women probably because women bear the greatest burden of pregnancy and child birth 
(Isiugo-Abanihe, 2003). Men‘s decisions are also very vital with regards to when a 
woman‘s condition is serious and need medical attention. Murthy et al. (2002) claim that 
women‘s dependence on men for accessing health care is one of the barriers for poor 
utilization of reproductive health care services. Men‘s action or inaction at critical times 
can spell death of the baby or the mother or both. The Cairo International Conference on 
Development (ICPD) 1994 and Bejing 1995 brought into the limelight the need for men 
to change their attitudes to reproductive health and gender issues. UNDFPA (1995) 
suggested the importance of responsible, respective and non-coercive sexual behaviour 
and shared reproductive decision-making.  
Studies in India revealed that men were aware of ANC, delivery and postnatal 
care, yet they did not accompany their wives to hospital. Those who did only went to 
confirm pregnancy, but subsequently pregnant women went alone or in company of other 
women. A further research reported that when some men attended ANC, they were not 
given adequate attention. They had to wait in the hospital corridor until their wives were 
ready. The report of FGD in Jammu and Kashmir in India revealed the view of some of 
the men that attended ANC with their wives: 
We are ready to get involved in accessing maternity care to our women. Men 
do accompany them, pay for their medical expenses, allow them take rest and 
even help them in sharing the household chores during pregnancy. However, 
when we accompany them to hospitals during their pregnancy or delivery, our 
maternity care hospitals have little to offer to men. Neither are we allowed to 
accompany our spouses in the OPD, nor is there any waiting room for men. 
Men have no option but to stand outside the main entrances of the hospitals 
and create hurdles in the movement of patients and staff. When hospitals or 
maternity wards are out of bounds for men, how can you expect them to 
interact with men?  
 
65 
                                                                                
 
Another participant had this tale to tell: 
 Like other responsible husbands, I also visited the local hospital a number of 
times with my wife. After all, she is carrying and nurturing my pregnancy and 
the expectant child belongs to both of us. True, I cannot share the pain of 
pregnancy but I have to support my wife during pregnancy, child birth and 
even in child rearing and caring. Though I had the impression that a lady 
doctor would talk to both of us, yet during these ANC visits, I was never 
called by the doctor to come inside and share information about the progress 
of pregnancy, any advice and precautions for safe pregnancy, information 
related to medicines, diet and other such issues. I do not know whether any 
government hospital in this State has a system to provide any education to 
male members. Staff working in these hospitals has a negative attitude towards 
men and they generally say to us that men have no business in maternity 
hospitals. 
 
Jammu‘s study revealed that two thirds of husbands were present during at least one 
ANC check-up. However, only 28% of them were informed about what to do in 
pregnancy complications, while only 20% were aware of any sign of pregnancy 
complications. 
Men who make it to ANC should be well informed about what is expected of 
them in labour and delivery. More importantly, they should be well informed about signs 
and symptoms of complication and what they can do in each case.  Hospital authorities 
need to look into how they can get husbands involved in pregnancy care by making 
provision for would-be fathers. 
This study revealed that men have limited knowledge of reproductive health. 
About 78% of men could not identify fertile period in a menstrual circle; more than half 
could not identify symptoms of pregnancy complications; while 71% were not aware that 
symptom of sexually transmitted diseases (STDs) may not be apparent, and that STDs 
can be transmitted from mother to unborn babies. A substantial proportion of the men 
were not informed about the need for ANC or delivery in health facilities. Forty-seven 
per cent of Indian men reported that their last babies were not delivered in health 
facilities because they did not feel it was necessary and did not allow it. The good news is 
that men are becoming the focus of reproductive health and soon men will become 
sensitized on their roles. The success of any health campaign depends on the cooperation 
66 
                                                                                
 
of the husbands. Husbands who want to acquaint themselves with contraceptive use have 
limited options available to choose from as health technology focused mainly on 
producing contraception for women. Husbands need to be sensitized on the great 
responsibilities placed on their shoulders and should take up increased financial 
responsibility for food and drug.  
As husbands dictate movement of their wives, they need information to be able to 
help their pregnant wives in time of emergencies. Many husbands are ignorant of and 
may not perceive dangerous signs and symptoms of pregnancy complications. It is 
imperative to educate them about this. Pregnant women need to get emotional and 
financial support from their husbands. Husbands must be sensitized to know that 
balanced diet, proper clothing and ANC are vital for safe delivery of healthy babies. They 
are to be educated on special emotional needs of pregnant women and be involved in 
family planning, especially vasectomy. They should recognize that things can go wrong 
at any time in labour and there is need for personal and environmental hygiene.  
In developed countries, the roles of husbands have gone beyond merely pacing up 
and down the hospital corridor awaiting the announcement of the arrival of their babies. 
They are now included from when the pregnancy test is positive to prenatal appointments 
and birth classes. Where the husband has aversion for blood or body fluids, he is allowed 
to stay in a safe distance which his comfort zone will permit. This could be beside, 
behind or on top of his wife‘s bed during delivery (www.parenting.ygoy.com). 
Husbands should be aware that lack of adequate rest and post-delivery heavy 
workload are sources of complications. They should be aware of direct and indirect 
causes that are responsible for maternal deaths. Direct causes include severe anaemia, 
induced abortion, ruptured ectopic pregnancy, eclampsia, obstetric haemorrhage and 
obstructed labour. Indirect causes include perception of cause of complications, harmful 
cultural and traditional practices, poor health facilities and infrastructural deficiencies, 
poor health providers‘ attitudes, viral hepatitis, abnormal haemoglobins, heart disease, 
bacterial infections, deprivation, ignorance, mass illiteracy and underdevelopment. 
Apart from husbands, mothers, mothers-in-law, and grandmothers were found to 
influence pregnant women‘s health management. Kisekka et al. (1992) revealed that in 
67 
                                                                                
 
northern Nigeria, disapproval from these women accounted for 45 per cent of non-
attendance at antenatal clinics, especially during the first pregnancy. Pregnant women 
may also influence each other on where to receive appropriate care. Many people usually 
give advice to primigravidals. These women usually recommend one caregiver or the 
other based on their former experiences, particularly the kind of care received during 
their last visits. 
From the foregoing, it can be established that MM is high in Nigeria but 
preventable if adequate and early health care delivery is received. Such care should 
include: safe and clean delivery, accessibility and transport to health facilities, family 
planning, emergency care and safe blood transfusion. Marriage should be contracted only 
after 18 years for females. There should be adherence to optimal breastfeeding, tetanus 
toxoid immunisation, healthy living and adequate nutrition and other instructions. 
Education of the girl child is a must. There should be good, workable and adequate 
referral system and feedback. There should be decision-making opportunities for women. 
It is important that health care be accessible, affordable, and cost-effective to reduce 
maternal mortality. This will be effectively done if conditions of living in rural and urban 
areas are conducive and encourage urban health workers to settle anywhere. There should 
be available basic, supervised, affordable, and equipped antenatal care centres. This has 
not been because of various social, religious, and economic factors that affect women‘s 
ability to seek hospital care. Pregnant women may avoid hospitals where hospital staffs 
do not allow delivery in squatting position or bath babies immediately after delivery, or 
where male health workers attend to pregnant women. 
 Economic reasons also affect health care in pregnancy. The poor are less likely to 
attend hospitals because of user‘s fees. They are more likely to have high parity and low 
birth weight. They are less literate and lack essentials of life. Cultural practices of early 
and forced marriages are more rampant among the poor. In order to reduce maternal 
mortality and morbidity rates, therefore, both the poor and the rich must have access to 
modern health care delivery system. 
 
 
68 
                                                                                
 
2.2  Theoretical framework 
 Functionalist Theory and Health Belief Model (HBM) were used as the 
theoretical background for this study.   
 
2.2.1  Functionalist Theory 
Talcott Parsons pioneered the functionalists‘ approach to sociological study of 
health in the early 1950s. He argued that all social actions should be understood from 
how they help society to function. He saw sickness from the social dimension and as a 
disruption and harm to the society. He viewed illness as a form of deviance which 
disturbs effective functioning of the society, as the sick are unable to perform their 
normal social roles. Illness needs to be controlled and the sick have to be helped or 
controlled to perform their social roles again. Parsons saw sickness as a social rather than 
biological concept. Being sick was a form of social role (sick role). There are rights and 
obligations that are attached to this role. The sick has a right to be exempted from his 
normal social obligations. This depends on the seriousness of the illness and other 
people‘s acceptance that a person is genuinely sick. The sick should not be blamed for 
their condition and should be looked after by those who are well. The sick, on the other 
hand, should perceive their condition as undesirable and seek to be well. They must seek 
medical assistance and cooperate with professionals to get well. Refusal to do these 
disqualifies a sick person from appropriating the sick role. The person should be forced to 
perform his social roles (Haralambos and Holborn, 2008).   
  However, the sick role does not take cognisance of chronic illnesses from where 
the individual may not recover over a long time. To Parsons, the doctor has to legitimise 
an illness but many people may not attend the health care providers‘ homes to be labelled 
sick. There are many people who ignore their sicknesses. In addition, patients have their 
own needs and wishes when they attend clinics. Doctors and patients are not always in 
harmony in treatment of illness. Parsons‘ sick role was modified by Safilios-Roschild 
(1970) to rehabilitation role for the chronically ill and disabled. This involves them 
accepting and learning to accommodate their condition by maximizing their ability and 
cooperating with medical professionals. The rehabilitation involves helping such 
69 
                                                                                
 
individuals return to normality by adjusting psychologically to their new identity 
(Haralambos, 2008).  
 Pregnant women are regarded as the healthiest patients in hospitals. They are 
expected to attend hospitals and adhere to doctor‘s prescriptions and instructions to 
enable them to have successful outcomes. In pregnancy, the woman and others must 
perceive pregnancy complications as serious and life-threatening and the pregnant 
woman must be exempted from normal social obligations.  
 To Durkheim, religion is to meet society‘s need for social solidarity. Social facts 
lie at the heart of his discussion on religion. Social facts are social structures and cultural 
norms and values that are external and coercive of the actor. He distinguished two types 
of social facts: material and non-material. Durkheim (1961) addresses religion as non-
material social facts. He shows that religion is a strong integrative force through its 
instilling of common values and identification (Wallace and Alison, 1986). He notes that 
religion has the ability to dominate individuals and elevate them above their ordinary 
abilities and capacities (Ritzer, 2000). Durkheim (1961) argues that all societies divide 
the world into two: the sacred and the profane. Society creates religion; the symbol is a 
totem, an emblem that distinguishes a clan from another. The sacred are revered, awed, 
respected, and honoured. This reference transformed the profane to sacred. Durkheim 
(1961) argues that worshipping god is worshipping society. To him, the sacred is superior 
to man and man depends on it.  
Durkheim (1961) notes that social life is made possible by collective conscience 
without which there will be no society. Religion reinforces the collective conscience. As 
people worship in society, they recognise the importance of social group and their 
dependence on it. Religion strengthens the unity of the group and promotes social 
solidarity. Religion, in modern society, expresses some collective sentiments through the 
development of a set of religious beliefs which expresses the nature of the sacred and the 
relationship which they sustain with each other. There is also the need for a set of 
religious rites which are rules of conduct in the presence of the sacred. A religion requires 
a church or a single overarching moral community.  
70 
                                                                                
 
Durkheim views totemism as a religious system in which certain emblems, such 
as plants and animals, are regarded as sacred emblems of the clan. Totems are material 
representations of the immaterial force. In the study area for this research, many pregnant 
women patronize religious houses for care giving and certain materials, such as water, 
oil, sponge, soap, rivers and mountain tops are regarded as sacred; and religious leaders 
take pregnant women there for prayers to avoid complications. Many of the pregnant 
women bathe in flowing rivers and/or pray on mountain tops to ward off evil. In many 
societies, pregnancy is perceived from religious view point. They believe that pregnancy 
is a gift from God and religious houses have appropriate solutions to whatever 
complications arise from pregnancy. 
 
2.2.2  Health Belief Model (HBM)  
 Symbolic interactionism perceives illness as a social definition and not direct 
result of some form of diseases. A disease condition may be present in a person but he 
may not define himself as ill. Rosenberg (1989), quoted in Haralambos and Holborn 
(2008), assert that, disease does not exist as a social phenomenon until it is somehow 
perceived as existing. 
 Illness behaviour explores the patterns of behaviour people engage in when they 
decide whether or not they are actually unwell and the action they should take as a result 
of their decision. To Mechanic (1968), illness behaviour is the way in which symptoms 
are perceived, evaluated and acted upon by a person who recognizes some pain, 
discomfort and other signs of organic malfunction. Sociologists claim that a large number 
of people who feel ‗unwell‘   do not visit a doctor. There are more illnesses than are 
presented to the doctor (Haralambos and Holborn, 2008). 
 The HBM is a psychological model that was first developed in the 1950s by social 
psychologists Hochbaum, Rosenstock and Kegels working in the U.S. Public Health 
Services to explain and predict preventive health behaviours, like utilization of health 
services, including screening and immunisation programmes. HBM focuses on attitudes 
and beliefs of individuals to health issues. It was developed in response to the failure of 
the free tuberculosis (TB) health screening programme, so as to explore other health 
71 
                                                                                
 
behaviours and apply them to illness behaviour. It is a psycho-social model of health-
seeking behaviour of a person who believes he is healthy for the purpose of preventing 
disease and a person who feels ill to regain his health. It is the process by which an 
individual weighs the risk to his health, accesses the benefits, and removes the barriers to 
actions taken. Becker et al. (1977) further investigated what influenced people to visit a 
health caregiver. 
 The HBM assumes that beliefs and attitudes of people are important determinants 
of health-related actions. It provides an understanding and predicts how a patient will 
behave in relation to his health and how he would comply with therapy.  
 The HBM is based on the understanding that a person will take a health-related 
action (that is, attend antenatal care) if that person:  
 feels that a negative health condition (that is, maternal mortality or morbidity) can 
be avoided, 
 has a positive expectation that by taking a recommended action, she will avoid a 
negative health condition (that is,attending antenatal clinic will prevent pregnancy 
complications and stillbirths), and  
 believes that she can successfully take a recommended health action (that is, she 
can attend clinic and use routine drugs comfortably and with confidence). 
The HBM consists of three stages:  
 Factors that lead the person to undertake recommended compliance behaviour. 
These factors include an individual defining herself as ill, her perception of the 
extent of harm which the illness may cause to her body and interference to her 
social roles as well as the extent she will benefit from receiving treatment.   
 Modifying and enabling factor refers to the probability that the ill person will 
adhere to the recommendations of health professionals. This will depend on such 
things as the age of the person, financial, social and physical cost of treatment; 
attitudes of professionals; and the social importance of people encouraging her to 
consult a medical professional and adhere to treatment. 
72 
                                                                                
 
 This stage involves whether or not the individual will adhere to all, some or none 
of the recommendations, depending on the outcome of the two stages above. 
Therefore, being ill, seeking medical attention and adhering to professional 
recommendations have social and medical undertones. There is a complex interaction 
between the individual, his perception of health, illness and the medical profession, and 
the view of social network around them (Haralambos and Holborn, 2008). 
 The model identifies three major variables that influence health behaviour: 
i).  Perceived amount of threat which is sub-divided into: 
a) Importance of health matters to the individual  
b) Perceived susceptibility to disease  
c) Perceived seriousness of the consequence of the disease. 
ii).  the attractiveness of value of the behaviour, which depends on perceived 
probability that action will lead to desired preventive result. 
iii).  Perceived benefits of taking action, which depends on a personal dispositional 
factor such as age. Other factors include income, place of work, residence, 
transportation, occupation and education. 
The HBM is based on the assumption that an individual will take health-related action, 
such as attend antenatal clinics or take tetanus toxoid if she feels that maternal and/or 
child mortality or morbidity will be avoided. If a woman has positive expectation that if 
she attends antenatal clinics and takes recommended routine drugs and rest, she will 
avoid negative health conditions; she will have safe delivery and her pregnancy will be 
convenient and comfortable. She will likely patronise Western orthodox hospitals.  
The HBM was further spelt out in four constructs: perceived susceptibility, 
perceived severity, perceived benefits, and perceived barriers. 
Perceived Susceptibility is an individual‘s chance of being infected with a disease. In 
this study, only pregnant women can be susceptible to pregnancy complications: such as 
haemorrhage, obstructed labour, pregnancy-related mortality and morbidity. 
73 
                                                                                
 
Perceived Severity indicates an individual‘s opinion of how serious her health condition 
is. For instance, women who perceive pregnancy as natural, normal way of life may not 
take pregnancy seriously and may take no health initiative. Many people believe that 
nobody takes delivery for goats and sheep, and these animals do not have complications. 
So they believe that, as pregnant women, they too will not have complications. Such 
women may not perceive any risk in pregnancy and so may take no action; whereas 
another woman, who perceives pregnancy as a step between life and death, will take 
preventive precaution. 
Perceived Benefits:  The individual may ask herself or others the benefits of attending or 
not attending antenatal clinics or taking hospital regimen. Will taking action reduce risk 
of mortality or morbidity? What are the benefits that she can derive from health care 
providers? What benefits can she derive from combining some or all health-care delivery 
systems?  
Perceived Barriers: When an individual perceives modern health management as 
efficacious and wants to patronise it, there may be barriers that will prevent her from 
taking actions. These barriers may include psychological, emotional, or financial cost. A 
pregnant woman may intend to patronize modern health care but may lack the 
wherewithal to do so. She may not be able to afford user‘s or registration fees; as well as 
the cost of accompanying relative, drug, accommodation, and feeding. Significant others 
may not approve of her seeking health care in a particular place. They may recommend 
other place(s). Ignorance of what to do or where to go may be a barrier to the pregnant 
woman. 
Cues to action are a new concept that was added to the model to include strategies that 
activate action. These may include information on the radio, self or other people‘s 
experiences, bodily symptoms, encouragement from husband, other pregnant women, 
mother, and mother-in-law. When a woman perceives herself to be susceptible to 
pregnancy complication and maternal mortality/morbidity, perceives the condition as 
severe (life threatening or can lead to partial or permanent morbidity), and she weighs the 
benefits of taking action against taking no action and suffering the consequences; when 
she weighs the consequences of action or inaction on herself, on her baby and others, she 
74 
                                                                                
 
may take action depending on her emotion, time and financial cost. When she places all 
costs side by side with consequences of inaction, she may take positive action by 
attending antenatal clinics and delivering her baby in hospital.  
          A more recent addition to the HBM is the concept of self-efficacy, or one's 
confidence in the ability to successfully perform an action. This concept was added by 
Rosenstock et al. (1988) to help HBM better fit the challenges of changing habitual 
unhealthy behaviours, such as being sedentary, smoking, or overeating. 
Day by Day (1977) criticized HBM for concentrating on negotiation between 
medical professionals and patients while ignoring wider social factors like inequality and 
pollution which are the actual causes of ill health. 
75 
                                                                                
 
 
2.2.3  Conceptual Framework 
   
                               
Pregnant woman‘s perceived 
 Susceptibility & seriousness 
  of pregnancy complications 
   
 
  Religious Beliefs 
Demographic Social Influence/cues to 
system  
 Background: action: 
Impact on choice of 
Age, Education, Perception of pregnancy 
 caregivers 
Income/Occupation complications 
   Parity/Gravidals  Husband / Significant 
 No of live births   
others 
Type of marital Adherence to caregivers 
  
union instructions 
  Availability of facilities 
  Benefits/threats/cues to 
 taking action 
Barriers to Utilization 
 Safety of mother & baby 
Transport 
 Comfort 
User‘s fees 
 Healthy mother & child 
Distance 
 Avoidance of 
Other tangible cost 
 maternal/Neonatal death 
Religion 
  & Morbidity 
   
  
 
 Women‘s Self efficacy 
 Sick role behaviour 
 Ability to make personal health decision 
 Significant others accept that preg. Woman 
 need assistance 
  
  
 
 Maternal health: Choice of Care Givers 
 Likelihood of making healthy choice among: 
 Home Based Care 
 Orthodox Western Medicine 
 Faith Based obstetric care 
  
Figure1: Conceptual Framework on Pregnant Women‘s Maternal Health 
(Adapted from Rosenstock, Stretcher and Becker, 1994) 
76 
                                                                                
 
2.2.4    Explanation of the conceptual framework 
Pregnancy is a social issue. It places women in need of health care services. 
Women‘s social standing reflects their utilization of ANC. Women in low social and 
demographic status find succour in FBBAs for financial reasons. Religion, however, 
plays a dominant role in utilization of health care services. Religious factor is strong, 
social status may become irrelevant to utilization of health care services. The attention 
the pregnant woman pays to her health is determined by the nature of her pregnancy 
whether the pregnancy is the first (primigravidals) or subsequent ones (multigravidals). 
The type of pregnancy will also determine the care she gives or receives as well as her 
adherence to instruction from caregivers. For instance, elderly and teenage primigravidals 
are perceived as susceptible to pregnancy complications and will receive special attention 
from orthodox care givers than a woman in her early twenties. Her perception of the 
seriousness of her health condition will dictate her level of adherence to the caregivers‘ 
instruction. A woman who has primary or secondary infertility, health history of chronic 
diseases, history of multiple births or repeated abortions will be perceived as susceptible 
to pregnancy complications which will be perceived as being serious. Such woman will 
give herself and receive special attention. A woman‘s perception of her susceptibility to 
and seriousness of pregnancy complications will determine the type of maternal health-
care she chooses. This will, as well determine her level of adherence. 
Demographic background and social influences will determine a woman‘s self-
efficacy and ability to take medical decisions. A woman who is enabled by her social and 
demographic backgrounds can weigh benefits and threats from each caregiver to herself 
and her baby. If she has the physical and social means to seek help, she will take health 
decision. Having weighed the benefits and hazards she might face with each of the 
caregivers, she may opt for a particular care provider or another. At a given time, she 
may decide to combine them to her mutual benefit. Whatever decision she or significant 
others arrive at will determine the health care giver she will patronize. A woman might 
determine to utilize a particular caregiver but barriers of transport, user‘s fees, distance, 
and other physical or psychological ones may prevent her from doing so. She may have 
to opt for another. For instance, a woman may perceive hospital care as effective and life-
77 
                                                                                
 
saving yet is unable to defray its costs. She may make do with FBBA because they are 
free or their payment may be deferred.  
The support of significant other−husband, her mother, mother-in-law, friends, 
neighbours, and other pregnant women in the neighbourhood−will also help to determine 
what her decision would be. The experience of the primigravidals is different from that 
of the multigravidals. The primigravidals usually have a lot of solicited and unsolicited 
advice from women around. These affect how they seek and receive care. The sick role 
accept that pregnant women need assistance and the community must be ready and 
willing to render it as well as exempt her from her social obligations. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
78 
                                                                                
 
 
CHAPTER THREE 
METHODOLOGY 
Both quantitative and qualitative research techniques were utilized to generate the 
data for this study.  Quantitative study had to be triangulated with qualitative because, 
unlike matter, human beings possess consciousness and cannot be studied as subject 
matters. Humans, according to positivists, see, interpret and experience the world in terms 
of the meaning they construct as social realities. Many sociologists advocate that 
quantitative methods are inadequate on their own for collecting, analyzing and 
interpreting data, and that they are inappropriate in subjects that deal with human 
behaviour. Some sociologists suggest that qualitative approaches should be used to 
supplement quantitative methodology, while others advocate that qualitative approaches 
should replace quantitative approaches altogether.  
For this work, both methods were combined for the work to enjoy the strengths of 
both and eliminate the weaknesses in them. While quantitative data are presented in 
numerical form, qualitative data are presented using content analysis. Qualitative data are 
perceived as richer, more vital and having greater depth and are more likely to present a 
true picture of a way of life of people‘s experience, attitudes and beliefs (Haralambos and 
Holborn, 2008). It is believed that only qualitative approach can help discover meanings 
behind social actions.  
This chapter therefore presents the design and methodology employed for this 
study. These are presented as follows: research design, study population, sample design, 
research instruments (survey, qualitative methods) ethical issues, methods of analysis as 
well as limitation to the study. 
 
3.1 Research design 
Research design is the strategy and plan utilized by the researcher to investigate 
the research questions and test the hypotheses. It involves the decision to make the 
79 
                                                                                
 
research a qualitative or a quantitative one or to make it a combination of both.  This 
study triangulated both methods to allow the one to make up for the weaknesses of the 
other. As stated earlier, sociologists advocate that quantitative method alone cannot 
capture social realities and man cannot be subjected to scientific methodology as matter. 
This combination will enable one to capture social phenomena. This is an explorative 
research. The main approach used for data collection was the qualitative method (in-depth 
interviews and case study). Structured and semi-structured questionnaire, and secondary 
records were triangulated to elicit robust information that helped to complement the 
qualitative information collected from the respondents.  
 
3.2  Study population 
This study targeted pregnant women, their husbands and their care providers in 
hospitals and faith healing homes in Ilesa, Osun State, Nigeria. All women who were 
pregnant at the time of the study, their husbands and their care providers formed the study 
population. Pregnant women and their spouses were selected as respondents so as to 
capture current behaviour pattern among the respondents. Data were collected from 
pregnant women at faith homes and hospitals. Quantitative data were generated from 
caregivers (lay and professionals) at 12 faith homes and 12 orthodox caregivers. The two 
local government areas (LGAs) in the town had 21 wards, ten of which were randomly 
selected; five from each LGA. Questionnaire was utilized to generate quantitative data, 
while in-depth interviews and observations were utilized to generate qualitative data. 
Additional information was obtained from Obafemi Awolowo Teaching Hospital 
(OAUTH), Ilesa delivery records from 2004 to 2008 on maternal loss and pregnancy 
complications that were reported in the institution.  
Five hundred and ten copies of the questionnaire were administered to pregnant 
women in form of personal interviews but five hundred of them were usable. The 
respondents were reached by repeated call backs to ensure that the questionnaires were 
usable. The questions were related to socio-demographic factors, the role of religion, 
adherence of pregnant women to hospital regimes, and husbands‘ roles in care-seeking. 
Pilot study was conducted in two of the wards that were not selected for the study. A total 
80 
                                                                                
 
of 500 pregnant women were surveyed based on the selection above. There were 250 
respondents from each of the LGAs.  Twenty-four caregivers and ten husbands of the 
respondents participated in the in-depth interviews. Twelve in-depth interviews were 
conducted among clinical caregivers and 12 among faith based birth attendants (FBBAs). 
The fieldwork held between June 2009 and January 2010.   
 
3.3 Sampling Techniques 
The multistage sampling technique was employed in selecting the survey 
respondents and ten of the twenty-one wards in Ilesa.  Pregnant women in the selected 
wards were identified at households (50), hospital/maternity centres (225) and in faith 
homes (225). Trained research assistants administered the questions to the women. 
Twenty-four in-depth interviews (IDIs) were conducted with FBBAs and hospitals 
caregivers; twelve were conducted among each of them. Heads of seven government 
maternity centres, five private hospitals, and the only general hospital were interviewed. 
Twelve heads of faith delivery centres were identified in their churches‘ delivery houses 
for interview. The birth houses were purposively selected. Those selected had a minimum 
of 30 pregnant women in attendance in their weekly faith clinics: three each from CAC 
and Cherubim and Seraphim Churches; five from other Pentecostal churches and one 
from The Redeemed Church of God.  Only two male FBBAs were identified using 
snowball method and both were part of the IDIs. Ten willing husbands were also 
interviewed; one from each street. They provided information on men‘s roles in 
pregnancy care.  
Twenty visits were made to prayer meetings and ANCs to observe the conduct of 
activities in them. In the prayer houses, the researcher joined in their prayer sessions and 
wrote down the major prayer points. In the hospitals, she listened to health talks that were 
given to the women and observed care giver- patients relationships. 
The researcher could not identify practising traditional birth attendants, as all 
those identified utilizing herbs and other rituals claimed they were faith care providers 
and operated under some established churches; in most cases, they were the founders of 
81 
                                                                                
 
such churches. They claimed that they did not have legitimate training but were inspired. 
However, hospital care givers regarded them as TBAs. 
 
3.4  Research instruments  
 The research instruments were utilised in this study includes: 
1. S
urvey questionnaire  
2. K
ey informant interviews (KIIs) 
3. I
n-depth interview (IDIs) 
 
3. 4.1. Survey Questionnaire 
This study was a descriptive survey that documented current caregiving patterns 
among pregnant women in Ilesa. Only women that were pregnant were interviewed to 
ensure accurate reporting and analysis of current health care. The questionnaire was 
designed to contain open-and close-ended questions on issues that can help to elicit 
enough information on the subject matter. The open-ended questions enabled the 
respondents to report their personal opinions on the subject matter. The questionnaire was 
divided into five sections: Socio-demographic characteristics of the respondents, religious 
beliefs, adherence of pregnant women to care providers‘ prescription, women‘s 
perception of pregnancy complications and husband‘s roles in decision-making pattern in 
pregnancy (see Appendix I). 
 
3.4.2 Key informants interviews (KIIs) 
 is an example of the qualitative method. This was useful in this study because it was 
open-ended and enabled the researcher to have access to the caregivers and husbands of 
82 
                                                                                
 
the women to elicit information. Its flexibility and practicality allowed the researcher to 
probe into the activities of the health providers  
 
3.4.3 In-depth interviews (IDIs) were with the husbands of the pregnant women. 
         Two female research assistants were involved in the IDIs. One had a PhD and the 
other was an undergraduate with a wealth of experience. The IDIs were conducted among 
heads of the Faith Homes, maternities and hospitals. The questions were on the 
qualifications of care providers, number of delivery in the last six months, food 
prescription and proscription, conformity to ANC and prayer sessions, husbands‘ roles 
and knowledge of causes of pregnancy complications and treatment modes (See appendix 
II). The researcher was present in all IDIs to extract this information. Although the study 
targeted pregnant women, inclusion of their husbands in the IDIs was in order because 
Ilesa is a patriarchal society, and husbands have the final say in pregnancy care and their 
attitudes can determine which caregiver the pregnant woman utilises. Discussions were 
allowed to flow naturally. The researcher did not insist on asking questions according to 
the order in the interview guide. The interview was conducted in an informal setting that 
enabled the interviewees to openly discuss their views on pregnancy care. The IDIs 
targeted health care providers and husbands of pregnant women. Thirty-four IDIs were 
conducted: 12 in faith homes, 12 in hospital/maternity centres, and 10 among husbands of 
pregnant women.  
To supplement the data collected from the IDIs, the researcher visited faith based 
birth homes (FBBHs) and ANC centres. The heads of the faith centres and hospitals were 
fully aware of the mission of the researcher, but the pregnant women were not initially so 
that they would not alter their behaviour in any way. Many pregnant women were in 
attendance; they could not distinguish the researcher from other women. Therefore, the 
presence of the researcher could not influence the actions of the respondents by any 
means.  
Twenty-four visits were made to FBBAs and orthodox caregivers to observe their 
prayer and clinic sessions. On twelve different occasions, the researcher was allowed to 
observe the entire ANC processes in private and government maternities centres. The 
83 
                                                                                
 
same numbers of visits were made to FBBAs. She participated in the prayer sessions and 
the health talks. As a result, she was informed on the prayer points as well as the content 
of the health talk. The content of the health talk included care of the breasts in preparation 
for lactation, HIV infection, and contraceptive, care of older children, husband and 
general hygiene. This provided her with opportunity of first-hand, on-the-spot information 
and clear picture of the respondents‘ activities in ANCs and FBBHs. The respondents 
could not, therefore, lie or mislead the researcher. The observation went in an unexpected 
direction that provided the researcher novel insights and ideas on the activities in faith 
clinics and ANCs.  
 
3.5.  Data collection process 
In the process of collecting the data, the researcher visited the headquarters of 
CAC in Okesa, Ilesa to seek permission to visit their birth houses. The pastor-in-charge 
asked the researcher to come a week later when all the pastors would be around for zonal 
meeting. This was done and the researcher was introduced to the pastors meeting. The 
pastor-in-charge appealed to all the pastors and FBBAs to cooperate. He allayed their 
fears, adding that the researcher did not intend to expose their activities. Six secondary 
school teachers were trained as research assistants. The training was for a day. The 
training included manner of approach, filling the questionnaire appropriately as well as 
the probable problems envisaged. They were trained to maintain confidentiality and 
anonymity. The field assistants were fluent in Yoruba and English.  
 
3.6  Ethical issues  
This study was basically a social research designed for academic purpose only. 
Respondents were duly informed of the purpose of the study and were given the liberty to 
participate or not to. The questionnaire was interpreted to them and they were allowed to 
respond or not to respond to any of the questions.  
The respondents‘ responses were made confidential. Strict anonymity was 
maintained, as neither name nor place of residence was captured. Information given could 
84 
                                                                                
 
not be used to identify the respondents. Verbal permission was sought and got from 
Supervisory Councillors for Health in the two LGAs. At each hospital and maternal 
centre, permission was sought and got from the heads of the sections. Permission was also 
sought from OAUTH authorities. Freedom of response was given to all respondents.      
 
3.7  Method of data analysis 
        The questionnaire was checked for completeness and consistency. The 
independent variables -age, sex, education, marital status, income, and parity were 
measured against perception of pregnancy complications, perception of treatment of 
pregnancy complications, place sought for pregnancy, adherence to caregivers 
instruction, number of immunization taken and husbands‘ roles in pregnancy care.   The 
quantitative data were analysed using descriptive and inferential statistics to show 
frequency distribution, chi square and cross-tabulation. The frequency distribution and 
chi- square and tests were used to explain association among the variables. Frequency 
distributions, means, percentages and multivariate analysis were used to analyze the 
quantitative data, which were processed using the Statistical Package for Social Sciences 
(SPSS17). The research objectives were used to categorize the data according to their 
themes. Similarities and differences in the data were analyzed. 
The qualitative data emerged from IDIs and KIIs. The qualitative data were 
analysed through ethnographic summaries and content analysis. The data were translated 
from Yoruba to English where necessary and then manually analysed. The data were 
analysed according to the themes and objectives of the study. Verbatim quotations were 
also employed. This was triangulated with the results from the quantitative data.  
Content analysis and ethnographic summary were employed to analyze the data from 
IDIs. Direct quotations were translated verbatim and transcribed.  
 
3.8  Limitations to the study 
The research assistants made many visits to the respondents before the 
questionnaire could be administered. Those copies that were found not to be adequately 
filled were returned and re-administered. Some FBBHs were uncooperative. For instance, 
FBBAs from Trumpeters Church and Holy Ghost Fire Ground were not included because 
85 
                                                                                
 
they did not volunteer to be interviewed. Efforts made by the researcher to visit or 
administer questionnaire there were practically unfruitful. A caregiver in one of them 
said, ‗It is a secret, do not poke into it. God does His Work.‟  Traditional birth attendants 
could not be identified because all FBBAs claimed that they were Christians and were 
called by God. Fund was also in short supply; hence, the research could not cover more 
than two LGAs. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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CHAPTER FOUR 
DATA PRESENTATION AND DISCUSSION 
4.1  Social and demographic characteristics of the respondents 
 This chapter presents analysis of data and discussion of the study. The data are 
presented in tabular forms.   
 Social demography explains the pattern and structure of social problems. A total 
of 500 pregnant women were surveyed so as to capture their current experiences. In this 
section, demographic factors are analysed and discussed under the following sub 
headings: age, marital status, educational qualifications of the respondents and their 
husbands‘/partners‘, estimated monthly income, marriage type, religious affiliation and 
respondents‘ access to utilization and place sought for delivery. This is to give a general 
background picture of the respondents. 
 
4.2.1  Age of the respondents 
 Table 4.1 shows that the respondents‘ ages ranged between 13 and 49 years. The 
mean age of the pregnant women was 29.54. The minimum age was 13 and the highest 
age was 45 years. The reproductive years fall within this period. Table 4.1 also shows 
that 21(4.2%) of the pregnancies took place among ages less or equal to 18 years; 160 
(32.0%) of the pregnancies took place within ages 19-24 years; 183 (36.6%) took place 
within 25-29 years; 94 (18.8%) of the pregnancies took place within ages 30 and 34 
years; 31(6.2%) of the pregnancies occurred between 35-39; and only 11 (2.2%) of the 
pregnancies occurred at 40 and above years of age. Most deliveries took place when the 
women were physically mature. The data revealed that few of the pregnancies and births 
took place within the teen ages and above forty. Adekoya (2012) reported that only 3.9 
percent and 3 percent of his respondents were below 20 and above 40 years of age, 
87 
                                                                                
 
respectively. He found that the majority of his respondents were pregnant between ages 
20 and 30. Nigeria Demographic Health Survey (2003) states that the best years for 
childbirth are between ages 20 and 30 years with the children evenly spaced. Neo-natal 
and maternal mortality (MM) are lowest among mothers within this age bracket. Women 
that are either too young or too old and those that have babies too close together are at 
high risk of death and pregnancy complications. Adolescent pregnancies have been 
associated with pregnancy complications (NDHS, 2003; Tinker and Ransom, 2002). 
Women with high parity are also at high risk of MM. Women above 35 years with more 
than four pregnancies are at an even higher risk of MM and morbidity and so they should 
be sensitized not to have children after 35 and not more than four children (Tinker and 
Ransom, 2002). Besides, many women have reached menopause and can no longer have 
children as from 40 years. 
 
Table 4.1 Percentage Distribution of Age of the Respondents 
Age Group (in years) Numbers of Respondents Percentage 
<18    21 4.2 
19-24 160 32.0 
25-29 183 36.6 
30-34  94 18.8 
35-39  31 6.2 
> 40  11 2.2 
Total 500 100 
Respondents’ mean age=29.54 
Source: Fieldwork, (2009) 
 
4.2.2  Marital status 
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 Table 4.2 showed that most of the respondents −373 (74.6%) −were married; 65 
(13.0%) were single; 51(10.2%) were co-habiting; 7(1.4%) were divorced; 3(0.6%) were 
separated; and only 1(0.2%) was widowed. The result showed that 51 (10.2%) of the 
pregnant women were cohabiting. High level of unemployed graduates and mature adults 
could be responsible for this. Those divorced and separated accounted for 4 (0.8 %) of 
the respondents.  
 
Table 4.2 Percentage Distribution of the Respondents’ Marital Status 
Marital Status Number of Respondents Percentages 
Single   65 13.0 
Married 373 74.6 
Cohabiting  51 10.2 
Divorced   7   1.4 
Separated   3   0.6 
Widow  1   0.2 
Total 500 100 
Source: Fieldwork, (2009) 
 
4.2.3  Educational qualifications of the respondents and their husbands/partners 
 Education has been found to play special roles in the utilization of health care 
services and has led to upward mobility of people. It is a major determinant of a people‘s 
socio-economic status. Education affects a people‘s perspective and determines whether 
or not a group of people will utilize hospital care services.  The level of literacy of the 
couple should influence the wife to utilize hospital care. Studies have found that women‘s 
education is positively related to their awareness and utilization of hospital care. 
Education has been found to modify a people‘s belief system and make them receptive to 
modern health care services. Jegede (2010), in his study in Bomadi and Ika, found that 
89 
                                                                                
 
there is a significant relationship between mother‘s education and the use of 
immunisation. 
 Table 4.3 reveals that among the respondents, 30 (6.0%) had no schooling: 46 
(9.2%) had primary education: 80 (16.2%) did not complete secondary education; 189 
(37.8%) completed secondary education; while 153 (30.6%) had tertiary education. The 
table further reveals that 13 (2.6%) husbands of the respondents had no formal education; 
35 (7.0%) had primary education; 59 (11.8%) did not complete secondary education; 204 
(40.8%) completed secondary education; while 189 (37.8%) had tertiary education.  
 Since 1954 when Action Group of Nigeria launched its free primary education in 
south-western Nigeria, various governments in the geo-political zone have placed a lot of 
emphasis on acquisition of basic primary education. This may be responsible for the large 
number of literates in the state. Over 97% of the respondents had acquired one type of 
education or the other. Only 2.6% had no schooling. When men‘s education was 
compared with the women, the result revealed that 13 (2.6%) of the men and 30 (6.0%) 
of the women received no schooling; 7.0% of the men and 9.2% of the women had 
primary education, 11.8% of the men and 16.4% of the women did not complete 
secondary education; 40.8% of the men and 37.8% of the women completed secondary 
education; while 37.8% of the men and 30.6% of the women had tertiary education. The 
overall result on education revealed that more men than women had formal education.  
 It has been established in the literature that more men have tertiary education than 
women. Therefore, women are at a disadvantaged position when health decisions have to 
be made. Olubayo-Fatiregun (2009), citing Sen (1988), claims that, in many societies, 
women have less educational opportunities than men and receive unequal access to 
resources, such as food and income, all of which are strong predictors of health status. A 
study carried out in Kammu and Kashir, India revealed lower female literacy (43%) than 
men (67%).  Even among literate women, the study revealed that women depended on 
their husbands for decision-making. The study further confirmed that, even in settings 
where women have acquired formal education, power relation in the household as well as 
social norms often prevent them from taking health and major decisions.  
90 
                                                                                
 
 These inequalities have major impact on their health. Girls face disproportionate 
deprivation, lack of opportunities, and low level of investment in their health, nutrition, 
and education. Women receive unequal distribution of land and access to resources, like 
food and health care. The inequalities harm girls and women‘s health directly or 
indirectly throughout the cycles of their lives. The neglect of their health needs prevents 
many women from taking part in society fully. Bammeke (2001), quoted in Adebowale 
(2009), asserts that females are withdrawn from school into marriages or they are allowed 
access to education considered relevant for a good wife. Lauer and Lauer (2002) also 
quoted by Adebowale (2009) posit that the traditional roles assigned to women inhibit 
their commitment to higher education, which diminishes their prospects in formal labour 
participation. These restrictions are seen in early marriages and over-dependence on men, 
which weigh women down and constitute serious hindrances to improving their lots in 
life. These practices influence parents to think lowly of, and under- invest in females‘ 
education, regarding it as economic waste (Adebowale, 2009). 
 The occupational status of group of people reflects their social status as well as 
their ability to take certain financial and health decisions. A husband‘s occupation may 
determine his decision-making power and ability to provide for the needs of his pregnant 
wife and the incoming baby. The table reveals that 106 (21.2%) of the husband were civil 
servants, 9 (1.8%) were farmers; 14 (2.8%) were small scale traders; 317 (63.4%) were 
self-employed; 27 (5.4%) were unemployed; 20 (4.0%) were students; while 7 (1.4%) 
were clergy. About 80% of the respondents‘ husbands worked in the informal sector of 
the economy. Since the introduction of Structural Adjustment Programme, it has become 
glaring that the formal sector of the economy cannot absorb the majority of the working 
class.   
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Table 4.3: Percentage Distribution of Respondents’ and Partner’/Husbands’ 
Qualifications and Occupations 
Educational Qualification Number of Percentages 
Respondents 
Respondent’s Educational Qual.   
No schooling 30 6.0 
Primary 46 9.2 
Secondary (Uncompleted) 82 16.2 
Secondary (Completed) 189 37.8 
Tertiary 153 30.6 
Total       500     100 
Husband's Educational Qual.   
No schooling 13 2.6 
Primary 35 7.0 
Secondary (Uncompleted) 59 11.8 
Secondary (Completed) 204 40.8 
Tertiary 189 37.8 
Total 500 100 
Husband’s Occupation   
Civil Servants 106 21.2 
Farming    9 1.8 
Small Trading  14 2.8 
Self-employed 317 63.4 
Unemployed   27 5.4 
Students   20 4.0 
Clergy    7 1.4 
Total 500 100 
Source: Fieldwork, (2009) 
 
 
92 
                                                                                
 
4.2.4  Income of the respondents 
 Table 4.4 shows the estimated income of the pregnant women: 379 (75.8%) 
earned less or equal to 10,000 naira a month; 61 (12.2%) earned between 10,001- 20,000 
naira a month; 25 (5.0%) earned between 20,001 and 30,000 naira a month; 19 (3.8%) 
earned between 30,001- 40,000 naira a month; 7 (1.4%) earned 40,001- 50,000; naira a 
month and only 9 (0.8%) earned 50,001 naira and above in a month. Thus most of the 
respondents were in the low income group. Although literate, they may not be able to 
access orthodox medicine because of user‘s fees. Therefore, there is need to upgrade 
women and make them have the financial impact of tertiary education. If women went to 
school but could not enjoy financial benefit of education, they might be discouraged to 
increase their knowledge. Economic empowerment of women in the community will 
result in empowering the women and ensuring their greater social standing.  
 
Table 4.4 Percentage Distribution of the Respondents’ Monthly Income 
Estimated Monthly Income Number of Respondents Percentages 
             ≤ ₦10, 000 379 75.8 
     10,001 -  20,000   61 12.2 
     20,001 -  30,000   25  5.0 
     30,001 -  40,000  19 3.8 
      40,001 - 50,000   7 1.4 
      Above    50,001   9 1.8 
Total 500 100 
Source: Fieldwork, (2009) 
  
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Poverty was so rampant among the women that seven FBBAs and the owner of a private 
maternity centre reported cases of pregnant women they had to give pants, clothes, food 
and even taxi fare to take them home.  One said:  
Some husbands absconded on the day of their wives‘ delivery because of 
poverty. We pray for such husbands because we know that some of them 
want to be responsible but are very poor. (IDI Female Faith Care Provider, 
Ilesa West, October 2009). 
 
One of the male Church founders/FBBAs buttressed this point when he cited a particular 
case in his church.  The woman came to deliver with nothing, not even food. He took her 
delivery and fed her for three days. For her not to continue to be a burden, he took her to 
her house on the fourth day because she had no money for transport. She eventually 
became a member of the religious group and participated in their children‘s thanksgiving. 
The literature reveals that, among the traditional care providers, payment can be delayed 
to a later date. 
 Some FBBAs reported that procrastination and stinginess were some of the 
economic problems they encountered during processes of taking deliveries. On the day of 
delivery, FBBAs reported that some stingy husbands ran helter-skelter to buy the things 
they ought to have bought earlier and because it was an emergency, their power of 
bargain dropped and so they bought at expensive prices. Pregnant women and their 
partners kept postponing the day when they would buy delivery materials until the babies 
came. 
To alleviate some of these economic hardships on pregnant women, the state and 
local governments provided free maternal care for pregnant women.  Government also 
provides maternity kits (mama kit) that contained minimum materials women needed for 
delivery. This cost one thousand and two hundred naira only. Women are allowed to pay 
on instalment basis, starting from the first day of ANC. The midwives/community nurses 
opened registers of payments.  When a woman completed the payment, the kit was given.  
But while the visits for this study lasted, most of the women kept postponing when they 
would buy. In addition to mama kit, all delivery centres had a list of other materials 
94 
                                                                                
 
which pregnant women were expected to buy.  This list was given on the first day of 
attendance at ANC or prayer meeting but many partners were not financially able to 
afford them. Therefore, on the day of delivery, many women went to FBBAs empty-
handed; in fact, even little as sanitary towels and babies‘ clothes had to be supplied by the 
church/FBBAs. 
 A private midwife recalled her experience with a pregnant woman whose pastor 
told her to come for special prayers, after telling her a vision of an impending danger.  
She was in the special prayer when labour set in.  She ran to this midwife only for the 
caregiver to discover that the baby was breech with buttocks presentation. It was an 
emergency and she had nothing to deliver with.  The baby was delivered eventually, but 
there were no clothes for the baby and the mother.  The caregiver reported that she gave 
her clothes to the woman and her grandchild‘s clothes to the baby.  When the husband 
came, he could not pay for any material. They already had many children whom they 
could not cater for. The caregiver advised them to go for family planning but they did 
not.  The woman was pregnant again and died in the process of delivery.  The baby 
survived, but the husband did not show up to take custody of the child, claiming that he 
had no one to help him take care of it. 
  Some maternity centres also reported cases where they had to use nylon bags as 
gloves to take delivery while they wrapped the babies with the mothers‘ headgears. 
Sometimes, they sent to the woman‘s house to get the clothes of the babies‘ siblings to 
cover them. Community nurses reported a case where the neighbours had to contribute 
money to buy clothes and other essential items for delivery. 
 
4.2.5  Marriage type 
 There are two major types of marriages in traditional Africa societies: monogamy 
and Polygyny. In monogamy a man marries one wife, while, and in Polygyny a man 
marries more than one wife simultaneously. Table 4.5 reveals that monogamy was the 
prevalent type of marriage, among the respondents as 452 (90.4%) were in this type of 
marriage. Only 48 (9.6%) were in Polygyny. This may be due to the prevalence of 
Christianity in the community that encourages one man one wife. Although the 2003 
95 
                                                                                
 
NDHS reported that 36.0% of Nigerian women are in polygynous forms of marriage, 
adherence of the respondents to Christianity influenced their marriage pattern. It could 
also be as a result of general economic trend that makes Polygyny unrealistic, as men are 
finding it difficult to cope with more than one wife. Further, men previously married more 
than one wife so as to provide needed help on the farms. However, Polygyny is no more 
fashionable, as many men are no more farming and women are no more contented with 
following their husbands to farm.  
 Cohesiveness and strength of the extended kin group is waning such that the 
nuclear family is becoming dominant in decision-making.  Ilesa women are predominantly 
traders and are not dependent on their husbands‘ economy. They are usually in full control 
of their finances. Jegede (2010) avers that Yoruba women distinguish their economic 
activities and products from those of their husbands. Orubuloye et al. (1991), quoted by 
Jegede (2010), reported that Yoruba women earn money from both farming and trading. 
They have access to land through their husbands and right to some produce. Sudarkasa‘s 
study in Awe, quoted by Orubuloye et al. (1990) and Jegede (2010), observes that a 
woman‘s income can be as high as that of her husband. 
 
Table 4.5: Percentage Distribution of Respondents by Type of Marriage                
 Marriage Type Number of Respondents Percentage 
Monogamy 452 90.4 
Polygyny  48  9.6 
Total 500 100 
Source: Fieldwork, (2009) 
 
4.2.6  Religious affiliation 
 The religion of a group of people influences their demographic behaviour and 
beliefs. It affects how an individual will act in a social setting and may decide whether 
96 
                                                                                
 
an individual will access health care services with one caregiver or the other. Table 4.6 
indicates that 433 (86.6%) of the respondents were Christians 54 (10.8%) were 
Muslims, only 13 (2.6%) were in traditional religion. This explains why the researcher 
could not identify traditional birth houses. Among the Christians, 88 (20.3 %) were 
Protestants; while 299 (69.1%) were Pentecostals. Pentecostal for this study included all 
Aladura Churches and those that believe in speaking in tongues and white garment 
churches.  
 
Table 4.6: Religious Affiliation of Respondents 
Religious Affiliation Number of Respondents Percentage 
Christianity 433 86.6 
Islam      54 10.8 
Traditional Religion   13  2.6 
Total 500 100 
Denominations   
Catholic   38   8.8 
Protestant 88 20.3 
Pentecostal 299 69.1 
Jehovah‘s Witnesses    8  1.8 
Total 433 100 
Source: Fieldwork, (2009) 
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4.2.7 Percentage distribution of demographic characteristics of qualitative 
respondents 
Table4.7. reveals the ages and marital status of the respondents. Among the 
FBBAs, 3 (25%) were 50-54; 55-59; and 60 years and above. None of the FBBAs was 
less than 50 years old. All the FBBAs had given births and had stopped childbearing and 
probably their children were already grown and could take care of themselves. This gives 
ample opportunities to these FBBAs to be easily available and accessible as they had a lot 
of time to themselves to take care of pregnant women. Conversely, orthodox caregivers 
were still within the childbearing ages and probably having children to take care of and 
were saddled with work and home responsibilities. FBBAs are usually elderly women. 
The literature reveals that TBAs are usually females that are elderly who acquired their 
skills generally by delivering babies themselves or by working with other TBAs (Eades, 
Brace, Osei and Laguardia, 1993).   
The table further reveals that among orthodox caregivers, 3 (25%) were within 
35-39; 40-44, 49-54 years; 1(8.3%) was within 55-59 years and 2 (16.7%) were in ages 
60 years and above. Those within ages 39-49 were in government maternity centres or 
hospitals while the rest were retired nurses who started their own clinics after retirement. 
From personal observation, in these clinics, the last two were mostly patronized among 
orthodox caregivers. This could be as a result of their years of experience in the civil 
service and private practice. Pregnant women may have developed confidence in them 
due to years of experience. Thirty percent (3) of the husbands were 35-39 years old. 
These were fathers having their first and second pregnancies. Another 3 (30%) were aged 
40-44 and 45-49 years and were fathers of third and fourth pregnancies. Only 1 (10%) 
was aged 50-54 years. This was a grand-multigravidal. Most of the men had stopped 
having children by this age bracket. The researcher tried to interview fathers in different 
age brackets to elicit husbands‘ contributions to pregnancy care in different gravidals.  
All that participated in the IDIs and KIIs were married. This was because the 
majority of those that were interviewed were already above 35 years and many people 
struggle to marry on or before this age.  
  
 
98 
                                                                                
 
Table4.7.  Percentage Distribution of Demographic Ages and Sex of Qualitative 
Respondents 
Age FBBAs Orthodox caregivers Husbands 
35-39 - - 3 (30%) 
40-44 - - 3 (30%) 
45-49 - 3 (25%) 3 (30%) 
50-54 3 (25%) 3 (25%) 1 (10%) 
55-60 3 (25%) 3 (25%) - 
60-64 3 (25%) 1 (8.3%) - 
65+ 3 (25%)  2 (16.7%) - 
Sex             Male 2 (16.7 - 10 (100%) 
                  Female   10 (83.3%) 12 (100%) - 
Marital Status 12 (100%) 12 (100%) 10 (100%) 
Source: Fieldwork, (2009) 
 
4.2.8  Percentage distribution of religion and educational qualifications of the 
respondents 
 
Table 4.8 shows that all FBBAs reported that they were Christians; this was because the 
FBBHs were established by Christians and caregivers are supposed to be members of the 
establishing Churches that run them. Apart from that, the founders were Christians. A 
total of 12 (100%) of the orthodox caregivers were also Christians. The researcher 
interviewed heads of the maternities, clinics and hospitals. All the people she met were 
Christians. This could also reflect the predominance of Christianity in the study area.  
Among the FBBAs, 4 (33.3%) had no schooling though they could read the Bible 
in Yoruba. Probably, they learnt it from the adult literacy classes of their churches.  This 
is essential for them to be able to read Psalms of the Bible during their prayer sessions, 
vigils and on delivery materials; 6 (50%) of the FBBAs had primary level of education. 
One male FBBA stopped his education at JSS3, while the other male completed 
secondary level of education. All orthodox caregivers had tertiary education. They 
needed a minimum of Community Nurse Certificate to be able to qualify to work in 
hospitals, clinics or maternity centres. Two (20%) of the husbands had primary 
99 
                                                                                
 
education; another 2 (20%) attempted secondary education; and 2 (20%) completed 
secondary level education. The rest 4 (40%) had tertiary education. Among the husbands, 
9 (90%) were Christians, while 1(10%) was a Muslim.  
 
Table4.8.  Percentage Distribution of Demographic Religion and Educational 
Qualification of Qualitative Respondents 
Religion & Educ. Qualification FBBAs Orthodox Husbands 
Caregivers 
Religion Christian 12 (100%) 12 (100%) 9 (90%) 
Islam - - 1 (10%) 
ATR - - - 
Educ. No Schooling 4 - - 
Qualification Primary 6 - 2 (20%) 
Sec. ncompleted 1 - 2 (20%) 
Sec. Completed 1 - 2 (20%) 
Tertiary - 12 (100%) 4 (40%) 
Source: Fieldwork, (2009) 
 
4.3.  Perceptions of pregnant women on aetiology of pregnancy-related 
complications 
 The first objective of this study was to find pregnant women‘s perception of 
aetiology of pregnancy-related problems. This was achieved by looking at the following 
items.  
i)  Perceived causes of pregnancy complications  
ii)  Perceived signs and symptoms of pregnancy complications 
iii)  Perceived means to avoid pregnancy complications 
iv)  Perceived treatment for pregnancy complications 
4.3.1a:   Pregnant women’s perception of aetiology of pregnancy complications 
The respondents were given a list of supposed causes of pregnancy complications 
and were required to select which of them they knew. Table4. 9 captures what they 
regarded as causing complications; 208 (41.6%) of the respondents attributed pregnancy 
100 
                                                                                
 
complications to witches and wizards; while 194 (38.8%) attributed them to infections.  
Infection is any kind of disease that can spread from one person to another and is capable 
of hampering the development and save delivery of the baby. Two hundred and seventeen 
(43.4%) of them attributed complications to adultery on the part of the woman, while 219 
(43.8%) attributed them to woman‘s physique. The physique of the pregnant woman has 
to do with whether she is tall or short, whether she has well-developed pelvic that can 
accommodate the head of the baby at delivery or not.  
Table 4.9: Perceptions of the Respondents on Aetiology of Pregnancy Complications 
Cause of Complications Yes No S.D 
Witches and Wizards 208 (41.6%) 292 (58.4%) 0.46 
Infection 194 (38.8%) 306 (61.2%) 0.48 
 Adultery 217 (43.4%) 283 (56.6%) 0.49 
Woman‘s physique 219 (43.8%) 281 (56.2%) 0.50 
Source: Fieldwork, (2009). 
 
 The study revealed inadequate knowledge of causes of pregnancy complications. 
Pregnant women who are not aware of causes of complications cannot work at preventing 
them. However, most of those with tertiary level of education attributed pregnancy 
complications to infection and physique of the woman rather than witches and wizards 
(primary 8 (44.1%); secondary 51 (66.2%); tertiary education (73.5%). Oke (1982) 
observes that Africans perceived diseases as natural, supernatural, and mystical. Jegede 
(2010) adds a fourth category, hereditary diseases. Although the classification can be 
overlapping, there is the belief that a disease that starts as natural may suddenly reflect 
supernatural symptoms; depending on the characteristic features of such disease.  
 Jegede‘s (2010) respondents in Ika and Bomadi also revealed that evil spirits were 
perceived as the causes of diseases. One of them stated that ‗witches are the causes of 
diseases and if you go to the hospital you have gone there to kill your child.‘ 
101 
                                                                                
 
However, an FBBA reported that: 
Witches and wizards do not go about eating people but some pregnant 
women that were attacked had misused their tongues to insult some 
wicked people who waited for them till the day of their deliveries and 
ensured that they had complications‘ (IDI, Female, Faith Home, Ilesa 
West, Sept. 2009).  
This FBBA asserted that when there were evidences of evil people at work, she told the 
pregnant women involved to apologize to those they offended. If the woman could not 
remember again, she told them to confess to God and ask God to intervene in their 
delivery. 
 Both the quantitative method and IDIs revealed that the respondents perceived 
extra-marital affair as a source of complication. When a woman gets involved and gets 
pregnant, it is believed she may have complications at delivery. Her husband would be 
called in and the woman would have to confess her unfaithfulness before she could have 
safe delivery. 
      To buttress the perception of adultery as a source of complication, an FBBA noted 
that a woman was brought by her husband and was having difficulty in labour. He 
claimed that he travelled and had no sexual relationship with his wife before December 
and the delivery was in June; he could not have fathered the child. While the woman was 
in labour, the husband and his mother came and said if the woman ever had safe delivery, 
the baby was not going to survive because the baby was not theirs. Eventually, the 
woman had a stillbirth and as the FBBA was trying to resuscitate the baby, the husband 
said: 
 Don‘t worry or labour in vain. This baby will not survive. After 
delivery, this woman should relocate to her parents as I would not 
father a bastard child and I will not marry her again (IDI, Female, 
Faith Home, Ilesa West, Sept. 2009). 
 The husband and the mother-in-law refused to pay for delivery or give the woman food.  
The FBBA had to feed and clothe the woman and later paid for her transportation to her 
parents‘ house. Orji et al. (2001) assert that labour complications are blamed on 
labouring mothers, accusing them of being unfaithful to their husbands.  
102 
                                                                                
 
 The number of pregnancies an individual has should affect her perception of 
pregnancy complications. Table 4.10 reveals that 94 (46.3%) of the primigravidals 
perceived that the physique of a woman can cause pregnancy complications, while 109 
(53.7%) did not. Among the multigravidals, 119 (42.3%) believed that the physique of a 
woman can cause pregnancy complications, while 162 (57.7%) did not; 6 (37.5%) of the 
grand multigravidals perceived the physique of women as source of pregnancy 
complications, while 10 (62.5%) did not. The table further showed that there was no 
significant relationship between the respondents‘ parity and perception of the physique of 
2 
a woman as a cause of pregnancy complication (χ = 1.680; df = 4; P > 0.05).  
 This study revealed inadequate knowledge of causes of pregnancy complications 
among all categories of pregnant women. In-depth interviews (IDIs) with hospital 
caregivers revealed that women with heights and weights below 1.5m and 40 
kilogrammes respectively are perceived as high-risk women and as being predisposed to 
pregnancy complications.  Nurses and community nurses claimed that they always 
referred them to the Teaching Hospital early. No FBBA mentioned these as indicators of 
complication. They need to be aware of this so that they can refer these categories of 
women early. When women with this nature are not aware, they may resort to being 
delivered at home or in faith homes.  
 
103 
                                                                                
 
 
Table4. 10: Influence of Number of Pregnancies and Perception of Woman’s 
Physique as a Cause of Complication  
Number of pregnancies Perception of Body Size as  
Cause of Complication 
Total 
Yes No 
Primigravidals 94 (46.3%) 109 (53.7%) 203 (100.0%) 
Multigravidals  119 (42.3%) 162 (57.7%) 281 (100.0%) 
Grand Multigravidals    6 (37.5%)   10 (62.5%)  16 (100.0%) 
Total  219 (43.8%) 281 (56.2%) 500 (100.0%) 
2
X critical = 9.49 X2cal =1.680 df 4 P 0.794 
Source: Fieldwork, (2009) 
 
 Table 4.11 shows that 84 (41.4%) primigravidals perceived infection as a cause 
of pregnancy complications, while 119 (58.6%) did not; 103 (36.7%) multigravidal 
perceived infection as cause of pregnancy complications, while 179 (63.3%) did not; 
and 7 (43.8%) grand multigravidal perceived infection as a cause of pregnancy 
complications, while 9 (56.3%) did not. There was no significant relationship between 
the respondents‘ number of children and perception of infection as cause of pregnancy 
2 
complications (χ = 1.838; df = 4; P > 0.5).  When women have infections, they may 
not go for treatment; this is because they are ignorant. Besides, many sexually 
transmitted infections in women present no symptom and only laboratory tests reveal 
their presence. A woman may be infected and yet be unaware. 
 
104 
                                                                                
 
 
Table4. 11: Influence of Number of Pregnancy and Perception of Infection as a 
Cause of Complications  
No. of Pregnancies Perception of Infection as  cause  
of Complications 
Total 
Yes No 
Primigravidal 84 (41.4%) 119 (58.6%) 203 (100.0%) 
Multigravidal  103 (36.7%) 179 (63.3%)     281 (100.0%) 
Grand-multigravidals 7 (43.8%)    9 (56.3%)  16 (100.0%) 
Total  194 (38.8%) 306 (61.2%) 500 (100.0%) 
2 2
X critical 9.49 X cal 1.838 df 4 P 0.765 
Source: Fieldwork, (2009) 
   
  The in-depth interviews further revealed that FBBAs taught that pregnancy 
complications could result from consumption of sugary food items, like Bournvita and 
Milo. Pregnant women were advised to avoid them. They believed that sugary food could 
cause big babies that could result in the ‗passenger being bigger than the passage‘. As 
the baby consumes out of the foods the pregnant woman eats, she is advised to eat less of 
sugary foods so that she does not end up having a big baby. When the baby is too big for 
the mother‘s pelvic, it is born through CS and most women dread it, not only because of 
its cost but also because of the general belief that it is abnormal, and that women whose 
deliveries are taken through CS have reproductive health problems. However, one of the 
midwives saw no reason why pregnant women should not take these beverages. 
According to her, some pregnant women could not tolerate solid food in the first 
trimester – only beverages can sustain them. She was of the opinion that solid foods, like 
eba and amala give more calories than beverages. Conflict of which to obey may occur to 
a pregnant woman that attends both the orthodox and FBBA delivery centres. 
105 
                                                                                
 
 Some orthodox caregivers blamed pregnancy complications on the carelessness of 
nurses and care providers. Nurses and midwives in public hospitals in particular have 
been alleged of shouting or insulting pregnant women in labour but FBBAs have not been 
so alleged. FBBAs have been known to be supportive and caring with or without training. 
One wonders why nurses that were trained would be known for shouting and putting up 
actions that would put off pregnant women. A nurse reported the ordeal of a pregnant 
woman who was about to give birth and the nurse on duty refused to take the delivery 
because she was about to end her morning duty. She told the pregnant woman:  
Don‘t push now; if you push before people in afternoon shift come, I will 
just leave the baby on the table for them. 
 
Another pregnant woman recalled how she was in labour and the midwife on duty went 
to shop for clothes which hawkers brought to the hospital and the midwife kept shouting 
at the woman in labour from where she was buying clothes.   
Madam if you won push call me o, if you no call me you go just push 
your baby for floor your baby go just die. 
 
Actions like these can result in the loss of the baby or the mother or both.  It may 
discourage such pregnant women from accessing health care delivery in hospitals in 
subsequent pregnancies. FBBAs do not talk or act like this. Jegede (2010) observes that 
workers‘ attitude constitute a great hindrance to health-care utilization. Read (1996), 
quoted in Jegede (2010) states that: 
Secret of unqualified practitioners is that they had learned by 
experience the proper approaches to their people; their sincerity, 
patience, perseverance, reassuring smiles, soothing words, pleasant 
attitudes, genuine understanding of the simple psychology of 
villagers, as well as their humane consideration of the weakness of 
people, their prompt response in time of need, their modesty all had 
contributed to their acceptance in the community as celebrated 
practitioners. 
 
Another source of pregnancy complication, according to a caregiver, is when caregivers 
abandon their duty posts. She said: 
106 
                                                                                
 
Many maternity centres are not functioning because the health 
providers abscond from duties. When pregnant women are not sure of 
meeting somebody at a maternity centre they are not likely going to 
patronize the place. Absenteeism is due to lack of supervision, basing 
nurses‘ appointment on political patronages rather than qualifications 
and experience.  Nurses who are qualified and well-trained are 
shortchanged for those who have political connection, some of whom 
feel they are untouchable, irrespective of what they do. 
 
The researcher confirmed this statement during the fieldwork.  Some maternity centres 
were found under lock and key for reasons of weekends and public holidays.  If a woman 
who registered at such maternity centres falls into labour on a weekend or a public 
holiday where does she turn to? This fear makes pregnant women to register for care in 
more than one place. 
 One of the caregivers noted that the care-giving job should be done by only those 
who are hard working and compassionate.  She admonished that the work should not be 
assigned to careless people.  There should be no dereliction of duty because lives of at 
least two persons are on the line. She, therefore, recommended that ANC should be daily 
not weekly, as done in other places, to be thorough, though it would be demanding on the 
caregivers. 
 The IDIs further revealed that the respondents believed in the existence of 
wandering evil spirits which torment pregnant women and drive out good babies and 
replace them. They also believed that there could be some spiritual manipulations by 
witches, wizards, and familiar spirits during delivery. This is believed to occur when 
pregnant women refuse to comply with instructions not to walk between 1-3 a.m. and 1-3 
p.m. Therefore, pregnant women were instructed to avoid walking about around 1.00 
p.m. or resting under big trees around the same time so that evil children walking around 
or staying inside the trees would not bring complications to them or drive out the babies 
inside them. 
 All the healthcare givers believed that non-attendance at prayer meetings or ANC 
could be a source of complications for pregnant women. All FBBAs said pregnant 
women that did not attend prayer meetings but just appeared for delivery would not be 
107 
                                                                                
 
entertained because they did not like emergency deliveries and did not know the history 
of their pregnancies. The majority of the FBBAs turned such pregnant women away. 
However, when FBBAs brought women who had been in labour many hours in faith 
homes to the hospital in morbid condition, they become agitated and ready to crucify 
teaching hospital staff for delaying to attend to unbooked patients. 
 
4.3.1b Drug abuse as a cause of pregnancy complication 
 Data from IDIs revealed that drug abuse was perceived to be another cause of 
complication. A midwife reported that 
 Pregnant women who have overworked themselves instead of going 
to eat good meal and rest go to drug vendors who gave them two 
paracetamol, 2 ampiclox, 2 tetracycline, 2 or more of other drugs and 
2 B. complexes (‗asape‟ or ‗saajo‟ meaning complete treatment).They 
throw all down their gullets and that may result in complications and 
bodily resistance to drug (IDI, Female, Nurse, Ilesa East, Oct. 2009). 
 
The FBBAs perceived and instructed that pregnant women who did not respect their 
husbands, fought, or stole could have prolonged labour. They instructed women to avoid 
these. This helped to preserve peace in the families. They believed strongly that the 
prayers they offered every week for the women would not allow any complications.   
 Another perceived cause of complication is the perceived source of the 
pregnancy. An FBBA said: 
 I don‘t know the foundation and source of their pregnancies. Some of 
them went to trees, rivers, or mountains to beg for babies; such babies 
as well as the pregnancies are problematic (IDI, Female, Faith Home 
Ilesa East, Oct. 2009).  
      
The IDIs further revealed that pregnancy complications can arise because of too many 
deliveries.  A health worker reported how two women‘s uteri came out with their twelfth 
and seventh babies, respectively. She said this was because the uteri were already elastic 
and overblown with frequent pregnancies and deliveries. Ilesa people, like the rest 
Yoruba, do not believe in counting the number of children.  Pregnant women may not tell 
108 
                                                                                
 
the truth about the number of pregnancies they had carried, especially if the babies were 
dead.  The clerking officer would have to press hard to get the women to tell the number 
of their dead babies, probably because they were trying to repress painful experiences and 
memory. When nurses suggested family planning, they always refused because their 
husbands would not support. The husbands believed that their wives would engage in 
extra-marital affairs if they used family planning devices. However, recently, some 
husbands are becoming enlightened and are supporting the practice of family planning. 
 Another cause of complication mentioned by a caregiver is mixing and oscillating 
between traditional healers and orthodox hospital. A midwife noted that a woman was 
attending ANC in a maternity centre and the nurses were aware that she was going to 
have a set of triplets. The community health worker who was monitoring the pregnancy 
was not on duty when she fell into labour.  By the time she arrived, the woman had 
delivered the first baby; the nurse reported that she delivered the second and went to put 
the baby in a cot. She did not know that the husband had invited a traditional healer. 
When she came in to check the woman for the third baby, she met a traditional healer 
who laid hands on the woman and was making incantations.  She said she was surprised. 
She told the traditional healer that the woman still had a baby to deliver. The traditional 
healer was sorry and said he was not aware that a baby was still inside, that the 
incantation he made was for the placenta, and that if any baby was inside he would be a 
stillbirth because the incantation he said was to call on ‗the foundation of the child‟. 
Truly the third of the triplet was delivered shortly as a stillbirth with the placenta.  
 
4.3.1c  Influence of perception of witches and wizards as a cause of complications on 
place sought for pregnancy care 
 It is believed that when women attended ANC regularly, their knowledge about 
pregnancy care should increase. Table 4.12 presents the places women attended for care 
and pregnant women‘s perception of witches and wizards, as causes of pregnancy 
complication. Seventy-seven (50.3%) of the attendees at government hospitals, 34 
(34.3%), and 97 (39.1%) of the attendees at private and faith homes, respectively, 
perceived the activities of witches and wizards as responsible for pregnancy 
complications. The table shows that there was a significant relationship between the place 
109 
                                                                                
 
sought for pregnancy care and respondents‘ perception of witches and wizards as causes 
2 
of pregnancy complication (χ = 7.573; df = 2; P< 0.05).  This may be why many 
pregnant women preferred to deliver in faith homes where they believed that the 
activities of witches and wizards would be checked with prayers and other rituals. This 
explains why they prayed on mountains, bathed in flowing rivers and utilized anointing 
oil to ward off evil. Jegede‘s (2002) respondents also perceived witches and wizards as 
causes of children‘s diseases. 
 
Table 4.12: Influence of Perception of Witches and Wizards as Causes of 
Complications on Place Sought for Pregnancy Care  
 Perception of witches and wizards as Total 
cause of pregnancy complications 
Place Sought for 
Yes No 
Pregnancy Care  
Government Hospital  77 (50.3%) 76 (49.7%) 153 (100.0%) 
Private Hospital  34 (34.3%) 65 (65.7%)  99 (100.0%) 
Faith Homes 97 (39.1%) 151 (60.9%) 248 (100.0%) 
Total  208 (41.6%) 292 (58.4%) 500 (100.0%) 
2 2
  χ critical 5.99 χ cal 7.573 df 2 P 0.023 
Source: Fieldwork, (2009) 
 
4.3.1d  Influence of perception of adultery as a cause of complications on place 
sought for pregnancy care  
 Table 4.13 shows that 81 (52.9%), 36 (36.4%), and 102 (41.1%) of respondents 
from government and private hospitals and faith homes, respectively perceived adultery 
as responsible for pregnancy complications. The table also shows that there was 
significant relationship between the place sought for pregnancy care and respondents‘ 
2 
perception of adultery as cause of pregnancy complication (χ = 8.137; df = 2; P< 0.05). 
110 
                                                                                
 
When significant others perceive that pregnancy complications occur because of adultery, 
women that have complications may not receive help on time. They might want her to 
suffer for her perceived ‗sin‘. Her situation might have got out of hand when help is 
eventually received. 
 
Table 4.13:  Influence of Perception of Adultery as a Cause of Complications on 
Place Sought for Pregnancy Care  
Place Sought for Perception of Adultery as a cause of Total 
Pregnancy Care  Pregnancy complication 
Yes No 
Government Hospital 81 (52.9%) 72 (47.1%) 153 (100.0%) 
Private Hospital 36 (36.4%) 63 (63.6%)  99 (100.0%) 
Faith Homes 102 (41.1%) 146 (58.9%) 248 (100.0%) 
Total  219 (43.8%)  281 (56.2%) 500 (100.0%) 
2 2
χ critical 5.99 χ
2
cal 8.137 df 2 P 0.017 
Source: Fieldwork, (2009) 
  
 To corroborate these findings, causes of Maternal Mortality in OAUTH, Ilesa 
branch was got. Table 14 indicates that haemorrhage was responsible for 6 (40%), 
obstructed labour was responsible for 2 (13.4%) of maternal loss, and eclampsia 
contributed 2 (13.3%) to maternal deaths. The result showed that haemorrhage was the 
major cause of maternal loss, yet, 33.6% of the respondents were not aware of 
haemorrhage as a cause of maternal mortality. Ante partum haemorrhage is excessive 
blood loss before delivery, intra partum occurs during and post partum occurs after 
delivery. If the haemorrhage was prolonged it can result in the woman being brought in 
deeply unconscious.  Globally, haemorrhage accounts for 34% of maternal loss (Salama, 
2008). Adebayo (2013) states that haemorrhage accounted for 25% of maternal loss in 
111 
                                                                                
 
Nigeria. He notes that, if all maternity centres were well-equipped with facilities and 
manpower to control excessive bleeding during labour and after childbirth, MM will 
reduce by one quarter worldwide. Pregnant women‘s inadequate knowledge of 
haemorrhage may cause delay in seeking help. Even when help is sought, 159 (31.8%) of 
the respondents would not accept blood transfusion.  
 
Table 4.14:  Distribution of Causes of Maternal Mortality Recorded at OAUTH 
Ilesa from 2005-2008 
 Causes of Death No of 
deaths 
Abdominal malignity 1 (6.7%) 
Ante, intra and post-Partum Haemorrhage (brought in deeply unconscious) 6 (40.0%) 
Eclampsia  2 (13.3%) 
Obstructed Labour 2 (13.3%) 
Respiratory obstructed tress  1 (6.7%) 
Retained Placenta 1 (6.7%) 
Ruptured uterus 
2 (13.3%) 
Total 15 (100%) 
Source: OAUTH, Ilesa, Secondary Data obtained November (2009)  
 
4.3.2 Perceived signs and symptoms of pregnancy complications 
A list of symptoms of pregnancy complications was given and respondents were 
required to identify the ones related to pregnancy complication. Table 15 shows that two 
hundred and eighty-seven (42.6%) of the respondents identified breech baby; 254 
(50.8%) identified convulsion; 333 (66.2%) identified excessive bleeding; 308 (61.6%) 
identified high fever; 330 (66.0%) identified labour of more than 12 hours; 300 (60.0%) 
identified swollen legs as symptoms of pregnancy complications. Globally, 11% of MM 
was ascribed to eclampsia (Salama, 2008). 
   
112 
                                                                                
 
Table4. 15. Perceived Signs and Symptoms of Pregnancy Complications 
List of Pregnancy Complications Yes No 
Breech Baby 287 (57.4%) 213 (42.6%) 
Convulsion (Eclampsia) 254 (50.8%) 246 (49.2%) 
Haemorrhage (excessive bleeding before or after delivery) 333 (66.2%) 169 (33.8%) 
High Fever 308 (61.6%) 192 (38.4%) 
Labour more than 12 hours 330 (66.0%) 170 (34%) 
Swollen Legs 300 (60%) 200 (40%) 
Source: Fieldwork, (2009) 
 
4.3.2a Perception of haemorrhage as symptom of pregnancy complications 
 Table 4.16 reveals that only 86 (56.2%) of the attendees at government hospitals, 
73 (73.7%) of those who attended private hospitals, and 173 (69.8%) of attendees at faith 
homes recognized haemorrhage (excessive bleeding) as a sign and symptom of 
complication. Studies have shown that one of the leading causes of pregnancy 
complication is haemorrhage. The table shows that there was a significant relationship 
between the place sought for pregnancy care and respondents‘ perception of excessive 
2 
bleeding as a sign of pregnancy complications (χ = 10.765; df = 2; P < 0.05).  
 
 
 
 
 
 
 
 
113 
                                                                                
 
Table 4.16: Perception of haemorrhage as a Symptom of Complications and Place 
Sought for Pregnancy Care 
Place Sought for Perception of Haemorrhage as a Symptom Total 
of  Complication 
Pregnancy Care 
Yes No 
Govt. Hospitals 86 (56.2%) 67 (43.8%) 153 (100.0%) 
Private Hospitals 73 (73.7%) 26 (26.3%)   99 (100.0%) 
Faith  173 (69.8%) 75 (30.2%) 248 (100.0%) 
Total  332 (66.4%) 168 (33.6%) 500 (100.0%) 
2 2
X critical 5.99 X cal 10.765   df  2   P <.005 
Source: Fieldwork (2009) 
 
4.3.2b  Perception of high fever as a symptom of pregnancy complications 
         Table 4.17 indicates that 83 (54.2%), 67(67.7%), 161 (64.9%) of attendees at 
government hospitals, private hospitals, and faith clinics respectively, perceived high 
fever as a symptom of complications. It also shows that there was a significant 
relationship between the place sought for pregnancy care and respondents‘ perception of 
2 
high fever as sign of pregnancy complications (χ = 6.158; df = 2; P< 0.05).   High fever 
could be a symptom of malaria or pre-eclampsia. The result of inadequate knowledge is 
that women would be applying home remedies (aajo), self-medication, and would not 
seek medical help on time. The literature has shown that 11% of pregnant women die as a 
result of malaria. As malaria is endemic in Ilesa, women may not perceive it as serious in 
pregnancy situation and many of them may not seek help early and delay may be 
dangerous.  
 
 
114 
                                                                                
 
Table 4.17: Perception of High Fever as a Symptom of Pregnancy Complications and 
Place Sought for Pregnancy Care 
Place sought High Fever as a Symptom of Total 
Pregnancy Complication 
for  Pregnancy Care 
Yes No 
Government Hospitals 83 (54.2%) 70 (45.8%) 153 (100.0%) 
Private Hospitals  67 (67.7%) 32 (32.3%)  99 (100.0%) 
Faith Homes 161 (64.9%) 87 (35.1%) 248 (100.0%) 
Total  311 (62.2%) 189 (37.8%) 500 (100.0%) 
2 2
X critical 5.99 X cal 6.158 df 2 P 0.046 
Source: Fieldwork, (2009) 
 
4.3.2c Perception of labour of more than 12 hours as a symptom of pregnancy 
complications 
 It is expected that the number of pregnancies and the place pregnant women 
patronize for care should enhance their knowledge and perception of pregnancy 
complications. However, Table 4.18 shows that only 91(59.5%) of those who attended 
government hospitals perceived labour of more than 12 hours as a symptom of pregnancy 
complications; 73.7% of those that attended private hospitals perceived labour of more 
than 12 hours as a symptom; while 172 (69.4%) of those who attended faith homes 
perceived labour of more than 12 hours as a symptom of complication. The table reveals 
that there was a significant relationship between the respondents‘ perception of labour of 
2 
more than 12 hours and the place where they sought for pregnancy care (χ = 6.582; df = 
2; P< 0.05).  This explains why some pregnant women would labour for 3 or 4 days in 
mission houses without trying to seek help. A gynaecologist reported that those who were 
transferred to the hospital and were advised to go for Caesarean Section (CS) would not 
give informed consent saying: 
115 
                                                                                
 
I believe God that I would deliver safely. I will not die. (IDI Female, 
OAUTH, March 2010). 
 
Table4. 18: Perception of labour of more than 12 hours as a symptom of 
complication and places sought for pregnancy care 
Place Sought for Perception of long Labour as Cause Total 
Pregnancy Care 
Yes No 
Government Hospital 91 (59.5%) 62 (40.5%) 153 (100.0%) 
Private Hospital  73 (73.7%) 26 (26.3%) 99 (100.0%) 
Faith Homes 172 (69.4%) 76 (30.6%) 248 (100.0%) 
Total  336 (67.2%) 164 (32.8%) 500 (100.0%) 
2 2
X critical 5.99     X cal   6.582     df 2     P .037 
Source: Fieldwork, (2009) 
 
4.3.2d  Perception of swollen legs as a symptom of pregnancy complications 
            Table 4.19 reveals that only 78 (51%), 66 (66.7%) and 152 (62.9%) of the 
attendees at government hospital, private hospitals, and faith homes respectively, 
perceived swollen legs as symptom of pregnancy complication. It also shows that there 
was significant relationship between the place sought for pregnancy care and 
2 
respondents‘ perception of swollen legs as sign of pregnancy complications (χ =7.891; 
df=2; P< 0.05). 
 
 
 
 
 
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Table 4.19: Perception of swollen legs as pregnancy complications 
Place sought Perception of Swollen Legs As A  
Cause of Pregnancy Complications 
for  Pregnancy Care Total 
Yes No 
Government Hospital 78 (51.0%) 75 (49.0%) 153 (100.0%) 
Private Hospital 66 (66.7%) 33 (33.3%)   99 (100.0%) 
Faith Homes 156 (62.9%) 92 (37.1%) 248 (100.0%) 
Total  300 (60.0%) 200 (40.0%) 500 (100.0%) 
2 2
X critical 5.99 X cal 7.891 df 2 P 0.019 
Source: Fieldwork, (2009) 
 
 When any part of a pregnant woman‘s body is swollen, in Ilesa it is believed that 
she carries multiple pregnancies. In pre colonial era, the birth of twins or triplets was 
regarded as a curse on families. Many people now cherish and highly esteem multiple 
births. They may be lost in the euphoria of expecting multiple births while danger looms 
in the corner. This may also cause delay in seeking help. The husbands, FBBAs, and 
significant others may be unaware of danger. Both high fever and swollen legs are signs 
of pre-eclampsia. The only FBBA that reported that she had MM claimed the woman had 
familiar spirit but in actual fact she had pre-eclampsia that finally degenerated to 
eclampsia.  
       Lack of or inadequate knowledge of convulsion as sign of complication would 
cause women and their husbands to seek help late. But as past researches have shown, all 
pregnancy problems are preventable and easily cured if identified and managed early 
(Ransome-Kuti, 1990). This would be possible if pregnant women attend ANC regularly 
and have freedom to discuss their problems with caregivers. 
 
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4.3.3  Perceived means to avoid pregnancy complications  
 It was widely believed that complications were the handiwork of malevolent 
spirits. In all the religious houses, prayer was perceived as means to avoid complications. 
In their weekly prayers, they prayed against wicked people who might be angry with or 
without cause. The prayers were said against  
Wicked people who will cause your family members to run helter-skelter on 
the day of delivery, who will not allow you or/and your child to survive 
(Female, Faith Care Provider, Ilesa East, Sept. 2009). 
 
A lot of time was spent in praying against complications on the day of delivery.  
 Frivolity was perceived as a cause of complication and so secrecy was 
encouraged. A private nurse and FBBAs warned pregnant women not to display their 
babies‘ materials for others to see. They were instructed to buy the materials and keep. 
When they wanted to eat balanced diet, they must not make a display of it for others to 
see as people looking for children or those that could not afford to eat good food could be 
annoyed and harm them or their babies.  
 FBBAs further instructed pregnant women not to advertise their pregnancies by 
showing their tummies and complaining to people how they feel.  They should not allow 
people to touch their pregnancies so as to prevent wicked people from having access to 
them and their babies. Pregnant women were instructed to be careful in the use of their 
tongues so that the evil ones would not catch them in their words.  They were not to talk 
when they were not invited and should speak few words when they are invited to talk.  
 Respondents were further instructed that when they have headache, diarrhoea and 
vomiting, they should report in clinic/maternity centres immediately to avoid premature 
contractions.  Whenever there were complications, FBBAs referred patients to a private 
hospital because the Teaching Hospital was often on strike. During the major part of 
collecting this data, the Teaching Hospital was on strike. If the doctors were on strike, the 
nurses would be on duty; when the doctors resumed, the nurses would go on strike; and 
the other paramedical staff would join at a later date.  
 
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4.3.4a  Perceived treatment for haemorrhage 
 Respondents were asked if they would agree to blood transfusion if they were 
anaemic. This question was used to measure response to pregnancy complication and 
treatment choice. Table 4.20 captured the perceived treatment of anaemia: 341 (68.2%) 
of the respondents claimed that they would agree to blood transfusion, while 159 (31.8%) 
said they would not agree to blood transfusion if there was anaemia. This observation 
2  
was statistically significant χ = 84.534, df = 1, N= 500, P< 0.05. If these women have 
reasons to be transfused, there may be problem of informed consent. One of the husbands 
during the interview vehemently disagreed that a woman should take another person‘s 
blood. Such husbands would not allow blood transfusion even if their wives had anaemia. 
The fear of contracting HIV/AIDS through infected blood causes women and their 
husbands to avoid blood transfusion like a plague. The solution is that pregnant women 
should ensure that they eat well and attend ANC on time to detect anaemia early.  
 The result revealed that at least two-thirds of the respondents would receive blood 
transfusion but the one-third that would refuse is high enough to be a source of concern 
and could result in high mortality rate. If these women have any reason to be transfused 
there may be a problem of informed consent.  
 
Table 4.20:  Percentage Distribution of Respondents’ Perception for Treatment 
of Haemorrhage 
Perceived Treatment of Yes % No % 
Anaemia  
Would you accept blood 341 68.2 159 31.8 
transfusion if anaemic? 
Source: Fieldwork, (2009) 
 
 
 
119 
                                                                                
 
As hospitals have their modes of treating complications so do religious houses. 
 From a Key informant interview conducted with a FBBA, he asserted that there 
were some complicated deliveries that needed various leaves for boiling or squeezing to 
make concoction. He said that when a pregnant woman was tired at the point of delivery 
and could push no further, he would add certain leaves with pap and give to the woman; 
the woman would have power to deliver. 
  One of the FBBAs averred that he treated haemorrhage with concoction: 
 ―heaven delivers such women when I prepare concoction with pap‖.  
According to this FBBA, the haemorrhage would stop. This FBBA claimed he never 
allowed pregnant women under his care to subscribe to blood transfusion. He emphasized 
that he had never sent anybody to Western medical facility for delivery because of 
complications. When he noticed that a pregnant woman was pale and might not have 
sufficient blood to undergo delivery, he usually prepared concoction made of leaves and 
stalk of guinea corn, coconut, lemon grass, and coconut shield which he boiled together 
and gave to the woman to drink. He claimed that the woman must have enough blood 
after taking the concoction.  
 
4.3.4b Treatment of placental previa and breech presentation 
 An FBBA asserted that he had successfully treated eight cases of placenta previa 
or retained placenta. He said he usually cut a particular leaf to which he added salt and 
squeezed the juice for pregnant women to drink. He was confident that the placenta 
would come out. Jegede (2010) states that therapeutic management involves both herbal 
remedies and therapeutic rituals, like incantations, prayers, and sacrifices to appease the 
supernatural forces.  
 Some FBBAs claimed that they did manual removal for placenta previa and used 
hot water mopping to resuscitate stillbirths.  These women reported that God taught them 
what to do on each occasion with different women. 
 The FBBAs believed that breech presentation is essentially the work of witches, 
wizards, and the devil. One of the FBBAs reported that whenever a woman went for 
120 
                                                                                
 
ultrasound and it was reported that her baby had assumed a breech position, he gave some 
leaves and concoction; and the position of the baby would change. He backed up his 
claim with the case of a breech presentation at a private hospital in Ilesa which he treated. 
The woman was to be operated upon, but the husband had no money. The doctor felt that 
the life of the woman was in serious danger and advised against self-discharge, but he 
pleaded with the doctor to allow him to take the woman. The doctor eventually agreed 
after they had signed discharged against medical advice (DAMA) papers. He said that he 
gave her some concoction and the woman had safe delivery. He claimed that afterwards 
the doctor gave him gifts and even offered that they be in partnership. 
  Belief system is an integral part of man and spiritual issues are difficult to 
explain scientifically. Care providers cannot just jettison this aspect if the lives of 
pregnant women would be saved. Life itself is a mystery. Interestingly, the very word 
mystery means the divine secret. It is from the Greek word mustes, which literally means 
close mouth; hence, as noun, an initiate into a mystery. The word means ‗I shut my 
mouth and close my eyes‘. 
 In one religious house, when complications arose, there were special works 
(aseje) concoctions to be made for the woman so that her ways might be through.  An 
FBBA claimed that such complicated cases were always undertaken with no record of 
casualty after the special concoction had been administered. If the complications were the 
work of the enemy, the FBBA claimed that she would give the pregnant woman ‗special 
water‘ which the founder had prayed upon and the woman would have safe delivery.  
If the complication was because the baby was too big for the passage, 
we refer the pregnant woman to hospital for CS (IDI, Female, Faith 
Home, Ilesa West, Sept. 2009). 
 
The Founder of this religious house claimed that she had been taking delivery for the past 
fifty- six years and her spirit told her which delivery was natural and which had the hand 
of the enemy.  
Common pregnancy complications like haemorrhage and breech babies 
were usually sent to the hospitals but we make serious prayers for them.  
We believe that some mothers and mothers-in-law are witches who do 
not want their daughters and daughters-in-law to become pregnant. If 
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they could not stop them from being married and becoming pregnant, 
they wait for them on the days of deliveries.  Such women we encourage 
to be prayerful and not to have bitterness. They should take care of such 
mothers and mothers-in-law. (IDI, Female, Faith Home, Ilesa East, Sept. 
2009). 
 
Two male FBBAs and one female FBBA claimed that private hospitals always called 
them for assistance in complicated deliveries.  One of them recalled two incidents where 
he was invited to the hospital to pray for two women who had complications. He said he 
gave them two tablespoonfuls of anointing oil and they were delivered safely.  Both male 
FBBAs claimed they had never had any complication which they had to refer to 
hospitals; rather, hospitals referred complicated cases to them. This could be an 
exaggeration of their performances. No medical practitioners ever reported that they 
referred cases to FBBAs.  
          Whenever there were complications, an FBBA gave pregnant women native 
sponge and soap upon which he had prayed and read psalms. According to him, when 
they bathed with them, they would be relieved and have safe delivery.  Usually no 
delivery charge was given but at the children harvest thanksgiving ceremonies all 
children delivered must come and invite people who would donate money and items to 
the religious house.   
 When labour prolonged, many FBBAs reported that they depended on God for 
direction as to what to do with each case.  
I have nothing other than the Name of Jesus.  I pray in His Name and 
He is doing His work and only He can help me. I happily refer those 
who can give me trouble and pray God will send them away (Female, 
Faith Care Provider, Ilesa West, Sept. 2009).  
 
This is in line with the findings of Orji et al. (2001). Prayers are often offered when 
complication ensues instead of transferring women early to hospital. The influence of 
religious beliefs was evident in the treatment of pregnancy complications as well as 
access to ANC at the point of delivery. 
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 When pregnant women attend ANC, nurses encouraged them to patronize 
hospitals for delivery, but the nurses interviewed noted that the women usually preferred 
mission houses because of prayers.  A nurse had this to say:  
but we pray for them here also throughout delivery and God answers 
prayers everywhere, evening, morning, house, mountain-top or valley, 
whether night or day (Female, State Hospital, Oct. 2009). 
 
One of the FBBAs claimed that: 
There were instances of pregnant women who had been told in hospitals that 
their scans showed they would have to deliver by CS. When such women 
come and confide in us, we encourage them to go to hospital and we pray for 
them but when they insist that they have faith and believe that God will 
deliver, we give them ‗blessed water‘ to bathe with and drink and God has 
been helping us. However, bleeding and placenta Previa are referred quickly to 
either Wesley or Adenle depending on the preference of the husband (which is 
usually Adenle). We prefer Wesley (OAUTH) for referral but they are 
insultive. They don‘t like us; even when women deliver without complications 
and go there for immunisation, they ask them ‗where did you have your 
baby?‘ When they tell them mission, they are subjected to ridicule that we use 
only holy water; and many nurses from the Teaching Hospital also come here 
to deliver‘ (IDI, Female, Faith Home Ilesa East, Oct. 2009). 
 
For all services FBBAs render, most FBBAs did not receive payment; only a few 
churches charged two hundred naira for registration and about one thousand naira for 
delivery.  Such centres had more or less standard labour wards and practising nurses who 
were members of the religious organizations and who attended to pregnant women that 
might have complications. In most faith houses, there were no registration and 
consultation fees but the women gave free-will offering every week during prayer 
meeting.  This was not compulsory unlike consultation fees in hospitals and one could 
give as little as one US cent or five to twenty naira.  This may have informed why the 
religious houses are always full of people on their prayer days.  
 
 
 
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4.4  Influence of religion in pregnancy care   
 The general Yoruba belief is that pregnancy and childbearing are the works of 
God the Creator of the universe who has supreme control over His creation and does 
what pleases Him. He gives and takes life at His will. He controls all that happens in 
heaven and on earth. No one can query Him. Pregnancy, therefore, is perceived as a 
mystery that only God knows and understands; no one can query Him.  He gives children 
to whomsoever He wishes. The respondents believed that God does not do evil and so 
breeched babies and pregnancy complications are the handiwork of the evil ones. If the 
orthodox medicine sees pregnancies as a natural or biological phenomenon, the pregnant 
women see it as spiritual. Half of the respondents patronised churches for care and a 
quarter delivered their babies there. They have much faith in mission houses and attend 
prayer meetings there religiously. Many caregivers in hospitals during the interviews 
confirmed that many pregnant women only come to them for ANC and immunisation but 
are delivered in mission houses. The researches carried out by Kisekka et al. (1992) and 
Ekanem et al. (1975) were in line with these findings. This is an indication that the 
people‘s religious belief system has great impact on maternal health-seeking.  
 Data from the IDIs revealed that a perceived cause of complication was belief in 
familiar spirits. The only FBBA that reported she had a maternal loss perceived it as the 
work of familiar spirits. She asserted that the woman complained that she dreamt and 
someone gave her injection in the dream. When she woke, she started losing fluid; she 
became swollen with oedema and had a fit.  She was referred to the General Hospital and 
later to the Teaching Hospital but she died on the way. The FBBA said she learnt that the 
woman had familiar spirit and her time was up. The FBBA claimed that the woman was 
the cause of her own death. When a woman dies in the process of delivery, her mother, 
mother-in-law, or herself is always held responsible. When a woman dies, a woman is 
blamed for it; when a man dies a woman is blamed for it. When a woman dies owing to 
carelessness or poverty of the husband, no stigma is attached to the man. However, if this 
woman had attended hospital consistently, the oedema would have been detected early 
and treated and eclampsia that caused her death would have been prevented. 
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 Although many women lacked scientific knowledge of causes of pregnancy 
complications, they were fully aware of their consequences and they dreaded them a lot. 
Many women resorted to FBBHs for solutions. Prayers in these homes illustrate this:  
It must not be hard for me o God. Even if days of delivery are hard 
for others, mine must be an exception in Jesus‘ name. O Lord, I 
take refuge in you. If they use knife to bring babies from other 
women; mine must not be so. O Lord, do not allow me to be 
rushed from delivery room to the operation theatre. O Lord, do not 
let them take the living out of the dead or the dead out of the living  
Those prayer points mean that there should be no maternal or neonatal death /stillbirth. 
Both mother and child should be alive. 
Another song is ―O FBBA, please do not be disillusioned because of my pregnancy.‖ It 
means that on the day of delivery, the work of the FBBA should be made easy because, 
the delivery will be easy.  
They prayed a lot against forces and powers that would not allow the pregnancy and the 
baby to manifest:  
O Lord, do not let Satan succeed concerning me and my pregnancy. 
Ground, open up and consume all that would not allow this 
pregnancy to succeed, ―In my husband‘s family, in my 
natal/orientation family, at my work place and market all those who 
are waiting to punish me on my day of delivery, who said I am too 
lousy and proud; all souls that have turned themselves into mighty 
battle for me during this pregnancy O earth, open up and swallow 
them, Let them be buried under the earth‖  
 
The women have absolute faith in the efficacy of prayers. They always prayed with 
enthusiasm.   
Other choruses include:  
Don‘t let me die with this pregnancy, have mercy on me. My voice 
and my baby‘s voice should be heard on the day of delivery. See me 
through, Father and Son. This nine- month journey, see me through O 
Father. 
 
Songs and prayer points for pregnant women were compiled into a book by some FBBAs 
and were sold to pregnant women. Most of the pregnant women who attended the prayer 
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houses bought the book. They used it for personal and corporate songs and prayers. The 
researcher observed that when these women went to hospitals, they were always agitated 
and in a hurry to leave.  They complained a lot that they were delayed unnecessarily; but, 
in the religious houses, they were more patient and did not complain of time wasting. 
 The beliefs of these respondents were further heightened by reported cases of 
activities of malevolent spirits they heard from FBBAs. Three of such cases are reported 
below. 
 
4.4.1  Reported cases of malevolent spirits’ activities in pregnancies care 
Case 1: 
A male FBBA described some spiritually manipulation experiences he and his colleague 
handled.  He reported that the pregnancy was three years and 11days old. According to 
him:  
The woman had been operated and the baby could not be found for 
the evil ones hid it. After she was closed up and discharged from 
the hospital, she still looked pregnant and was having contractions. 
She was taken to a Celestial Church. The pregnant woman‘s 
mother-in-law came to me for prayer and I saw the pregnant 
woman in a vision during the prayer. I told the mother-in-law to 
bring her. I encouraged her that she would deliver safely. I will 
start to ‗work‘ out her delivery in three days. Soon after she left, 
four women came to me physically and told me not to attempt to 
deliver the woman and that if I did I was going to pay dearly for it. 
I asked them who they were and the offence of the pregnant 
woman, one of them said she was the mother. They did not leave 
without reminding me of the warning not to attempt the delivery. I 
sang a song to them after the warning (Male caregiver, Ilesa LGA, 
Oct. 2009). 
  
(The song means: He (the FBBA) is a living vineyard and that the Spirit of God in him 
cannot dwell with the devil.)  
I told them that I would take the delivery because I was called of God.      
After they left, I told the pregnant woman to be prayerful as some people (I did not 
declare their identities) would not want her to deliver safely.  
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He said that he went to a place he called ‗Fonkoro‘ across a body of water to look for the 
materials to use for the woman and as he was returning with the material his vehicle was 
involved in an accident and he was the only one in the vehicle that was injured. He had a 
broken arm. (As at the time of interview, the hand was still in bandage). According to 
him,  
by the grace of God I saw the baby and the mother wrapped and 
after I administered the concoction, the woman gave birth to a 
maize cob and then a baby boy with a set of teeth (Male caregiver, 
Ilesa LGA, Oct. 2009). 
He said he was to be killed as a result of this delivery but God saved him. When the baby 
did not urinate for five days he reported that he did another ‗work‘ for the baby before he 
urinated and excreted on 8/2/2009. He said the baby was alive and well. 
Jegede (2010) avers that the concept of healing among the three ethnics groups he studied 
is the totality of all steps taken physically and spiritually to bring health back to the 
afflicted. 
 
Case 2:  
This FBBA described another supernaturally perceived manipulated pregnancy his 
colleague took. According to him, the mother of the pregnant woman was going to all 
places with her and paying the bills, including Western medicine but the woman‘s 
delivery was elusive. The mother was pleading that they should help her to ensure that 
her first child was delivered safely. He said they told her mother to release the daughter 
by removing her ―girdle‖. She refused and said she was not willing to remove the said 
girdle even if it resulted in the death of her pregnant daughter. The pastor claimed they 
forced the girdle loose. Before long, the pregnant woman was delivered safely while her 
mother wriggled in pains. He reported that when they set the girdle on fire, the elderly 
woman died. 
 Osunwole (1989) states that beliefs play important roles in traditional health care 
system because some steps taken to procure the medicine are sometimes directed towards 
supernatural beings, particularly the spiritual aspects, like prayers, sacrifices, charms, and 
incantations. Jegede (2010) states that traditional medicine is believed to be capable of 
curing all forms of disease and misfortune. Divination is used to diagnose the nature and 
prescribe cure for diseases. Barks, roots, leaves, and animal parts are often used to cure 
people of their diseases. Most of the steps taken to prepare and administer traditional 
127 
                                                                                
 
medicines are spiritual and cannot be explained by scientific reasoning. Yoruba medicine 
is spiritual in form and depends largely on the belief system of the practitioners.   
 The other male FBBA claimed he was given ―power of the spoken word‖ (afose). 
He said when he commanded babies to come forth, they had to obey.  He said he listened 
to spiritual directions before he attended to pregnant women. Sometimes a ‗maleka‘ (a 
spirit) told him to use coconut water for them.   
 
Case 3: 
 The male FBBA narrated another complicated delivery he took. The woman involved 
insulted an elderly woman in the market. He reported that the elderly woman came to him 
to confess that she had planned that the woman‘s delivery would not be safe so that she 
might learn not to lash elderly women.  He claimed that witches and wizards were 
everywhere but they could not prevail where the power of God was supreme. 
FBBAs use various methods to care for pregnancies and deliveries. 
 This FBBA said he decided to handle only complicated pregnancies and to refer 
those without complications to the hospitals except the pregnant woman and her family 
decided that he should handle it. For such deliveries, he reported that he charged nothing 
―because the delivery gives me no trouble‖. If the family decided to show appreciation 
and brought gifts he took them. He said he knew that there were some families that were 
too poor to offer such gift. He reported that there were some deliveries he took and the 
families could not afford sponge and soap with which to bathe the baby and there was no 
cloth to put on the baby after bathing, yet, he bathed the baby for three days. From such 
families he took nothing; he usually used his money and material for them free.  
 When the researcher asked him on how he got to know all these things, he said 
they were by divine revelations: 
When I sleep, I see them and write them down. I do not forget any of 
the things I dream about and when I awake I follow the instructions 
given and try the concoction when such cases arise and they work.  
 
128 
                                                                                
 
He said that by merely looking at a pregnant woman he could discern whether the 
pregnancy was normal or devil manipulated.    
 These cases revealed the general beliefs of the people on pregnancy care. Women 
who perceive that their pregnancies have any supernatural influence may not patronize 
the orthodox health care system. They are likely going to patronize religious houses for 
care. They are likely going to pray on mountains and take spiritual baths. When such 
women go to hospital for its care, they are likely going to deliver in faith-based homes.  
 The result shows that during the respondents last deliveries, 189 (63.6%) 
delivered in hospitals, 73 (24.6%) of them delivered in FBBH, and 35 (11.8%) at home. 
The table further showed that in the current pregnancies, 211 (42.2%) hoped to deliver in 
hospitals, 179 (35.8%) would go to FBBH, 43 (8.6%) hoped to deliver at home, while 67 
(13.4%) were yet to decide where to have their babies. About one third of the respondents 
hoped to deliver their current pregnancies in faith homes. Sixty-seven (13.4%) of them 
were not decided, on where to have their babies. They hoped God would decide for them. 
When such women fall into labour, they would not be able to take concrete decision on 
time on where to go. This causes Type I delay in seeking help; such women would also 
not be able to purchase the needed delivery materials. This is because there is little 
variation in the material to be bought from one caregiver to the other.  
 Respondents were requested to give reasons for the places they chose for delivery, 
the result reveals that 250 (50.0%) of them chose their caregiver because of religion 
(prayer); 182 (36.4%) did because of care, 44(8.8%) because of cost and 24 (4.8%) 
because of distance. Women were predominant in prayer houses because they claimed 
they believed the in efficacy of prayers. 
  The researcher observed that the FBB A centres were always filled. When 
questioned on how they advertised to bring the women, one of them said: 
We do not advertise, our work advertises us. Pregnant women 
inform one another and once they come they become my friends and 
they are the ones who invite their pregnant friends (IDI, Female, 
Faith Home, Ilesa West, Oct. 2009). 
When women received appropriate treatment, and were happy; they would invite their 
friends and neighbours. However, in some of the churches, the FBBAs reported that 
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during church services and revivals, their pastors announced to the congregation that 
special prayers and delivery services were available in the church for pregnant women. 
They announced that intensive prayers would be offered when they came. These 
encouraged the pregnant women to come and also invite their friends. 
 
4.4.2  Respondents’ religious affiliation and places sought for delivery 
 Table 4.21 captures the distribution of pregnant women and their religious 
affiliations-67 (26.2%) Christians and 6 (15.8%) Muslims had their babies in religious 
centres, 159 (62.4%) Christians; 26 (68.4%) Muslims and 4 (100%) traditional religious 
adherents had their last babies in the hospitals while 29 (11.4%) Christians and 6 (15.8%) 
Muslims had their last babies at home.  There were no religious barriers to places of 
delivery. Many Christians had their last babies in the hospitals probably because many of 
the hospitals such as OAUTH have Christian background. Further, there are sensitisation 
programmes that encourage women go to church for prayers but should go to hospital for 
delivery. It is interesting to note that all ATR members delivered in hospitals.   
 
Table 4.21: Religious Affiliation and Places Where Respondents had their last 
Babies 
Religious Places Respondents Delivered their Last Babies 
Affiliation 
Religious centres Hospital Home Total 
Christianity 67 (26.2%) 159 (62.45%) 29 (11.4%) 255(100%) 
Islam   6 (15.8%) 26 (68.4%) 6 (15.8%) 38 (100%) 
Traditional Rel. - 4 (100%)        - 4 (100%) 
Total 73 (24.6%) 189 (63.6%) 35 (11.8%) 297 (100%) 
Source: Fieldwork, (2009) 
 
130 
                                                                                
 
 Table 4.22 reveals places where women in different religious affiliations hoped to 
deliver their current pregnancies; 158 (36.5%) Christians, 16 (29.6%) Muslims and 5 
(38.5%) Traditional Religion (TR) adherents hoped to deliver their babies in religious 
centres. One hundred and seventy-nine (41.3%) Christians, 29 (53.7%) Muslims and 3  
(23.1%) TR adherents planned to deliver their current pregnancies in the hospital. On the 
other hand, 37 (8.5%) Christians, 2 (3.7%) Muslims and 4 (30.8%) TR adherents hoped 
to deliver their current pregnancies at home. Fifty-nine (14.6%) Christians, 7 (13.0%) 
Muslims and 1 (7.7%) TR adherents were undecided on places to deliver their 
pregnancies. The table also shows that there was significant relationship between 
religious affiliation and places where respondents hoped to deliver their current 
2 
pregnancies (χ =12.830; df = 6; P< 0.05).  
 
Table 4.22: Religious Affiliation and Where Respondents Hoped to Deliver Current 
Pregnancies 
Religious Places respondents hoped to delivery their current pregnancies 
Affiliation 
Rel. centres Hospital Home Undecided Total 
Christianity 158 (36.5%) 179(41.3%) 37(8.5%)  59 (14.6%)    433(100%) 
Islam 16 (29.6%) 29(53.7%) 2(3.7%) 7 (13.0%) 54(100%) 
Traditional Rel. 5(38.5%) 3(23.1%) 4(30.8%) 1 (7.7%) 13(100%) 
Total 179 (35.8%) 190(38.0%) 43(8.6%) 67(13.4%) 500 (100%) 
Source: Fieldwork, (2009) 
 Muazu (1992) and Population References Bureau (2005) claim that 65% of 
Nigerians employ the services of traditional healers. Ekanem et al. (1975) aver that many 
women still prefer the services of TBAs even where trained midwives and physicians are 
available. Bourdillion quoted in Jegede (2010) states that spiritual healing churches 
attract a significant number of conversions even from Islam. 
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  The result reveals that 179 (35.8%) of the respondents hoped to deliver their 
current pregnancies in mission houses. As many respondents were interested in delivery 
in faith homes, the researcher inquired from the FBBAs if they would like to be trained in 
obstetric care. The IDIs revealed that all FBBAs interviewed were ready to be trained. 
Therefore, government needs to spend some money to train them so as to save the lives 
of women and children. There is a need to observe treatment measures adopted by the 
faith homes that attracted the respondents. 
 
4.4.3 Pattern of referrals of pregnancy complications 
 When complications occur and the health care provider patronized is unable to 
handle the case, they usually refer such patients to other care providers. In order to make 
referrals easy, a nurse suggested that ambulances be located near all delivery centres 
because many deliveries take place at night when it would be difficult to arrange for 
transportation.  She observed that, in some emergencies, ten minutes of delay may be 
fatal.  Pregnant women should be made to pay certain amount as contribution so that lack 
of fund would not be a reason why a woman in emergency would not receive care. This 
nurse reported an incident that happened earlier on the day of this interview:  
A woman came to deliver but passenger was greater than the passage (that 
means the baby was too big for the mother to deliver on her own).  The 
lady was a student and had no money.  Her parents and husband were 
hundreds of kilometres away; I called them but had to take ten thousand 
naira from my personal money to refer her to another hospital (female 
Faith Home, Ilesa West Oct. 2009). 
 
 Sometimes faith homes refer patients to each other before the patient is eventually 
referred to the Teaching Hospital. This results in Type 1 Delay described by Adelani 
(2008). A caregiver in one of the faith homes reported a pathetic case where a woman 
had been in labour for three days in another faith home. By the time she was referred to 
this faith home, serious sepsis had set in: 
Immediately she came and we examined her we sent her to the 
hospital. You see there are different assemblies that claim they have 
been called of God.  But many are not called of God but nobody 
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would claim that she was called by Satan. God knows those He 
called; He is helping them (FBBA. Ilesa East, Oct. 2009). 
 
 When complications arise in government maternity centres, health care providers 
refer the women to the Teaching Hospital or a prominent private hospital. However, 
care providers in maternity and FBBAs reported that they preferred the private hospital 
because of the receptive attitude of the care providers there. All religious houses except 
one claimed that they had never had any maternal mortality or stillbirth. One FBBA 
said: 
In the hospitals, deaths are common and expected; that is why they 
built mortuaries. Nobody is held responsible for death in hospital, 
and nobody has ever been punished for deaths that occur there. If 
any woman dies here, there will be a great outcry. I do not refer 
pregnancy complications to hospital. Rather, I help private hospitals 
out when they have complications (Male Faith Home, Ilesa East 
Oct. 2009). 
 
When complications have reached critical stages, FBBAs normally advise the woman‘s 
family to take her to the hospital.  If she arrives too late to be saved, death occurs in the 
hospital and not at the birth house and FBBAs could not be held responsible for death 
that occur in the hospital or on the way to hospital. Deaths that were orchestrated in 
FBBAs‘ houses are pushed to the hospital because of this wrong notion. The effect may 
be that pregnant women begin to associate hospitals to where MM occurs and FBBAs as 
where life is preserved without them being able to associate deaths in hospitals with 
handling in FBBAs‘ homes. Most FBBAs claimed that they referred complicated cases to 
the hospital but the big question is ―how early?‖ Etuk et al. (1999) and Orji et al. (2001) 
note that late referrals from these untrained FBBAs and churches predispose women to 
maternal morbidity and mortality. 
 
 
 
 
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4.4.4 Modes of avoiding complications in faith birth homes 
i) Prayers within the church  
 This result is derived from IDIs and the personal observation during the visits the 
researcher made to faith homes and hospitals. During church regular services, prayers 
were said for safe delivery for pregnant women. In the religious houses, pregnant women 
meet on a specific day in a week between 9 a.m. and 12 noons for prayer. The 
respondents made several of such visits during pregnancy duration.  A typical meeting 
starts with a long time of dancing, singing and praise worship to God for sparing their 
lives, husbands, children, and homes; and that God in His mercies had averted many 
dangers from the women. The prayer items often included praising God that they were 
not involved in spending money on unplanned medical expenses, provision of food, and 
daily maintenance and God‘s goodness in their lives. Shortly after this, they would make 
rigorous prayers against maternal mortality and stillbirths.  They would pray for easy and 
safe delivery and against evil imagination of wicked people; and that they would not be 
referred from one delivery house to another.  They would pray that the evil ones would 
not follow them and that there would be no cause for maternal or/and neonatal deaths.  
Prayers were said also against breech babies and whatever would cause Caesarean 
Sections.  
 The influence of religion could also be seen in hospitals; when women attend 
ANC in hospitals, prayers were always said for safe delivery. One orthodox caregiver 
said ―we encourage women to go to pray in the church but to come for delivery in the 
hospital as the two works hand in hand‖.  Religious houses, however, spend more time in 
prayers than do hospitals. They ask God for mercies on their delivery. They sing songs 
like: 
Baba saa nu mi bi e se sa nu fun obrin onisun eje. E saa nu fun mi. 
Ajaga yi wuwo mee le ruu. E maa se jeki esu fi iya je mi o. E saanu 
fun mi bi mo se nke pe yin o. 
Meaning 
Father God, have mercy on me as you had on the woman with the 
issue of blood. Have mercy on me, this burden is heavy I cannot 
carry it alone.  Do not allow the devil to triumph over me. Have 
mercy as I cry unto you.   
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At another time, the pregnant women kneel down and sing; 
 Ji se Re nde Jesu. Fi agbara Re agbara Re han. Fohun to le j‟oku 
dide je ke niyan re gbo  
Meaning. 
 Stand up to the task Lord Jesus. Show forth your mighty power and 
let it be manifest to everyone. Speak loudly that your people may 
hear. 
 
Psalms 24 of the Holy Bible is commonly read in all mission houses.  
1. The earth is the Lord‘s and the fullness thereof; the world and they 
that dwell therein. 
2. For he hath founded it upon the seas, and established it upon the 
floods. 
3. Who shall ascend into the hill of the Lord? Or who shall stand in his 
holy place? 
4. He that hath clean hands, and a pure heart, who hath not set his soul 
unto vanity, nor sworn deceitfully. 
5. He shall receive the blessing from the Lord, and righteousness from 
the God of his salvation. 
6. This is the generation of them that seek him, which seek thy face, O 
Jacob. 
7. Lift up your heads, O ye gates; and be ye lifted up, ye everlasting 
doors; and the king of glory shall come in. 
8. Who is this King of glory? The Lord strong and mighty in battle.  
9. Lift up your heads, O ye gates; even lift them up, ye everlasting 
doors; and the King of glory shall come in. 
10. Who is this King of glory? The Lord of host, he is the King of glory 
(Full Life Study Bible, 1997).  
 Different Psalms were read for different stages of pregnancy; during the first 
trimester (1- 3 months) they read Psalms 1- 5. To those at the last stage of pregnancy 
(third trimester), they read Psalms 29:8 on water. They drank this water regularly and 
added some to their bath water. They believed this water to be sacred and that it would 
make their delivery easy. The Psalms they read reveal that the fear of the supernatural is 
prevalent. They were afraid of real and imagined enemies. They all believed in the 
supernatural intervention of God to deliver from the hand of the wicked. Pregnant women 
saw pregnancy as a burden which only God could help them to bear. 
 
 
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ii)  Prayer on birth materials 
 In addition to these, as pregnant women bought the materials for delivery such as: 
baby clothes, mackintosh, pampers, napkins, candle or rechargeable lamb, sanitary 
towels, gloves, jik (an antiseptic liquid), razor blades, olive oil, cord clamp, salvon, 
needle thread, cotton wool, mentholated spirit, sponge and soap they were to bring them 
to Mission Delivery Centres where the items were prayed upon and kept.  Each pregnant 
woman submitted a bag with all her delivery materials inside.  She kept a key to the 
materials and left one with the FBBAs. The FBBAs reported that they continued to fast, 
pray and read psalms of victory on them until the women came for delivery.  The prayer 
point was that the materials must be used for the purpose they were bought. Leaving the 
items with the FBBA for her individual and corporate prayers was believed to prevent 
evil ones from knowing when the woman was going to give birth. When contractions 
started, the pregnant woman would walked out of her house without carrying any load as 
if she was going to market or any other place.  No one would know that she was in 
labour, as she would not have to carry any load so that perceived evil eyes would not 
follow her. Belief in secrecy of life is also manifest here. This practice compels the 
pregnant women to give birth with the FBBAs, as most women could not afford to 
duplicate the materials.  If the materials were in the mission house, they would not be 
able to retrieve the materials even if they intended to patronize other caregiver at 
delivery. 
 
 
 
 
 
 
 
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Figure 1: Pregnant Women during a Prayer Meeting in a Church 
                                
 
 
 
 
 
Figure 1: Pregnant Women during a Prayer Meeting in a Church 
 
      
iii)  Vision and foretelling in Religious Homes 
 Qualitative data in some of the religious houses reveal that prophets and seers saw 
visions for pregnant women. Sometimes, they told the women that their babies had been 
tied several times by witches and wizards. In such visions, the women were instructed on 
the health caregiver they were permitted to visit. If anything goes wrong with a specified 
caregiver and the woman has to be referred to another hospital, fear is already created in 
the heart of the woman and they may not want to go to another hospital.  
 A pastor emphasized the importance of visions and prophecies as one of the 
reasons why pregnant women patronized faith homes. He said people had problems and 
they were looking for solution. They also wanted to know what the future held for them. 
These services are not available in orthodox medicine. The researcher observed that, in 
some of the faith homes, pregnant women knelt in front of their pastors/ prophets to hear 
―Thus says the Lord. There are 3 to 4 battles to be fought in front of you. God will 
137 
                                                                                
 
destroy all of them.‖ Then the prophet/ prophetess would pray for them.  A 
Prophet/FBBA said:  
 You nurses and doctors in hospital are blind. You only open your 
eyes and could see nothing. You collect chalk and give people to 
swallow you cannot see the problems in their lives. As for me 
when a pregnant woman comes, and I look at her, maleka‟ (angel) 
would tell me the problems in her life and the ‗maleka‟ would tell 
me what solutions to proffer to their problems. (IDI, Male Faith 
Care Giver, C&S Church Ilesa East, 2009).  
 
Jegede (2010), quoting Frazer (1911), corroborated this, stating that ‗religion is a 
propitiation or conciliation of powers superior to man, which are believed to direct and 
control the course of nature and human life.‘ 
 Solutions include from bathing in flowing river or with water from the well 
within the church, going to mountain tops to pray, using anointing oil to rub the body, 
and fasting.  The pastor provided the soap and the sponge as well as the anointing oil.  
He took those who were to go for prayers to their selected mountain top for whatever 
number of days the ‗maleka‟ stipulated. Jegede (2010), quoted Smith (1950), as saying 
that:  
―Full explication of religion involves complete exploration of social 
and political organizations, material culture, law and custom as well 
as the physical environment‖ 
 
IDIs revealed that (what the researcher describes as) ―pastoral authority‖ (though it may 
have some economic undertone) influenced choice of caregiver. In one church, the pastor 
instructed members of his church not to give birth in hospitals. Members were mandated 
to come to the mission delivery house to give birth. Children born outside would not be 
christened. Those who delivered outside were regarded as having no faith. Those who 
delivered in the church gave five tubers of yam, five measures of rice, and one gallon of 
kerosene to the FBBA. There was a register of all children born within the year and they 
were mandated to be present at the annual children‘s harvest where they donated money 
and other items to the religious house. Whatever proceeds came out of these would be 
shared between the FBBA and the pastor. Sometimes two or three women may be giving 
138 
                                                                                
 
birth at the same time in this place. Community health workers claimed that they paid 
visits to this religious house to see if they could be of assist to the FBBA in charge but 
the FBBA shunned them. They reported that on one of their visits, they met the FBBA 
and three women in labour at the same time. When they volunteered to help they were 
rebuffed. The FBBA was quoted as saying: 
 I live on proceeds from the number of pregnant women that 
patronize this place and I would not allow anyone to block my 
source of livelihood. When I have four or more patients, I may refer 
one to you at maternity centre.  
 
However, when complications arise in that religious house, they usually refer such patient 
to this maternity centre. The health workers asserted that when such patients were 
referred to them, they in turn referred them to the Teaching Hospital, contributing to 
Type 1 Delay (Adelani 2009). The community nurses claimed that when they visited the 
pastor of the church to tell him the happenings in his church, he told them that it was the 
policy of their religious group. On the contrary, the majority of the FBBAs claimed that 
they encouraged women that patronised them to visit hospital for care and referred 
difficult ones. Only three of the FBBAs said they never had causes to refer complications 
to hospitals.  
 
139 
                                                                                
 
 
Figure 2: A pregnant woman and a woman who had been delivered of a baby kneeling in front of a pastor 
 
 
 
140 
                                                                                
 
 
vi).    Prayers on mountain tops 
 Christ Apostolic Church, Cherubim and Seraphim faith caregivers took pregnant 
women to designated mountain tops for prayers regularly; every month or twice a month, 
where they prayed, read Psalms and held vigils. In two of the faith houses, the FBBAs 
said, when they looked at pregnant women, they could discern the position of the babies 
in the wombs.  Those who were perceived to have problems had rigorous prayers said for 
them. If the babies were in breech positions, they claimed that they prayed to make the 
babies take the desired positions. Jegede (2010), quoting Frazer (1911) observed that 
religion enables man to cope with the natural environment and its effect on human 
activities. 
 
v) Exclusive Prayer Camping (Igbe ’le Adura) 
There was also exclusive camping for prayer for women who were perceived to 
have special problems for special prayers and God‘s protection. When the 
prophet/prophetess (FBBA) perceived in a vision that evil was looming for a pregnant 
woman, s/he ordered such a woman to come to church for special prayers. The pregnant 
woman would come to reside in the religious house for a whole day, three, seven, or more 
(usually odd numbers), depending on the seriousness of the perceived evil as directed by 
the ‗maleka‘ (angel). The pregnant woman would bring her food and other necessities to 
the religious house for the number of days.  Prayers would be said for her at stipulated 
times such as 9a.m, 12 noon, 1p.m., 3 p.m., 6 p.m., 9 p.m., midnight and 3 am or on 
hourly intervals. This would be repeated as such if the „Igbe‟le‟ lasted for more than one 
day.  The following Psalms: 128, 91, 62, 35, 29: 5, 28, 24: 1-7 were usually read at 
‗Igbe‟le adura‘ and other meetings. All FBBAs believed in the efficacy of prayers,, 
saying: ―Things prayers would accomplish physical exertion/energy/agility would not be 
able to.‖ 
 The special prayer sessions served as bed rest and relaxation for these women. 
They slept, rested, ate, and prayed without having to bother about care of the husbands 
141 
                                                                                
 
and older children.  They did not cook or do much running around. Food was brought for 
them or they bought food from vendors. 
 For all categories of pregnant women, vigils were organized by Faith Homes on a 
day in a week where pregnant women prayed throughout the night to allay their fears of 
witches and wizards and household troubles as well as whatever evil dreams they had.  
An FBBA said:  
We do not abuse or threaten them. Sometimes, visions are revealed 
concerning them and we take time to pray for them and we encourage 
them to come for special seclusion prayers for the troubled. The prayers 
encourage them a lot (Female IDI Faith House, llesa West, Sept. 2009). 
 
Other women, apart from pregnant women, dominated prayer houses because when 
problems ensued, women tended to be more anxious in looking for solutions. Because 
they bore the brunt of pregnancy and its attendant risks, they always wanted to attend 
these prayers to give them spiritual and emotional comfort.  
 
vi) Application of Blessed, Sanctified Water (omi Iye) and Anointing Oil               
(Ororo Adu’a) 
 All pregnant women came with kegs or bottles of water that they submitted at the 
altar of the church for prayers. Some FBBAs also use anointing oil. Book of Psalms from 
the Holy Bible were read into the water and the oil. One of the FBBAs averred that:  
I give Olive or Robot or Goya oil upon which I had prayed and read 
Psalms 3, 11, 24 to women to drink and rob on their bodies. I use it to 
make sign of the cross on their foreheads and tummy to ward off evil 
from them and their babies (IDI, Female, FBBA Sept 2009). 
When the baby is eventually delivered, she used same Goya oil to clean the baby. The 
baby will be bathed with sponge into which Psalms 1-7, 11, 24 had been read. Anointing 
oil was also for pregnancies that were not developing as they ought. Women in such a 
situation were to drink two spoonfuls of the oil every week until their deliveries. 
Respondents that attended faith homes and collected ‗holy water‘ for drinking and 
bathing were instructed not to boil the water or use it to take hospital drugs. The blessed 
water was believed to be more efficacious than drugs. They were to use fresh water for 
142 
                                                                                
 
drugs if they must take them. In some faith homes, to register in and attend hospital for 
ANC amounted to having no faith, and many members did not want to be seen as having 
no faith. Among some faith homes, civil servants attended ANC just to collect hospital 
paper to pursue their maternity leave form. This is in line with Emile Durkheim‘s 
Functionalist Theory. Durkheim claimed that the society sets apart some items as sacred 
while the rest are profane. In these religious centres, Psalms are read and prayer said on 
the oil, water, soap, sponges and delivery materials. The psalms read and prayers made 
the items sacred. The pregnant women believed this would drive evil far from them.  
  
vii).  Baths in flowing rivers and utilisation of sanctified soap and sponge                
(Ose-Awebi ati Kainkain) 
 Some of the religious houses especially CCC and C&S are located on the bank of 
a river that runs through the town. Those who were not near the river had wells in the 
religious houses. Pregnant women with perceived serious problems took spiritual births 
in this river. Pregnant women who came to these religious houses for prayers and care of 
their pregnancies took water from either the running water or the wells. They used that 
water to bathe there and took some home in bottles or kegs for bathing and drinking. The 
FBBAs and pastors prayed and read psalms over the water. The women were to drink this 
water until the next visit. If the water got exhausted, they were at liberty to come back to 
take more supply. However, the women were at liberty to bring their own water from 
home. 
  The health implication of drinking water from the flowing river is glaring. In 
Ilesa, like other town in Nigeria, a lot of people throw their wastes into this running 
water.  It serves as toilets for many. While some bathe in it, others drink it as the river 
flows down.  Women who take care of their pregnancies in some of these religious 
houses are at risk of water-borne diseases such as typhoid, cholera, dysentery and others. 
 In addition to bathing in flowing river, a faith home, gives ‗ose awebi‟ (soap for 
easy delivery). This could be any toilet soap upon which various prayers have been said 
and many Psalms have been read. This caregiver gives them this soap to bath with and oil 
to rob on their bodies. The researcher was in one of the prayer sessions where the FBBA 
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used the oil to make signs of the cross on all the pregnant women‘s foreheads and 
tummies. The women joyfully robbed this on their heads, their tummies and bodies. She 
bought and gave them this oil herself so that ―they will not buy fake‖. Pregnant women 
who attended faith homes were bound to adhere to all instructions given in the place if 
their deliveries would be taken. 
 Another FBBA gave local black soap or special Lux or any toilet soap and 
sponge. Pregnant women must bath with the soap and sponge every Friday when they 
attended prayer meetings. There was a section of a river called „Omi Ayo‟ (water of joy) 
that passes through the town. Troubled people, pregnant women inclusive, go to bath 
naked in the morning, afternoon and night depending on the gravity of their perceived 
problems. It is believed that as rivers do not flow backwards, the problems they brought 
would flow away with the river. 
 Furthermore, to avoid pregnancy complications, all FBBAs instructed pregnant 
women that they should not be found outside between 1-3 p. m and 1-3 a. m daily.  They 
believed that children with familiar spirits who move around at that time can drive out 
good children in pregnant women‘s wombs and replace them with bad ones. 
We tell the women not to go out in hot afternoon or at midnight 
between 1-3am and pm to avoid evil children who may take over their 
wombs (IDI, Female, FBBA Sept 2009). 
 
viii).  FBBAs and Counselling Services 
 Apart from care giving in pregnancy, FBBAs also provided counselling services 
for pregnant women and their spouses. Women were able to discuss their marital 
problems with faith caregivers freely. One FBBA recalled that a husband came to report 
that his wife always refused sexual advances from him and he had sent her away.  The 
FBBA sent for the wife, advised her and reunited the family. 
We encouraged them to do family planning so that they would not send 
their husbands out (Female, Faith Home, Ilesa West, Oct. 2009) 
One FBBA recalled the case of a pregnant woman whose last baby was less than one 
year.  She was sick and was contemplating an abortion.  The FBBA reported that she 
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encouraged her not to abort; and that God had special plans for them and would take care 
of them. She left the pregnancy and had a safe delivery.  
 FBBAs instructed pregnant women on how to live peacefully with their in-laws 
and husbands to avoid complications. Pregnant women were told to avoid arrogance, 
quarrelling, and fighting with their husbands so that he would buy maternity materials.  
The FBBAs reported that they usually invited husbands for progress report on the 
character of their wives. They tried to find out whether there was improvement in their 
marriage relationships. If any husband complained of misbehaviour of the wife, the 
woman would be reprimanded and advised to turn a new leaf. This was done to enlist the 
cooperation of the husband on the day of delivery. 
 Faith caregivers further instructed pregnant women to endure some hardship with 
their husbands and be grateful for whatever the husband could afford because of the 
prevalent economic crisis in the country. Women whose husbands were irresponsible 
were advised not to fight to avoid being kicked in the tummy, the damage of which might 
be incalculable. They were encouraged to be patient and avoid trouble. They were 
admonished never to quarrel because of pregnancy or children. Those in the early stage 
of pregnancies were advised to rest and avoid fighting to avoid miscarriage. 
 FBBAs warned pregnant women about other women outside who were ready to 
entice their husbands with money and materials so that they could go out with them.  
They were counselled that: if their husbands were having extra-marital affairs, they 
should not fight the man or the woman friend; if the husbands were members of FBBA‘s 
church, they would be called and advised to desist for the sake of their children so that 
the children would provide social security for them in future.  This cautioned the men 
because they did not want to suffer at old age. Hospitals have no such services. 
 Some of these services endeared the hearts of pregnant women to the FBBAs. 
IDIs revealed preference for FBBAs as caregivers probably because of their attitudes. 
FBBAs were amiable, easily available and their phone numbers were given to all 
pregnant women. They were allowed to call them any time of the day. Worthy of note is 
the cordial relations the researcher observed among the religious caregivers and pregnant 
women. The women were allowed to sleep and sit anywhere they liked. The researcher 
145 
                                                                                
 
observed that some women went to lay full length on the altars of the churches asking 
God for mercy during their deliveries. This was different from what was observed in 
hospitals where the women sat on long benches and sleeping was not allowed because of 
space congestion or fear of the nurses. 
 Faith homes instructed their attendees not to bring advanced pregnancy of eight to 
nine months to them for delivery because they did not know the history of such 
pregnancies. As a result they did not take emergency deliveries.  They sent such to the 
hospitals as captured below:  
When such pregnant women insisted on delivering with us claiming 
nothing was wrong with them and their last babies were easy, we educated 
them to know that no two pregnancies were the same; the fact that the last 
pregnancy was free of trouble and complication does not guarantee that 
complications could not show their ugly heads suddenly at the last minute. 
But those who come for prayers must have prayed off complications (IDI, 
Female, Faith Home, Ilesa West, Nov. 2009). 
 
Women who did not conform to regular prayers were refused at labour because, according 
to the FBBA, 
We need the prayers; a woman who has not been coming for the prayers 
cannot be admitted because we are not aware of how her pregnancy had 
fared (IDI, Female, Faith Home Ilesa East, Oct. 2009). 
 
 It is interesting to note that the FBBAs rejected women who came for emergency 
delivery without attending their weekly prayer sessions. They claimed that they did not 
know the histories of their pregnancies and had not prayed through on such women and 
could not expose themselves to unnecessary stress if any complication arose. But they 
were quick to accuse the Teaching Hospital of not taking prompt care of unbooked 
patients they referred there. 
  Apart from spiritual help given by faith homes, they were more sympathetic to 
the cause of the pregnant women. A hospital caregiver reported an incident of a pregnant 
woman who tested positive to HIV. When she was in labour, she went to the hospital. 
The midwife on duty who knew her status told her to come back hours later because she 
146 
                                                                                
 
still had many hours to labour but actually it was to give the nurse time to finish her duty. 
The pregnant woman had no alternative but to resort to a faith home where she was 
delivered of a baby shortly on arrival. The FBBA did not use gloves. It was the pregnant 
woman who knew her status that insisted that gloves be used or that she be allowed to 
pack her blood by herself as she could not tell the FBBA her status and was not willing to 
spread the virus. FBBAs used bare hands to take deliveries and circumcise children. If 
FBBAs become infected, thousands of pregnant women and children are at risk because 
these FBBAs do not go for HIV test. 
 For all these services, FBBAs usually did not receive regular payment. During the 
interviews, some FBBAs confessed that they were not really happy with the financial 
returns of their work. Many complained that, sometimes, women vomited and passed 
stool on them and yet they were not able to pay. The FBBAs continued the work because 
they believed that God called them and they had to obey. In many religious homes, 
although deliveries were free, couples and their children were required to come to church 
that took their children‘s delivery during harvest and thanksgiving programmes in 
September or October of the year. The parents gave money and those that appreciated the 
FBBAs gave them personal gifts. Women who refused the invitation were regarded as 
ingrates and such women would normally come when they face another problem. To 
solve that problem they had to show gratitude for help rendered in the past. This is 
evident in the report of this FBBA: 
There was a woman who did not come back for thanksgiving. She had 
other problems and, where she went to pray; she was reminded that she 
did not give thanks where she received her baby. She had to return to me 
after many years with money and yams.  
 
This indicates that, although there may not be immediate gratification, many pregnant 
women return at later dates to appreciate the FBBAs.  
 The belief that evil people can harm pregnant women pervades the study area. 
This may be responsible for the secrecy that attends pregnancy and deliveries. It may be 
the reason why pregnant women do not register in hospitals during the first trimester. 
Many women would not want people to know they are pregnant until their tummies 
147 
                                                                                
 
protrude and it becomes evident for all to see. However, secrecy is not limited to 
pregnancy alone; it is manifested in other facets of life. Many people hide successes in 
career, academia, business, and employment. They would not tell their neighbours and 
relations; they have gained admission to a university, or are travelling, or building a 
house. When they go to their villages, they go in public transport so that their people will 
not know that they own a car. They believe that people of darkness can overturn the good 
things of life that come to them. A common adage in Ilesa is ―bi isu eni ba ta, se ni a a 
dowo boo je‖ (if your yam yields well on the farm, you should not expose it. You should 
cover it and eat it quietly, without allowing others to see.) 
 A few religious houses cooperated with hospitals and allowed nurses to attend 
their prayer meetings to give health talks to pregnant women on cleanliness, personal and 
environmental hygiene, immunisation, blood tests, and scan. Some FBBAs instructed 
women to go to hospital for scanning and blood examination to ensure that they were 
physically okay and there would be no complications. Women were free to do these tests 
in any hospital of their choice. During the following prayer meeting, they would give 
feedback to FBBAs on what the hospital discovered and it would become a basis for 
more prayers. Where these tests were done, and there were no signs of complications, the 
FBBAs would take the deliveries but when the result suggested complications, the 
FBBAs would allow nurses to direct the women to appropriate hospital, as seen in this 
except: 
But when the women insist that they would deliver here; I ask the 
heavenly spirit:  If the spirit tells me to deliver her I will do; if not I 
send her away (Female Ilesa West, Oct. 2009). 
 
The respondents had great faith in FBBAs being vested with more power through prayers 
to avert dangers than orthodox medicine. However, OAUTH records revealed that more 
maternal deaths are recorded from unbooked patients than those who booked in hospitals. 
Many of such women were brought in with their babies born before arrival (BBA). 
Maternal loss record at OAUTH Ilesa revealed that 73.3% were unbooked patients who 
were referred at moribund conditions. In fact, 33.3% had already delivered elsewhere and 
were brought when life was almost lost. 
148 
                                                                                
 
 
 
4.4.5  Maternal mortality recorded at OAUTH Ilesa from 2005-2008 
 Secondary data from OUATH reveals that the majority of maternal deaths 
recorded in the hospital were unbooked women that were referred to the hospital in 
critical conditions. Fifteen MMs were identified between years 2005-2008; 11 (73.3%) of 
them were unbooked women, while 4 (26.7%) were booked.  Causes of death in five 
(33.3%) were post partum haemorrhage (PPH) whose babies were born before arrival 
(BBA); four (80%) of these were unbooked.  Another two died as a result of eclampsia: 
one was booked and the other unbooked. Two died from obstructed labour; both were 
unbooked. One unbooked woman died from Ante-partum haemorrhage (APH); one 
unbooked from abdominal malignity; one booked from ruptured uterus; one booked died 
from respiratory distress; and the last was brought in deeply unconscious. Audu-Airede 
(2000) found that many women came to hospital as a last resort when complications had 
set in and ―mother is on death road‖.  
  This buttresses the claims of Harrison (1997) that unbooked emergencies 
constitute no fewer than 70% of all hospital maternal deaths in Nigeria. The researcher 
found it so, even after 38 years of Harrison‘s study. The women received no ANC care 
and arrived at the hospital for the first time when their lives were already endangered by 
difficult labour, advanced pregnancy complications, or coincidental disease (Harrison, 
1997).  
 Many of these women attempted to deliver outside the hospitals but when 
complications arose, there were delays in getting them to hospital on time. The women 
knew that, if they laboured for two days in hospital and could not deliver, CS would be 
done; but, in mission houses they could labour for four days or more before they would 
be referred to another place. This delay might be life-threatening and result in the women 
being taken to hospital in moribund conditions, which Adelani (2005) describes as Type I 
Delay. It may result in mortality of either mother or child or both.   
 
149 
                                                                                
 
 
 
Table4. 23 Percentage Distribution of Causes of Maternal Mortality Recorded at 
OAUTH Ilesa from 2005-2008 
 Causes of Death Booked Unbooked Total 
Abdominal malignity - 1 (100%) 1/15(6.7%) 
Ante-Partum Haemorrhage (APH) - 1 (100%) 1//15 (6.7%) 
BBA/PPH brought in Deeply    
Unconscious 
1 (20%) 4 (80%) 5/15 (33.3%) 
Eclampsia  
1 (50%) 1 (50%) 2/15 (13.4%) 
Obstructed Labour 
- 2 (100%) 2/15 (13.4%) 
`Respiratory Distress 
1 (100%) - 1/15 (6.7%) 
Retained Placenta 
- 1 (100%) 1/15 (6.7%) 
Ruptured uterus 
1 (50%) 1 (50%) 2/15 (13.3%) 
Total 4 (26.7% ) 11(73.3%) 15 100%) 
Source: OAUTH, Ilesa, Secondary Data obtained in November 2009  
 
4.4.6 Influence of denominations on places respondents delivered their last 
pregnancies 
Table4. 23 shows that 19 (11.9%) Catholics, 38 (23.7%) Protestants, 101 (63.7%) 
Pentecostals and 1 (0.7%) member of Jehovah‘s Witnesses had their last babies in 
government hospitals. Six (9.0%) Catholics, 13 (19.2%) Protestants, 46 (69.2%) 
Pentecostals, 2 (2.5%) Jehovah‘s Witnesses had their last babies in FBBHs; while 2 
(5.3%) Catholics, 5 (17.6%) Protestants, 21 (74.8%) Pentecostals and 1 (2.3%) member 
of Jehovah‘s Witnesses had their last babies at home. Altogether, 159 (62.3%) Christians 
had their last babies in hospitals; 67 (26.3%) Christians had their last babies in FBBHs, 
while 29 (11.4%) Christians had their last babies at home. NDHS (2003) states that, as at 
150 
                                                                                
 
2003 63% of the women received ANC from orthodox caregivers and 61% from urban 
centres received ANC from doctors and 23% from nurses and midwives (Giwa- Osagie et 
al., 1990). 
 
Table 4.23 Influence of Denominations on Places Respondents Delivered their 
Last Pregnancies 
Places of last Denominations 
Delivery Catholics Protestant Pentecostals Jehovah Total 
Witnesses 
Govt. Hosp. 19 (11.9%) 38 (23.7%) 101 (63.7%) 1 (0.7%) 159 (62.3%) 
Mission/FBBHs 6 (9.0%) 13 (19.2%)    46 (69.2%) 2 (2.5%)  67 (26.3%) 
Home 2 (5.3%)    5 (17.6%)    21 (74.8%) 1 (2.3%)   29 (11.4%) 
Total 27 (8.8%)  56 (20.3%)  168 (69.1%) 4 (1.8%) 255 (100%) 
Source: Fieldwork, (2009) 
 
4.4.7 Influence of Denominations on Places Respondents Hoped to deliver their 
Current pregnancies 
Table 4.24 reveals that 22 (12.2%) Catholics; 33 (18.2%) Protestants; 123 
(68.0%) Pentecostals and 3 (1.7%) Jehovah Witnesses hoped to deliver their current 
pregnancies in hospitals; 10 (6.7%) Catholics; 24 (16.0%) Protestants; 114 (76.0%) 
Pentecostals and 2 (1.3%) Jehovah Witnesses hoped to deliver their babies in FBBHs 
while 3 (7.9%)  Catholics; 9 (23.7%) Protestants 24 (63.2%) Pentecostals; 2 (5.3%) and 
Jehovah Witnesses hoped to deliver their current pregnancies at home. Among all 
denominations, 3 (4.7%) Catholics; 22 (34.4%) Protestants; 38 (59.4%) Pentecostals and 
1 (1.6%) member ofJehovah Witnesses were not decided on the caregivers to utilize at 
the point of delivery. The implication of this is that when labour sets in, this indecision 
may result to type 1 delay. There may be the problem of where to take the women to 
deliver; it may also mean that the needed delivery materials for any particular caregiver 
may not be ready because each of these caregivers has distinct materials they request 
pregnant women to purchase.   
 
 
151 
                                                                                
 
Table 4.24: Influence of Denominations on Places Respondents Hoped to Deliver 
their Current Pregnancies 
Places Hoped to Denominations 
Deliver Current Catholics Protestant Pentecostals Jehovah Total 
Pregnancy Witnesses 
Hospital 22 (12.2%) 33 (18.2%) 123 (68.0%) 3 (1.7%) 181(100%) 
Mission/FBBHs 10 (6.7%) 24 (16.0%) 114 (76.0%) 2 (1.3%) 150 (100%) 
Home   3 (7.9%)   9 (23.7%)  24 (63.2%) 2 (5.3%)    38(100%) 
Undecided   3 (4.7%) 22 (34.4%) 38 (59.4%) 1 (1.6%)    64 (100%) 
Total  38 (8.8%)  88 (20.3%) 299 (69.1%) 8 (1.8%) 433 (100%) 
Source: Fieldwork, (2009) 
 
 Table 4.25 captures the number of deliveries in OAUTH, Ilesa from the year 2004 
to 2008. Fifty-seven (2.3%) of them were assisted breech deliveries; 884 (35.4%) were 
CS. Forceps deliveries were 9 (0.4%). There were 1,514 (60.7%) cases of spontaneous 
virginal deliveries (self-deliveries), while vacuum deliveries were 28 (1.12%). The 
number of CS was high because when the women labour for two days in the hospital and 
delivery was delayed, hospital authorities would subject such pregnant women to CS to 
save the lives of the mother and the child. Besides, many women were referred to 
OAUTH in moribund conditions and only emergency CS could save their lives.  
 
 
 
 
 
 
 
 
 
 
 
152 
                                                                                
 
Table4. 25: Distribution of Types of deliveries at OAUTH, Ilesa from 2005-2008 
Types of Deliveries Number of Deliveries 
Year 2005 2006 2007 2008 Total 
Assisted Breech (ABD)   6 16  12   23 57 (2.3) 
Caesarean Section (CS)   161 201 242 280 884(5.4) 
Forceps delivery     1   2  2    4      9 (0.4) 
Induced -    2 0         -    2 (0.08) 
Spontaneous Virginal Deliveries (SVD)   264 393 380 477 1514(60.7) 
Vacuum    5  16 3 4     28(1.12) 
Total 437 630 639 788 2494 
(17.5) (25.3) (25.6) (31.6)  (100) 
Figure in brackets are in percentages 
Source: OAUTH delivery Records in Ilesa (2005 – 2008) 
 
Three of the FBBAs assured pregnant women that if hospitals wanted to do CS and 
they came to them, they would deliver within one hour. Women who heard this 
constantly may refuse CS. This might cause delay that might be life-threatening and 
result in the women being taken to hospital in moribund conditions. However, hospital 
reports may not have the final answer at all times. An FBBA noted a supernatural 
intervention in a pregnant woman‘s case. The woman went for a scan and the baby was 
breech. The FBBA sent her to a hospital but she refused to go but started crying. The 
pregnant woman, according to the FBBA, looked through the window towards the sky 
and said:  
O God, you know my financial position. The money I owe in this 
hospital I have not paid it; one nurse stood in for me. Wouldn‘t you 
have compassion on me and deliver me safely without operation? 
(IDI, Female, Pregnant woman, Sept.  2009). 
 She said as she tearfully prayed, she sat and in 30 minutes the baby had turned so that in 
less than one hour she was delivered safely. 
153 
                                                                                
 
 Many studies have found that haemorrhage, eclampsia, obstructed labours, 
retained placenta and ruptured uterus were major causes of MM (Harrison, 1997). 
Although unbooked patients constituted 23.8% of hospital admission, they contributed 
73.3% of maternal loss. Audu-Airede (2000) also claims that users‘ fees increased MM 
by 600% in University of Nigeria Teaching Hospitals beginning in 1987.  
 
4.5  Factors that influence decision on care during pregnancy 
4.5.1  Influence of formal education on place of pregnancy care 
  Education is perceived as one of the indices of economic status in Nigeria. It is 
established in the literature that literate men and women have access to information and 
are more likely to utilize hospital services. Table 4.26 reveals the respondents‘ 
educational qualifications and choice of place of pregnancy care. Ten (33.3%) of the 
respondents with no schooling attended ANC in government hospitals; 7 (23.3%) in 
private hospitals; 8 (26.7%) in church/religious centres; and 5 (16.7%) combined church 
and hospital.  
 Among the women that had primary education, 7 (30.0%) attended government 
hospitals, 12 (26.1%) went to private hospitals; 11 (23.9%) attended religious centre for 
pregnancy care and 6 (13.0%) combined the two. Thirty-eight (46%) of those who did not 
complete secondary education attended government hospitals; 16 (19.5%) attended 
private hospitals; 20 (24.4%) had the ANC in mission houses; 2 (2.4%) went to drug 
stores; 6 (13%) combined church with hospital. Among those who completed secondary 
education, 64 (33.9%) attended ANC in government hospitals; 47 (24.9%) went to private 
hospital, 47 (24.9%) attended churches; 1 (0.5%) visited drug shops; and 30 (15.9%) 
combined hospital and church. About 38% of those who had tertiary education went to 
government hospitals; 40 (26.1%) went to private hospitals; 34 (22.2%) attended mission 
houses; 1(0.1%) claimed herbal treatment; while 20 (13.1%) combined church and 
hospital. The result reveals that all levels of educational groups attended faith homes for 
pregnancy care and many have reasons for combining them. This is consistent with earlier 
studies. Jegede‘s (2010) respondents in Ika combined hospital treatment with church 
healing services, while others combined hospital treatment with traditional remedies; 
154 
                                                                                
 
many members of Pentecostal churches were found not to believe in hospital medical 
care. 2008 NDHS also reported that 36% of Nigerian pregnant women received no ANC 
during the period of it study. There was no substantial change in proportion of women 
receiving no antenatal care between 2003 NDHS (37%) and 2008 NDHS (36%). 
 
Table4. 26: Influence of Formal Educational on Place of Pregnancy Care 
Highest Educ. Therapeutic Choice for ANC/ Pregnancy Care  
Qualification 
Total 
Govt. Private Mission Church Pharm Herb 
Hosp. Hosp. & 
Store 
Hosp. 
No Schooling 10( 33.3) 7 (23.3) 8(26.7) 5(16.7) - - 30 (100) 
Primary 1 (30.0) 12 (26.1) 11(23.9) 6(13.0) - - 46 (100) 
Secondary (Uncomp.) 38(46.3) 16(19.5) 20(24.4) 6(13.0) 2(2.4) - 82 (100) 
Secondary (Compl.) 64(33.9) 47(24.9) 47(24.9) 30(15.9) 1(0.5) 1(0.1) 189(100) 
Tertiary 58(37.9) 40(26.1) 34(22.2) 20(13.1) - - 153(100) 
Total 187(37.4) 122(24.4) 120(24.0) 67(13.4) 3(0.6) 1(0.2) 500(100) 
Figure in brackets are in percentages 
Source: Fieldwork, (2009) 
 
4.5.2. Influence of formal education on knowledge of convulsion as a symptom of 
pregnancy complication 
 Table 4.27 shows that 11(36.7%) of the respondents fell into ―no schooling‖ 
category, while 23 (50%), 38 (46.3%), 19 (52.4%) and 90 (54.2%) of them had primary, 
secondary uncompleted, secondary completed and tertiary education, respectively. 
Overall, only 254 (50.8%) of the respondents recognized convulsion as a sign of 
complications; no wonder 2 (13.3%) of MM in the Teaching Hospital was due to 
eclampsia. There was no significant relationship between educational qualification and 
2 
respondents‘ perception of convulsion as a sign of pregnancy complications (χ =3.979; 
155 
                                                                                
 
df=4; P> 0.05).  There was a wide gap in respondents‘ knowledge of pregnancy 
complications. Pregnant women of all categories of educational qualifications were 
ignorant of convulsion as a symptom of pregnancy complications.  
 
Table 4.27 Influence of Formal Education on Knowledge of Convulsion as a 
Symptom of Pregnancy Complication 
Educational Knowledge of Convulsion as a Symptom of Total 
Pregnancy Complications 
Qualification 
Yes No 
No schooling 11 (36.7%) 19 (63.3%) 30 (100.0%) 
Primary 23 (50.0%) 23 (50.0%) 46 (100.0%) 
Sec(uncompleted) 38 (46.3%) 44 (53.7%) 82 (100.0%) 
Sec (completed) 99 (52.4%) 90 (47.6%) 189 (100.0%) 
Tertiary 83 (54.2%) 70 (45.8%) 153 (100.0%) 
Total 254 (50.8%) 246 (49.2%) 500 (100.0%) 
2 2
X critical 9.49 X cal 3.979 df 4 P 0.40 
Source: Fieldwork, (2009) 
 
4.5.3  Influence of formal education on perception of breech baby as pregnancy 
complications  
 Education is believed to enhance a person‘s knowledge and perception. Table 4.28 
reveals the educational qualification of the respondents and perception of breech baby as a 
symptom of pregnancy complication. Fourteen (46.7%), 28 (60.9%), 44 (53.7%), 115 
(60.8%) and 86 (56.2%) of respondents with no schooling, primary, secondary 
uncompleted, secondary completed, and tertiary education, respectively, perceived that 
breech babies were a symptom of complications. The rest were not aware. There was no 
156 
                                                                                
 
significant relationship between educational qualifications and perception of breech baby 
2
as sign of pregnancy complications (χ =3.116; df =2; P> 0.05).            
 
Table 28:  Influence of Formal Education on Perception of Breech Baby as        
                     Pregnancy Complications 
Educational Perception of Breech Delivery as a Sign Total 
of Pregnancy Complications 
Qualification 
Yes No 
No schooling    14 (46.7%) 16 (53.3%)  30 (100.0%) 
Primary  28 (60.9%) 18 (39.1%)  46 (100.0%) 
Secondary uncompleted)  44 (53.7%) 38 (46.3%)  82 (100.0%) 
Secondary(completed) 115 (60.8%) 74 (39.2%) 189 (100.0%) 
Tertiary  86 (56.2%) 67 (43.8%) 153 (100.0%) 
Total 287 (57.4%) 213 (42.6%) 500 (100.0%) 
2 2
χ critical 9.49  χ cal 3.116 df 4 P 0.539 
Source: Fieldwork, (2009) 
 
4.5.4  Respondents’ level of income and perceived place to treat pregnancy 
complication 
 A person‘s perception of causes of pregnancy complication will determine where 
she goes for treatment. The respondents were required to identify places where they 
perceived pregnancy complications should be treated. Table 4.29 contains pregnant 
women‘s perception of where to treat pregnancy complications: 230 (46.0%) of them 
believed that pregnancy complications should be taken to religious centres; 195 (39.0%) 
believed they should go to hospitals; 74 (14.8%) reported that maternities were right 
places for treatment of pregnancy complications; only 1(0.2%) would stay at home for 
157 
                                                                                
 
2 
home remedies. This observation was statistically significant (χ = 505,737 df =1, N= 500, 
P< 0.05). The table further reveals that 179 (47.2%) of those that earned 10,000 naira 
perceived that pregnancy complications should be treated in religious centres; 146 
(38.5%) would treat complications in maternity centres 54 (15.2%) in hospitals; and none 
at home. Twenty-five (41%) of those who earned 10,001-20,000 naira would treat 
pregnancy complications in mission or religious centres; 24 (39.3%) of them at maternity 
centres; 11 (18%) in hospitals and 1(1.6%) at home. Among the respondents that earned 
20,001- 30,000 naira; 14 (56%) would treat complications in religious centres, 6 (24%) at 
maternity centres; 5 (20%) in hospitals and none would stay at home. Among those who 
earned 30,001-40,000 naira, 8 (42.1%) would treat pregnancy complications in religious 
centres; 10 (52.6%) would treat them at maternity centres; 1 (5.3%) in hospitals; while 
none would stay at home. Among those who earned 40,001-50,000 naira, 2 (28.6%) 
would go to religious centres for treatment of pregnancy complications; 4 (57.1%) would 
treat complications at maternity centres; and 1(14.3%) would go to hospitals. Among 
those who earned 50,000 naira and above 2 (22.2%) would go to religious centre; 5 
(56.5%) would treat complications at maternity centres and 2 (22.2%) would go to 
hospitals; while none would stay at home.  
 The table shows that there was no significant relationship between income and 
2 
perceived places sought for treatment of complications (χ = 8.137; df = 2; P > 0.05).  
Jegede (2010) posits that, in time of special stress, anyone may find attractive the support 
of the tight-knit and enthusiastic community of healing churches and accept confidence in 
the powerful symbols of their preaching and rituals. Bourdillion (1991), cited in Jegede 
(2010), argues that there are varieties of possibilities that people could choose from when 
they require relief from sickness. Modern medicine, in most cases, is combined with 
other sources of healing.  
 The overall result is that, there was no economic barrier in patronage of FBBAs. 
All categories of women patronized mission houses. Even those who patronized 
government hospitals still supplemented it with visits to mission houses.  
 
 
158 
                                                                                
 
Table 4.29: Influence of Respondents’ Monthly Income on Choice of Place to 
Treat Complications 
Income of Place for Treatment of Pregnancy Complications Total 
Respondents 
Rel. Centres Maternity Hospital Home 
< ₦10,000  179 (47.2) 146 (38.5%) 54 (15.2%) - 379 (100%) 
₦10,001-₦20,000  25 (41.0%) 24 (39.3%) 11 (18.0%) 1 (1.6%) 61 (100%) 
₦20,001-₦30,000  14 (56.0%) 6 (24.0%) 5 (20.0%) - 25 (100%) 
₦30,001-₦40,000  8 (42.1%) 10 (52.6%)     1 (5.3%) - 19 (100%) 
₦40,001-₦50,000  2 (28.6%) 4 (57.1%) 1 (14.3%) - 7 (100%) 
₦50000+  2 (22.2%) 5 (56.6%) 2 (22.2%) 9 (100%) 
Total  230 (46%) 195 (39.0%) 74 (14.8%) 1 (0.2%) 500 (100%) 
 
Source: Fieldwork, (2009) 
 
4.6  Aderence of pregnant women to care providers’ prescriptions and basic 
instructions. 
 It is one thing for pregnant women to attend hospitals for care in pregnancy, it is 
quite another for them to adhere to instructions given to them. WHO defines adherence as 
the extent to which a person‘s behaviour−taking medication, following diet and / or 
executing a lifestyle changes−corresponds with agreed recommendations from a health 
care provider. Non-adherence is common with negative consequences of failure to 
achieve the desired medical treatment. The level of adherence of pregnant women to 
hospital‘s instruction determines how much benefit accrues to them in hospital maternal 
159 
                                                                                
 
care. The researcher sought to know the level of women‘s adherence to instructions under 
the following sub headings: 
i) Adherence to Focused Antenatal Clinic (FANC)  
ii) Adherence to immunisation regimes 
iii) Reason for non-adherence. 
iv) Adherence to FANC by marital  status 
v) Adherence to sleep, food and exercise among respondents during pregnancy 
vi) Adherence to drug administration 
 
4.6.1a  Adherence to Focused Antenatal Clinic (FANC) 
 Respondents were requested to indicate whether they ever attended ANC. Table 
4.31 reveals the pregnant women‘s level of adherence to attendance at ANC: 398 (79.6%) 
attended ANC, while 102 (20.4%) did not attend any. Among those who attended FANC, 
only 258 (51.6%) did ultrasound diagnostic tests; 380 (76.0%) did blood tests; while only 
52 (10.4%) attended hospital at other times apart from ANC when they were sick; 448 
(89.6%) did not attend hospital outside FANC. This implies that only pregnancies force 
women to attend hospital. Most of the women attended hospitals only when they were 
pregnant. Jegede (2010) found that the majority of people first used traditional medicine 
before utilizing modern medicine after attempts at traditional medicine had failed. 
 Ultrasound diagnostic tests would enable caregivers to know early the positioning 
of the baby so as to know what management procedure to follow. But when women 
refuse or cannot afford the money for ultrasound, the caregiver may be unaware of 
impending danger. By the time he/she is aware of any complication; things may have 
gone out of hand or may require higher cost of management. 
 Blood test is to ensure that the pregnant women have adequate blood and prevent 
anaemia. This test is to be done often to detect anaemia, but 24% of the respondents did 
not subject themselves to this test. The IDIs reveal that some caregivers refused to do the 
test so that they would not expose themselves to other people‘s blood because of HIV 
160 
                                                                                
 
infection. When this happens, anaemia may be detected late, when blood transfusion 
would be the only appropriate solution; but the IDIs reveal that pregnant women and their 
husbands dread blood transfusion. Researches have shown that early detection and 
management of diseases, like cancer ensures their cure. NDHS (2008) claims that early 
detection of problems during pregnancy leads to more timely treatments and referrals in 
case of complications. 
 Table 4.31 further shows that only 242 (48.4%) of the respondents took the 
immunisation at the appropriate time, while 258 (51.6%) did not. Not taking the 
immunisation as and when due renders the ones taken useless and ineffective and it can 
be counter-productive. The respondents that did not take immunisation on time would not 
be able to complete the doses as scheduled and the immunisation would not be able to 
prevent the diseases it is meant to prevent.  
 
Table 4.30:  Adherence to Focused Ante-natal Care 
Adherence to Hospital Regimes Yes No Total 
Ever attended ANC 398 (79.6%) 102 (20.5%) 500(100%) 
Undertook Ultrasound Diagnostic 258 (51.6%) 242 (48.4%) 500 (100%) 
Examination 
Undertook Blood Sample Examination 380 (76.0%) 120 (24.9%) 500 (100%) 
Immunisation taken as and when due 242 (48.4%) 258 (51.6%) 500(100%) 
Source: Fieldwork, (2009) 
 
 Among those that did blood tests 155 (75.2%) of prim; 136 (62.4%) of 
multigravidals and 4 (50.0%) of grand multigravidals would accept blood transfusion if 
there was a need. There was significant relationship between number of pregnancy and 
decision to accept blood transfusion if there was a need. Among the three categories, 
most prims would accept blood transfusion. This may be due to fear on the part of the 
inexperienced primigravidals who would not want to leave their health to chance. 
 
161 
                                                                                
 
4. 6.1b. Respondents’ access, utilisation and places sought for antenatal clinic 
service 
 Attendance at ANC is perceived to be a positive indication of maternal and child 
health. Attendance at ANC has been associated with positive pregnancy outcome. Table 
4.31 reveals that 398 (79.6%) ever attended ANC; 309 (61.8%) attended ANC in 
hospital/maternity only, 182 (39.4%) attended ANC in FBBH only 61 (13.4%) combined 
hospital and FBBH; while 4 (0.8%) went to Pharmacy/ drug store. Among the 
respondents that ever attended ANC, 86 (17.2%) attended only once, 152 (30.4%) 
attended twice, 24 (4.8%) attended three times, while 199 (39.8%) attended four and 
more times. 
 
Table 4.31:  Percentage Distribution of Respondents Access to, Utilization and 
Places Respondents Sought for Antenatal Clinic Service 
ANC Attendance  Variables Number of Respondents Percentage 
Ever attend ANC   
Yes 398 79.6 
No   102   20.4 
Where did you attend?   
Hospital/Maternity only 309 61.8 
Mission only 120 24.0 
Church & Hospital   67 13.4 
Pharm/Drug Store     4   0.8 
How many times did you attend?   
None  39  7.8 
Once  86 17.2 
Twice 152 30.4 
Thrice   24   4.8 
4 & More  199 39.8 
Source: Fieldwork, (2009) (F= 500) 
 
162 
                                                                                
 
4.6.1c Age of Pregnancy at First ANC Attendance 
Attendance of ANC at the right time is paramount to effective care. Table 4.32 revealed 
that 151 (50.8%) of the respondents attended ANC for the first time at the first trimester 
during their previous pregnancy; 92 (31.0%) at the second trimester and 54 (18.2%) at 
the third trimester. Among those who attended ANC during their current pregnancy, 274 
(54.8%) attended ANC for the first time during the first trimester, 174 (34.8%) attended 
during the second trimester, and 52 (10.4%) attended at the third trimester. Nwokocha, 
(2006) reported late antenatal registration among Ibani people of Rivers State, Nigeria. 
The 2008 NDHS reported that only 16% of women had their first ANC at the first 
trimester and 36% did not receive any ANC.   The result of late registration is that the 
respondents would not be able to take the right number of immunisations or undergo 
other required tests. This may also cause delay in early detection of pregnancy 
complications.  
 Many of the pregnant women went to hospital only when the pregnancies had 
developed considerably and could not take more than 2 out of the 3 compulsory Tetanus 
Toxoid injections. Many of them could not take more than one because of lateness to 
register. The lateness to register may be due to general secretive nature of pregnancy in 
the study area. Many women believe that if evil people get to know that they are 
pregnant early, they can attack such pregnancy. There is the tendency to hide the 
pregnancy until it can no longer be hidden. Although the respondents attended ANC, 
they could not adhere to immunisation regimes, despite the caregivers‘ emphasis on the 
importance of immunisation. 
 
 
 
 
 
 
 
163 
                                                                                
 
Table 32: Age of Pregnancy at First ANC Attendance  
st nd rd
Trimesters 1 2  3  Total 
1-3 months 4-6 months 7-9 months 
Age at 1st ANC attendance 151 (50.8%) 92 (31.0%) 54 (18.2%) 297 (100%) 
Previous Pregnancy. 
Age at 1st ANC attendance 174 (34.8%) 274 (54.8%) 52 (10.4%) 500 (100%) 
Current Pregnancy. 
Source: Fieldwork, (2009) 
 
4.6.2a  Adherence to immunisation regimes 
 Respondents were requested to indicate the number of times they attended ANC. 
Table 4.33 indicates pregnant women‘s level of adherence to attendance at ANC Among 
the 398 (79.6%) that ever attended ANC, 27 (6.8%) attended once, 129 (32.4%) 
attended twice, 68 (19.2%) thrice, and 166 (41.8%) attended four or more times. 
Hospital authorities regard pregnant women as booked if they attend ANC at least 4 
times and take all immunisations and other recommended tests. The table shows that 
only 166 (41.8%) attended up to the stipulated 4 times. Irregular attendance would not 
allow women to take all the immunizations, or complete other examinations that are 
necessary for the success of the pregnancy.  
 Immunisation regimes have been found to be effective in reducing maternal and 
child mortality as well as morbidity. Table 4.33 reveals the respondents‘ adherence to 
immunisation regimes: 91 (18.2%) did not take any immunisation, 173 (34.6%) took only 
one, 188 (37.6%) took two, 19 (3.8%) took three and 29 (5.8 %) took four. The majority 
(72.2%) of the respondents did not take more than two tetanus toxoid.  
 
 
164 
                                                                                
 
Table 4.33: Percentage Distribution of the Respondents’ Adherence to 
Immunisation Regimes 
Number of Times  0 1 2 3 > 4 Total 
Ever Attended ANC 102 68 129 27 166 500 
(20.4%) (19.2%) (32.4%) (6.8%) (41.8%) 100% 
Number of  91 173 188 19 29 500  
immunization (5.8%) 
(18.2%) (34.6%) (37.6%) (3.8%) 100% 
Source: Fieldwork, (2009) 
 
4.6.2b  Religious affiliation and number of immunisations taken 
 To adhere strictly to instruction, hospital authorities expect pregnant women to 
take at least three tetanus toxoid injection. Table 4.34 captures the respondents‘ religious 
affiliation and number of immunisations taken. Among the Christians, 84 (19.4%) took 
none, 151 (34.9%) took one, 153 (35.3%) took two, 45 (10.4%) took three. Among the 
Muslims, 6 (11.1%) took none, 16 (29.6%) took one, 30 (29.6%) took two, 2(3.8) took 
three. Among traditional religious worshippers, 1 (7.7%) took none, 6 (46.2%) took one, 
6 (46.2%) took three. Only 48 (9.6%) completed minimum requirement of the 
immunisation while 91(18.2%) did not take any. There was significant relationship 
2 
between religious affiliation and number of immunisation taken (χ = 12.830; df = 6; P< 
0.05). NDHS (2003) reported that less than 50% of pregnant women took tetanus toxoid 
injections in Nigeria. Despite the great campaign in Ilesa on the radio, television and 
house-to-house campaign by community nurses on the need to immunize children, the 
result reveals that pregnant women did not learn from immunisation campaigns on 
children that they also needed to get immunized. The 18.2% that did not take 
immunisation is still high and there is need to continue the sensitization programme. The 
2008 NDHS put Nigerian immunisation level at 64% in the South and 46% in the North. 
165 
                                                                                
 
Some women augment their access to ANC with attendance in religious homes, while 
some depend solely on faith homes. 
 
Table 4.34 Religious Affiliation and Number of Immunisation Taken 
Religious Number of  immunisations taken 
affiliation 
None 1 time 2 times 3 times Total 
Christianity 84 (19.4%) 151(34.9%) 153(35.3%) 45(10.4%) 433 (100.0%) 
Islam 6 (11.1%) 16 (29.6%) 30 (55.6%) 2 (3.8%) 54 (100.0%) 
Traditional Rel. 1 (7.7%) 6 (46.2%) 5 (38.5%) 1 (7.7%) 13 (100.0%) 
Total 91 18.2%) 173(34.6%) 188(37.6%) 48 (9.6%) 500 (100.0%) 
2
X critical     12.59 df 2 P 0.046 
Source: Fieldwork, (2009) 
 
4.6.3 Respondents’ reasons for non-adherence to regimes 
 Table 4.35 reveals the respondents‘ reasons for not attending ANC; strike 1 
(0.2%), engagement in other things, 117 (23.4%); no money, 9 (1.8%): religion, 131 
(26.2%); and 133 (42.6%) forgot or had no reason. The table also presents the reasons 
for non-adherence of respondents to immunisation schedule. Two hundred and twenty 
(44.0%) of the respondents failed to adhere because of religious reasons; while 38 
(7.6%) of the respondents did not because they forgot/had no reasons. The FBBAs 
asserted that to solve the problem of forgetfulness, they mandated husbands to remind 
their wives of when to come for the next prayer meeting. Strike actions were common in 
the Teaching Hospital. The respondents said that they had to register in other places to 
avoid being embarrassed on the days of delivery. 
 
166 
                                                                                
 
Table 4.35: Percentage Distribution of the Respondents’ Reasons for Non-
Adherence to Regimes 
Reasons for  Strike Engaged in No Religious Forgot Total 
other money Belief No 
Non adherence   
things reason 
To   
ANC 1 117 9 131 133 301 
Attendance (23.4%) (1.8%) (26.2%) (44.4%) (0.2%) (100%) 
To Drug    _ Do not like 18 42 (27.3%) 49 154 
drug (11.8%) (31.8%) (100%) 
45 (29.2%) 
To     _         _     _ 220 38 258 
immunisation (85.3%) (14.7%) (100.0%) 
regimes 
Source: Fieldwork, (2009)  
  
4.6.4 Adherence to FANC attendance by marital status 
 It is expected that married women would be encouraged by their husbands to 
attend ANC more than the other categories of women. Table 4.36 shows that, among the 
singles 10 (15.4%), 20 (30.8%), 15 (23.1%) and 20 (30.8%) attended ANC once, twice, 
thrice, four and more times, respectively. Among the married, 69 (18.5%) attended once, 
113 (30.3%) attended twice, 39 (10.5%) attended ANC thrice, 152 (40.7%) attended 4 
times or more. Among the divorced/separated/widowed, 2 (28.6%) attended once, 
4(36.4%) attended twice, 4 (36.4%) attended four or more times, while 1 (9.0%) went 
thrice. The table also shows that, there was no significant relationship between marital 
2 
status and number of ANC attended (X = 17.816; df = 20; P> 0.05). The result reveals 
that respondents of all categories attended FANC and that marital status did not affect 
attendance at ANC. 
167 
                                                                                
 
Table 4.36: Marital Status and Attendance at ANC 
 Number of  Times ever Attended Ante-Natal Clinic  
Marital Status TOTAL 
1 2 3 4+ 
Single 10 (15.4%) 20 (30.8%) 15 (23.1%) 20 (30.8%) 65 (100.0%) 
Married 69 (18.5%) 113 (30.3%) 39 (10.5%) 152(40.7%) 373 (100.0%) 
Co-habiting 5 (9.8%)   15 (29.4%)   8 (15.7%) 23 (45.1%) 51 (100.0%) 
Divorced/ 2 (18.2%)    4 (36.4%) 1 (9.0%) 4 (36.4%) 11 (100.0%) 
Separated/ Widow 
Total 86 (17.2%) 152 (30.4%) 63 (12.6%) 199(39.89%) 500 (100%) 
2
  X cal 17.683 df 20 P 0.608 
Source: Fieldwork, (2009) 
 
 Attending ANC is not enough; it is imperative that pregnant women decide to 
deliver in hospitals. This is because a seemingly risk-free pregnancy can suddenly 
become risky at the point of delivery, needing experts‘ attention. 
 When the respondents were poor and could not afford delivery materials, they 
might result to mission houses for fear that they would be reprimanded in the hospitals. 
The respondents were aware that churches were given to charity and would come to their 
aid by providing for them when the couples had little or nothing prepared for delivery. 
Community nurses also asserted that women went to local government maternity centres 
without delivery materials and might be lucky to have leftovers from other pregnant 
women. The nurses reported that nylon bags were used as gloves for some women when 
they had no money for gloves.  
 Another factor that determines adherence to instruction is the problem of male 
preference.  At one of the maternities, the caregiver mentioned cases of women who were 
abandoned by their husbands because all their previous deliveries had been girls, the 
168 
                                                                                
 
women always believed that their current pregnancies would be boys. A gynaecologist 
mentioned similar cases of grand multigravidals who were advised to do permanent 
family planning to save their lives. They always refused because they believed that their 
next babies could be boys but, many times, the next pregnancies ended up being girls. 
They kept trying for baby boys to the detriment of their lives. This is in line with the 
claim of Isiugo-Abanihe (2003), that preference for male children encourage high fertility 
rate. Women are forced into having many pregnancies so as to have male children who 
would secure their inheritance at the demise of their husbands. 
 Generally, the respondents reported that they did not deliver by themselves at 
home. When this happened, the babies were usually wrapped and taken to the maternity, 
hospital or mission for care of the umbilical cord. 
169 
                                                                                
 
 
 
Figure 3: ANC Attendance at a Private Hospital 
  
 
 
 
 
 
  
170 
                                                                                
 
Most faith caregivers instructed pregnant women to take all the necessary immunisation, 
precautions, and then pray; and that their prayers would be answered. An FBBA said the 
conclusion was ―listen to instructions, accept what you are told and act on it‖ (IDI, 
Female, Faith Home Ilesa East, Oct. 2009).  
 FANC new schedule requires that pregnant women make their first visit at the end 
of 16 weeks, a second visit between 24-28 weeks, the third at 32 weeks and the fourth at 
36 weeks. However, women who stand the danger of being exposed to risks are expected 
to pay additional visits (2008 NDHS). It is one thing to register in faith home or hospital; 
it is another thing to attend regularly. To ensure regular attendance, FBBAs kept registers 
of attendance to detect those who were irregular so as to know whether or not to take 
their deliveries.  Most of the FBBAs commented that they did not accept to take 
deliveries of women who had not been coming to them for prayers as well as those who 
refused to adhere to instructions. 
 
4.6.5 Influence of religious affiliation on places respondents attended for pregnancy 
care  
Table4. 37 reveals that 255 (82.5%) Christians; 48 (15.5%) Muslims; 6 (1.9%) ATR 
members attended ANC in hospitals alone; while 113 (94.2%) Christians, 3 (2.5%) 
Muslims and 6 (1.9%) ATR members attended FBBHs alone for pregnancy care. 
However, 6 (1.9%) Christians; 3 (4.5%) Muslims and 3 (4.5%) ATR members combined 
church and hospital care-providers.  The result showed that most of the respondents 
patronized hospitals and FBBHs for their pregnancy care. However, the majority of 
Muslims delivered in hospitals. NDHS (2003) notes that, the proportion of births attended 
by TBAs in North East, North West and North Central Nigeria, which in the northeast, 
which is predominantly Muslims, is far greater than that in the other geographical zones. 
 
 
 
 
 
171 
                                                                                
 
Table 4.37: Influence of Religious Affiliation and Places Respondents attended for 
Pregnancy care  
Places attended Religious  Affiliation  
for Pregnancy Christianity Islam ATR Total 
care  
Hospital 255 (82.5%) 48 (15.5%) 6 (1.9%) 309 (100%) 
Mission/FBBHs 113 (94.2%)    3 (2.5%) 4 (3.3%) 120 (100%) 
Church& Hospital   61 (91.0%)    3 (4.5%) 3 (4.5%)   67 (100%) 
Pham. /drug store      4 (100%) - -     4(100%) 
Total 433 (86.6%) 54 (10.8%) 13 (100%) 500 (100%) 
Source: Fieldwork, (2009) 
4.6.6  Adherence to FANC attendance by number of pregnancy 
 Table 4.38 reveals that of all categories of respondents, 106 (77.4%) prim attend 
antenatal clinics‘ followed by multigravidals 79 (50%) and grand multigravidals 2 
(28.6%) at the early months. There is a significant relationship between number of 
pregnancy and early attendance of ANC. Most of all, primigravidals attend ANC most 
regularly. This may be because of fears and inexperience. They want to take precaution 
while grand multigravidals might take things for granted because of their past 
experiences. In actual fact, grand multigravidals are supposed to take extra precaution 
because of the health hazards of high parity. 
Table 4.38: Number of Pregnancy and Antenatal Attendance 
Age of pregnancy at Number of pregnancy  
first ANC Prim Multigravidals Grand mult. Total 
1-3 months 106(77.4%) 79 (50.0%) 2(28.6%) 187(61.9%) 
4-6 months 26 (19.0%) 72 (45.6%) 5(71.4%) 103(34. %) 
7-9 months   5 (3.6%)   7 (4.4%) 0 (0.0%)    12 (4.0%) 
Total 137 (100%) 158 (100%) 7 (100%) 302 (100%) 
2
X cal 28.703 df 4 P 0.000 
Source: Fieldwork, (2009) 
172 
                                                                                
 
4.6.7 Influence of denominations on places Christians patronized for pregnancy 
care 
Table 4.39 reveals places where different Christian denominations patronized for 
pregnancy care.  The table reveals that 19 (7.0%) of Catholics; 69 (25.5%) of Protestants; 
179 (66.1%) of Pentecostals and 4 (1.5%) of Jehovah Witnesses attended Government 
hospitals. Fourteen (13.6%) of Catholics; 12 (11.7%) of Protestants; 74 (71.8%) of 
Pentecostals 3 (2.9%) of Jehovah Witnesses attended FBBHs for pregnancy care. The 
following combined FBBHs and hospitals: Catholics 5 (8.9%); Protestants 5 (8.9%); 
Pentecostals 45 (80.4%) and Jehovah Witnesses 1 (1.8%). The results reveal that 271 
(62.6%) of Christians patronized orthodox caregivers for ANC; 103 (23.8%) patronized 
FBBHs alone while 56 (12.9%) of Christians combined hospitals and FBBHs. The result 
shows that almost two thirds of Christians patronized orthodox care-providers for ANC. 
NDHS, (2003) reports that more pregnant women in Southwest patronized orthodox 
caregivers and that TBAS are more patronized in Northeast, Northwest and North Central 
than in other geo- political zones. NDHS, (2003) reveals further that 62.7% of pregnant 
women in the South received two or more tetanus toxoid. 
 
Table 4.39: Influence of denominations on places Christians patronized for 
pregnancy care 
Places of attended Denominations 
for Pregnancy care  Catholics Protestant Pentecostals Jehovah Total 
Witnesses 
Govt. Hosp. 19 (7.0) 69 (25.5) 179 (66.1) 4 (1.5) 271 (100) 
Mission/FBBHs 14 (13.6) 12 (11.7)   74 (71.8) 3 (2.9) 103 (100) 
Church& Hosp.    5 (8.9)    5 (8.9)    45 (80.4) 1 (1.8)   56 (100) 
Pharm./drug store -    2 (66.7)       1 (33.3) -     3 (100) 
Total 38 (8.8) 88 (20.3) 299 (69.1) 8 (1.8) 433 (100) 
Source: Fieldwork, (2009). 
 
4.6.8  Adherence to food, sleep and exercise regimes among women during 
pregnancy 
 To be healthy, all human need adequate intake of all categories of food; this is 
particularly important for the pregnant woman. She has to take enough for herself and 
the baby. Three hundred and forty-eight (69.6%) of the respondents took fruits daily; 
173 
                                                                                
 
104 (20.8%) took fruits weekly, and 39 (7.8%) seldom took fruits. For healthy living, 
daily consumption of all categories of food in adequate quantities is also essential. The 
respondents were requested to state the type of food and fruits they ate in the last two 
days. Those who indicated that they ate fruits and vegetables daily were categorized as 
having taken balanced meal, while those who did not take fruits were classified as 
having taken unbalanced meal. Four hundred and fifty-six (90.4%) indicated they ate 
balanced diet, while 46 (9.2%) did not. This, however, was different from what 
qualitative data reported. The IDIs revealed that many women wanted to appear 
gorgeous on the day of christening their babies. Instead of using their money for good 
food, they saved it to buy clothes that they would exchange for ―show off‖ at their 
children‘s christening. In their health talks, FBBAs tried to discourage this tradition and 
encourage women to use such money for good food to avoid complicated deliveries. 
They were told that their children should be seen as their clothes.  
 Table 4.40 presents women‘s adherence to sleep, food and exercise prescriptions. 
Among the respondents, 52 (10.4%) slept only for 4 hours a day; 93 (18.6%) slept for 5 
hours a day; and 355 (71.0%) slept for 6 or more hours a day. A pregnant woman needs a 
lot of rest and at least six hours of sound sleep to be healthy and carry the baby through. 
Lack of sound sleep can predispose her to hypertension and some pregnancy-related 
complications. Pregnant women need daily consumption of adequate quality food, 
especially protein, fruits, and vegetables to produce healthy babies. The researcher 
grouped women as having eaten balanced diet if they indicated that they ate fruits and 
vegetables daily. A lack of adequate consumption of these categories of food may result 
in food deficiencies that may result in pregnancy complications. To prevent 
complications, caregivers instructed pregnant women to take fresh fruits. The respondents 
were also instructed to eat fruits so that their babies‘ bodies would be neat and healthy. 
This is possible because Ilesa is blessed with different types of fruits and vegetables that 
are available all year round; therefore they are easy to come by.  
 To be healthy, daily exercise is necessary for adequate function of the heart. The 
respondents identified the type of exercises they did; 15 (3.0%) did none; 173 (34.6%) 
did some trekking, 195 (39.0%) did house work, while 117 (23.4%) drew water from the 
wells. The respondents were instructed in ANC and faith clinics to avoid strenuous 
174 
                                                                                
 
work. The FBBAs also instructed husbands to assist their wives in drawing water from 
the well. This could have accounted for the low number of women that drew water from 
the well.  
 The respondents were instructed to do some exercises like trekking to keep them 
strong and active. This is essential to make them strong and energetic during labour. 
However, itinerant hawking of wares from street to street that would subject pregnant 
women to kilometres of trekking was discouraged. This was perceived to be capable of 
exposing them to too many prying eyes, some of which could be evil. Pregnant women 
who were traders were encouraged to sell their wares in the same place with little 
exercise. All caregivers discouraged rigorous sexual activities during the first trimester of 
pregnancy to avoid miscarriage; but they instructed the pregnant women to allow their 
husbands to have access to them so that there would be no misunderstanding at home. 
Primigravidals were instructed to have sex regularly with their husbands to allow for 
easy passage of the baby at delivery. 
 
Table 4.40 Adherence to Sleep and Food Regimes 
Adherence to Regimes Number of Percenta- Df Chi Sig. 
Respondents ges Square 
Hours of < 4 hours 52 10.4    
Sleep    5 hours 93 18.6    
   6 hours 355 71.0 1 399.809 .000 
Quality Balanced 456 90.4 
of Food Diet 
Unbalanced 46 9.2 
Diet 
Fruits in Daily  Weekly Seldom  Don‘t like Fruits 
take 348 (69.6%)  104 (20.8%) 39 (7.8%) 9 (1.8%) 
Types of None  Trekking  House work Drew water 
exercise 15 (3.0%) 173 (34.6%) 195 (39.0%)  117 (23.4%) 
Source: Fieldwork, (2009) 
175 
                                                                                
 
 An FBBA instructed pregnant women to take plenty of unpolished grains. 
Nutritionists have found this to be helpful to encourage bowel movement. Health talks in 
hospitals were similar to those in faith homes (although food proscription is not common 
in hospitals). Faith homes discourage pregnant women from eating plantain to avoid 
stomach upset and congenital skull deformities. Plantain contains a lot of calcium, iron 
and vitamins. This instruction could lead to iron deficiency, causing the woman to 
become anaemic if she cannot get alternative source of these nutrients. Wahab (2004) and 
Erinosho (2006) observe that banana, mango, gizzard, fish, egg, melon soup, antelope, 
grasscutters were proscribed for pregnant women in some societies. Both groups of 
caregivers prescribed taking a lot of water, protein, fruits, and vegetables for mothers and 
proscribed excessive carbohydrate that might lead to excessive weight gain which might 
precipitate pregnancy-induced hypertension.  
 The respondents that had swollen legs and bodies were discouraged from taking 
salt. Some caregivers instructed the respondents to eat melon, green vegetables, eggs, 
moinmoin and leguminous products. They were instructed to eat this food while pregnant 
and not keep them until after delivery. Traditionally, pregnant women keep melon soup 
and other attractive food till after delivery. The FBBAs said they discouraged over-eating 
or eating of fried food to avoid diarrhoea and prevent premature labour. Both groups of 
caregivers encouraged pregnant women to eat their breakfast on time. All caregivers 
advised pregnant women on absolute cleanliness in food preparation to avoid diseases 
and consumption of artificial spices. This advice is perceived to reduce complications in 
pregnancy and deliveries.  They were instructed that their older children should eat well 
to avoid sickness and being hospitalized. Strict adherence to this will make them avoid 
unnecessary spending and the trouble of being hospitalized. When pregnant women 
adhere to all instructions, they still need adequate care throughout the duration of 
pregnancy because complications can occur at any point without warning. 
 As much as respondents would want to adhere to instructions from ANC or 
prayer houses, marital disunity was reported to be one of the reasons of non adherence 
to hospital regimes. A health officer noted that they had to take delivery of a woman 
with a nylon bag. The woman said she bought everything with her money and kept them 
with her mother, hoping that the husband would give her money but he did not. When 
176 
                                                                                
 
she fell into labour, she could not get to her mother to collect the materials. This 
illustrates role separation in the area. Even where women were capable of paying, they 
still expected their husbands to pay. 
 Many of the religious houses encouraged the pregnant women to go to the 
hospital for care, especially scanning and blood test. This encouraged the respondents to 
combine orthodox and religious houses. Some FBBAs employed nurses to assist them in 
taking delivery, especially if they envisaged complications; but a few of the FBBAs 
discovered that the nurses cheated them to make quick money.  An FBBA lamented that 
she employed a nurse and was paying her from the altar to assist to palpate, administer 
drug, do blood test, scan, as well as assist her when she had many deliveries to take 
simultaneously. Unknown to the FBBA, the nurse had her own clinic and secretly, gave 
her phone numbers to direct pregnant women there.  
 
4.6.9  Adherence to drug administration 
 Pregnant women are required to take routine drugs to prevent malaria and 
anaemia and to supplement their food intake to ensure they have enough vitality to cope 
with the stress of pregnancy, labour and delivery. The respondents were requested to state 
whether they got the drugs and took them. Table 4.41 reveals that 321 (64.2%) of them 
were given drugs, while 179 (35.8%) were not given. Among women that were given, 
222 (69.2%) claimed they took the drugs as prescribed, while 99 (30.8%) did not. Those 
who got drugs but did not utilize them were not better than those who did not collect the 
drugs at all, if they were not worse, because the drugs would have been useful to some 
other people.  
 
Table 4.41: Drug Administration and Utilization 
Adherence to Drug Yes No Total 
Drugs Administered 321(64.2%) 179 (35.8%) 500 (100%) 
Drugs Taken as prescribed 222 (69.2 %) 99 (30.8%) 321 (100%) 
Source: Fieldwork, (2009) 
177 
                                                                                
 
 The qualitative data also revealed that some respondents did not adhere to drug 
use. Some husbands noted that they reminded their wives to take their drugs and they 
did but a particular husband said his wife was an adult and should take her drugs 
without being guided. He, however, reported that there were lots of un-used drugs in 
their house. The cooperation of husbands, pregnant women and mothers-in-law and 
significant others is necessary to reduce non-adherence to drug use and, by extension, 
pregnancy complications. Drugs, immunisation and other tests should be adhered to. 
The quantitative data also supported this claim, as some of the respondents claimed that 
they did not utilize drugs given to them because they did not like taking drugs. When 
drugs are not taken as prescribed, they cannot be effective and may even be counter- 
productive.  
 Table 4.42 reveals that among the respondents, adherence to drug varied 
according to the number of pregnancy ever had. The study showed that 184 (88.9%) 
primigravidals, 152 (73.4%) multigravidals, and 3 (66.7%) grand multigravidals 
received drugs; while 178 (85.2%) primigravidals, 149 (68.7%) multigravidals; and 3 
(42.9%) grand multigravidals adhered to drug prescription. There was a significant 
relationship between number of pregnancy and drug utilization. This could be because 
the primigravidals lacked experience and were not willing to leave things to chances, 
while the grand multigravidals might be over-confident owing to their past experiences. 
However, the grand multigravidals were ranked as having high-risk pregnancies in the 
literature and they are supposed to take precautions and adhere strictly to prescription. 
This study showed a significant relationship between number of children and adherence 
to drug prescription. 
178 
                                                                                
 
 
Table 4.42: Adherence to drug prescription and number of Pregnancies  
Adherence to drug Number of Pregnancies  
administration 
Total 
Prim Multigravidals Grand multigravidals 
Drug Administered 184 (88.9%) 152 (73.4%) 4 (66.7%) 340(100%) 
Drug utilized 178 (85.2%) 149 (68.7%) 3 (42.9%) 330 (100%) 
2
X cal 22.210 df 2 P 0.000 
Source: Fieldwork, (2009) 
 
 Health talk also included avoidance of drugs that were not prescribed and local 
concoction.  The respondents were instructed not to drink alcohol. Orthodox health 
caregivers reported that wives to okada (commercial bike) riders reported that their 
husbands gave them malaria and piles concoction that were made with alcohol. The 
women were advised not to take such. The respondents that refused to adhere to FBBAs 
instruction were referred to hospitals. 
  The qualitative data revealed that packed cell volume (PCV) and HIV tests were 
mandatory for all pregnant women; but some caregivers did not adhere strictly to this 
because of fear that they might contract HIV.  According to one hospital caregiver:  
The less you puncture other people, the less the risk of exposures to 
their blood the less the risk of contracting the disease (Female, Private 
Maternity, Ilesa East, Sept 2009).  
 
Retroactive or HIV/AID tests are compulsory in government hospitals and caregivers in 
such hospitals sometimes refused women who did not submit to the test because their 
HIV status was unknown and they might be at health risk. The most patronized private 
maternity centre in Ilesa did not do retroactive blood test. When the researcher asked the 
owner why she did not do the test, she said: ―It will be adding other financial burden to 
179 
                                                                                
 
already impoverished women‖ (IDI, Female, Private, Maternity, Ilesa West, Oct. 2009). 
This revealed the ignorance of this caregiver too. She was not aware that the test was 
free. Some caregivers insinuated that high patronage of this maternity was because no 
premium was laid on HIV test there.  The respondents were scared about the test.  
 Other instructions given at the FBBHs were that pregnant women should not bend 
over so that their babies would not have hiccups. This actually prevents falls.  
Respondents were instructed to take care of their bodies and environments.  
 Some orthodox caregivers complained that pregnant women did not adhere to 
instructions on maintaining their normal skin texture.  They bleached and, when they had 
complications that needed surgery, suturing became difficult. 
 
4.7   Men’s roles in caring for the health of pregnant women 
 In every patriarchal society, men play significant roles in their families. Men are 
perceived as responsible when they are financially sound and could procure all or most of 
the materials for delivery and afford other bills related to taking care of their families. 
They are expected to take care of their pregnant wives by rendering different services to 
assist their wives. The researcher sought to identify the roles men play in pregnancy care. 
In ANC and prayer meetings, women were instructed to show their attendance cards with 
list of delivery materials to their husbands/partners so that they could help them pay and 
remind them of next appointment at ANC or FBBH as well as encourage  them to adhere 
to instruction given.  
 
4.7.1:  Men’s roles in pregnancy care  
 Table 4.43 indicates that 309 (61.8%) of the husbands paid for maternity 
materials; 102 (20.4%) wives paid, while 67 (13.4%) jointly paid. One husband in an IDI 
said proudly: ―I paid for everything. I am the owner of my child‖ (Male, husband, Ilesa 
West Oct. 2009). However, three of the husbands reported that they did joint purse and 
the payment was from that purse. These husbands asserted that they jointly chose 
OAUTH for care giving. Those who claimed that they paid everything noted that they 
180 
                                                                                
 
single-handedly recommended caregivers for their wives. Two husbands averred that 
they allowed their wives to choose care providers for themselves because they knew how  
their bodies felt and who best could help them.  A health officer also affirmed that ―many 
husbands paid for their wives maternal care though they may rain curses on the wives‖. It 
was possible for women to pay because they also had their own sources of income 
distinct from those of their husbands. Many women were traders and were economically 
independent. Women that depended solely on their husbands were regarded as lazy. ‗Ole 
a ji woo video‘ (Lazy woman that wakes up early to watch films). Jegede (2010) observes 
that Yoruba women engage in economic functions, such as trading, and they have 
absolute control over their income. Only a few turn their income to their husbands and 
these do so in a situation where there are no competing co-wives. 
 Parents or in-laws paid for 11 (2.2%) teenagers whose partners probably denied 
the paternity of the babies or absconded. Eleven (2.2%) of the respondents reported their 
bills were paid by the church. In these days of a shift from extended to nuclear family 
system, many people find solace and comfort in their religious groups in time of crisis 
rather than in extended family ties. One interviewee confirmed this: 
I find that members of my church are closer to me than my blood relations 
because these are the people I see around me in times of crises (Female, 
Pregnant woman, Oct. 2009). 
 
In every facet of life, choices are made and the choices we make determine our destiny. 
Some choices we made many years ago determined where we now find ourselves. 
Women are required to take decisions concerning childbearing. The pregnant woman‘s 
preferences will reflect the kind of decision she makes. These preferences are reflected in 
the places she patronizes for care of her pregnancy and these would also influence where 
she delivers present and future pregnancies. The choices she made of care providers may 
make or mar her pregnancies. This decision can be a herculean task, depending on the 
nature of her husband. In most instances, the man takes this crucial decision for her. 
Table 4.43 presents the decision-making patterns of the respondents: 140 (31.6%) 
husbands single-handedly decided on the number of children they were to have in the 
family; 90 (18.0%) wives decided on the number of children; 90 (18.0%) of the 
181 
                                                                                
 
respondents decided jointly 100 (20.0%) of them claimed that God decided; while 21 
(4.2%) cases were unplanned. In about 25% of the deliveries, there were no concrete 
plans on family planning. They did not use family planning devices and hoped God 
would plan their families for them.  
 Table 4.43 equally reveals that 251 (50.2%) of the husbands chose health 
caregivers for their wives; 164 (32.8%) of the respondents chose for themselves; 51 
(10.2%) were joint; in laws decided 23 (4.6%); friends (other pregnant women) invited 
10 (2.0%); while cost determined only 1 (0.2%). This upholds the view expressed in 
earlier studies, that husbands were major decision makers in their wives‘ health-seeking 
behaviour (Kisekka et al. 1992; Ekwenpu, 1990). The literature reveals that men are the 
most influential decision makers in patriarchal societies. Cost was played down because 
the women could go to FBBAs where they did not necessarily have to pay.  
 
Table 4.43: Percentage Distribution of Husbands’ roles and Decision-Making 
Patterns 
Roles in Who Takes Decisions? 
pregnancy 
Husbands Wife  Jointly In laws  God Mission Unplann- Total 
care 
ed 
 
Payment of 309 102 67 11 - 11 - 500 
Maternity 
(61.8%) (20.4%) (13.4%) (2.2%) (2.2%) (100%) 
material 
Number of 140 90 90 59 100 - 21 (4.2%) 500 
children (31.6%) (18.0%) (18.0%) (11.8%) (20.0%) (100%) 
Who chose 251 164 51 23 Friends  Cost 500 
Care giver (50.2%) (32.8%) (4.6%) (100%) 
(10.2%) 
10 (2.0%)  1 (0.2%) 
Source: Fieldwork, (2009) 
 
 
182 
                                                                                
 
 
4.7.2 Influence of the respondents’ marital status on payment for delivery 
materials 
Table 4.44 shows the marital status of the respondents and payment for delivery 
materials; 35 (11.3%) single; 239 (77.3%) married; 30 (9.7%) cohabiting; 5 (1.4%) 
divorced / separated had their husbands/partners paid for delivery materials; 21 (20.6%) 
single; 73 (71.6%) married; 6 (5.9%) cohabiting; 2 (2.0%) divorced / separated and the 
only widow paid for themselves. Ilesa, the study area is a patriarchy society and there is 
role segregation in pregnancy care. While the woman is expected to bear the burden of 
carrying the pregnancy, the male partner is expected to pay for delivery materials and buy 
food and drugs. Any man who is unable to do this is regarded as oku guro or oku aaye 
meaning a standing corpse or the dead among the living. A widow of course bears her 
own burden and pays her bills. 
 
Table 4.44: Influence of the Respondents’ Marital Status on Payment for Delivery 
Materials 
Payment Marital Status  
for Single Married Cohabitin Divorced/ Widow Total 
Delivery g Separated 
material 
Husband/ 35 239              30 (9.7%) 5 (1.4%) - 309 
Partner (11.3%) (77.3%) (100%) 
Self 21(20.6%) 73 (71.6%)  6 (5.9%) 2 (2.0%) 1 (1.0%) 102 
(100%) 
Jointly   6 (9.0%) 46 (68.7%) 12(17.9%) 2 (3.0%) -   67 
(100%) 
In-laws   3    8 (72.7%) - - -   11 
(27.3%) (100%) 
Church -    7 (63.6%) 3 (27.3%) 1 (9.1%) -   11 
(100%) 
Total 65(13.0%) 373 51 10(2.0%) 1 (0.2%) 500 
(74.6%) (10.2%) (100%) 
Source: Fieldwork, (2009) 
183 
                                                                                
 
 
It is one thing to pay the bills; it is another to provide things that money cannot 
buy. Wives were required to state other things outside payment of bills that their 
husbands did. The result shows that 189 (37.8%) husbands did house work; 170 (34.0%) 
fetched water only; 32 (6.4%) gave money only; and 109 (21.8%) of their husbands did 
not care and did nothing to assist their wives in pregnancy. Thomas et al. (n.d) also found 
that only 27.3% sampled women claimed that their husbands helped them in household 
chores. They found that men played very limited role in supporting their wives in major 
reproductive events. 
Some husbands also reported that they only gave money to their wives.  They could 
not do household work, though they might assist their wives to draw water from the well 
whenever they were around. Drawing water from the well is a great assistance for 
pregnant women because there was no pipe-borne water in Ilesa and it could be quite 
stressful for pregnant women to draw water from wells that could be as deep as 40- 60 
feet. Most husbands claimed that they gave money for delivery materials; bought food as 
well as encouraged their wives to take their routine drugs. Only two husbands mentioned 
that they took their wives to clinic on ANC days. The others said they waited for their 
wives to return and give report of the instructions given them at the clinic. A husband 
asserted that:  
‗To help my wife, I took my wife and children to clinic for immunisation. 
I used to be the only man among so many women but I was not ashamed 
because they are my children and I love them dearly. I followed my wife 
to hospital and stayed till she delivers. I left all my work because I love 
my wife but I cannot stand to witness labour real life. The pain would be 
too much for me to bear‘ (Male, husband, Ilesa West Oct. 2009). 
 
All husbands, irrespective of their religious affiliation claimed they prayed intensively 
during the deliveries of their wives. Many of them reported that they wept when they 
heard cries of agony of their wives in the delivery rooms. A husband had this to say:  
When she started labour at home, when she stretched, I stretched, 
when she twisted I did the same. I was doing what she was doing 
until we got to the hospital I could not stand my wife to deliver in my 
184 
                                                                                
 
presence, I may spoil things. I may misbehave (Male, husband, Ilesa 
West Oct. 2009). 
 In the qualitative study, some husbands claimed that they cooked, swept, washed fetched 
water and did household work when their wives were pregnant; while others claimed they 
brought in helpers, church members or instructed their older children to help their wives. 
Another husband allowed the wife‘s younger sister to stay with them to perform house 
work because he could not assist his wife. A husband reported that he could not do any 
house work but he did not complain about any food she prepared: 
I can‘t cook but I don‘t make any food demand. I eat whatever she 
cooks without asking for special type of food (Male, husband, Ilesa 
East Oct. 2009). 
 
 Another husband said: 
During the first trimester of pregnancy, my wife always had morning 
sickness. She would be feverish and vomit I helped her to bring water to 
wash her mouth and sprinkle it on her face.  I encouraged her that she 
would soon overcome and talked to her to relax‘ (Male, Husband, Ilesa 
East, Nov. 2009).  
 
Two husbands reported that their wives requested for strange uncommon food 
items during pregnancy and they searched and got them. One said: 
My wife could not eat well; she told me she wanted crabs soup. I did 
not know where to get crabs from. I started searching for fishermen. 
Fortunately, I met some boys who had some fresh fish to sell. I 
requested that they get me crabs and they had two. I took them to her 
and she was happy. She only took the stew and not the crab (Male, 
husband, Ilesa West Oct. 2009). 
Another said: 
 
My wife wanted roasted groundnut and ekuru (beans pudding). I got 
her some groundnuts but she insisted it must be the type that Nupes 
(an ethnic in Nigeria that specialises in roasting groundnuts for sale) 
make. I looked for it but could not get. I had to persuade her to 
manage the type I got (Male, husband, Ilesa East Oct. 2009). 
 
 
185 
                                                                                
 
 
Another husband also claimed that: 
 
Whenever my wife is pregnant, she suffers from muscle pull at night. 
She wakes me up and I help her to stretch and massage the affected 
leg(s). Sometimes both of us do not sleep until day break (Male, 
husband, Ilesa West Oct. 2009). 
 
All husbands affirmed that their wives gave them reports from ANC or FBBH. Their 
wives reported that they were instructed to take vegetables and fruits. They all claimed 
that their wives told then they should not drink Milo, Bournvita and milk to avoid big 
babies. 
A husband also averred that: 
When my wife was in early stage of pregnancy, she could not eat 
well so I fed her and we ate together to ensure she took her food. 
Whenever, she was sick I called doctor or took her for consultation 
(Male, husband, Ilesa East Oct. 2009).  
 
Another husband argued that:  
 
In the early stage of the pregnancy my wife spit saliva. I didn‘t like 
her to spit everywhere so I controlled it to one place. I encouraged 
her to do some exercises and not sleep all the time (Male, husband, 
Ilesa West Oct. 2009). 
 
All husbands, irrespective of their religions, claimed that they prayed intensively during 
pregnancy and deliveries of their wives. Many of them said they wept when they heard 
cries of agonies of their wives in the delivery rooms. Some husbands said they went to 
mountain tops to pray for successful pregnancy and delivery.  A Muslim husband 
reported that he made special prayers from the Qur‘an into water for the wife to drink for 
safe delivery. According to him; 
There are special Qur‘anic passages that I read into water to give my 
wife and I also did it for my friend‘s wife who was having difficulty 
in delivery. She was to be operated when the husband came to me. I 
made special prayer for her and she delivered without operation. 
Whenever my wife was pregnant, I prayed for safe delivery on 
money and give to the blind and beggars as zaka (Male, husband, 
Ilesa West Oct. 2009).  
186 
                                                                                
 
This he believed would make God have mercy upon her during delivery. 
4.7.3  Husband’s roles at delivery 
 Table 4.45 reveals that 247 (54.8%) of the husbands went with their wives to the 
places where their deliveries were taken and 269 (53.8%) stayed until their wives were 
delivered. This is similar to the findings of Thomas et al. (n.d) in Bangladesh that 54.8% 
of the women reported that their husbands accompanied them during pregnancy and 
check-ups and 63.6% claimed that their husbands gave them money for medicine.  
 
Table 4.45: Percentage Distribution of Husband’s Roles at Delivery 
Husband went with wife to place of delivery Yes No 
274 (54.8) 226 (45.2) 
Husband stayed with wife 269 (53.8) 231 (46.2) 
Source: Fieldwork, (2009)  
 
 During the interview, most of the husbands claimed that they followed their wives 
to the place of delivery and stayed until they could hear the voices of mothers and babies. 
 In faith homes, husbands were not allowed to stay with their wives during 
delivery. They were usually sent to the church auditorium to pray but they must stay until 
their wives‘ deliveries had been taken.  Those who were not around were called on cell 
phones.  
 Health care providers said that they did not allow husbands who wished to 
witness their wives‘ delivery to stay, because other women could be in labour at the same 
time and women could open up themselves and it would not be proper for a husband to 
be gazing at the nakedness of other women. This is at variance with happenings in 
developed nations where men are allowed to be with their wives during delivery. Another 
caregiver said that their clinic was isolated and some husbands might be problematic and 
harass the nurses sexually, especially at night. Sometimes ago, there were reports from 
187 
                                                                                
 
Lagos University Teaching Hospital (LUTH) that men harass nurses and female doctors 
sexually at night. At another maternity centre, husbands that came with their wives to 
deliver at night were kept with the night guards while some went to their homes to take 
care of older children. Others left their wives and their phone numbers to be called after 
their wives had put to bed. Some husbands ran away only to return whenever they were 
called because they could not stand birth pangs and the sight of blood or other body 
fluids.  
 All husbands asserted that their wives could not attend any caregiver without their 
permission. In fact, all claimed that their wives had to inform them weeks or days ahead 
of their intention to attend ANC or prayer meetings. Even when they travelled, the wives 
should inform them on phone. The husbands affirmed that their wives gave them 
feedback on ANC attendance; and that they bought drugs, food, fruits, vegetables, meat 
and fish for their wives during pregnancy because they believed that, if any problem 
arose during delivery, they were the ones to suffer. One of the husbands claimed that the 
parents of his wife also helped to buy fruits and vegetables. Most husbands said that they 
encouraged their wives to adhere to all instructions given by the caregivers. Most of the 
husbands interviewed said they reminded and encouraged their wives to attend ANC and 
to take their routine drugs.   
A husband said: 
My wife did not like drugs so I brought water for her and encouraged her 
to take the drugs because if there was problem I would be in trouble (IDI, 
Husband, Ilesa West, Nov. 2009). 
Another husband had this to say: 
As for me, I think my wife is an adult. If she is told to use drug for her 
health, I expect her to take it. She is not a child. However, there are lots of 
unused tablets at home which she did not take and she throws them away. 
Since she delivers safely I don‘t have problems (IDI, Husband, Ilesa West, 
Nov. 2009). 
 
One of them said: 
 I check her card so that I can remind her of next clinic day and prayer 
appointments; (IDI, Husband, Ilesa East, Nov. 2009). 
188 
                                                                                
 
  
Another husband averred that: 
Whenever any of the old children was sick I gave her money to take 
him/her to hospital and I carried the child to give the drugs prescribed.  In 
this pregnancy, I reminded her to adhere to hospital regimes. I bought 
fruits for her and gave her money to buy some. I followed her to hospital 
during labour and whenever they sent me to go and buy something I did. I 
prayed a lot during her labour until she delivered.  I was with her during 
the birth of the first child but during the second I was not given the chance 
though I loved to be there (IDI, Husband, Ilesa East, Nov. 2009).  
 
While a husband was concerned about the welfare of his wife another husband (when the 
researcher was collecting secondary data at the OAUTH) was calling his wife who was in 
labour and shouting on cell phone saying: ―Stop shouting now; are you the only one in 
labour in the whole hospital?‖ (Husband, Ilesa East, Nov. 2009). When the nurses told him 
to go and purchase more gloves he told them that he was not going anywhere; he said the 
nurses should know the number of gloves they needed for one delivery and should have 
told him to buy them at once; and that they should stop ordering him around. The next 
thing he did was to call the wife‘s elder brother to come and stay.  The wife‘s elder brother 
came and continued the running around. These are individual differences, similar to the 
findings of Centre for Research, Evaluation Resources and Development (1999), which 
revealed that some men wanted their wives only for sex and care less after.  
 Another husband said he preferred his wife to go to government hospital because of 
adequate medical attention. No husband mentioned that he absconded on day of delivery or 
did not buy delivery materials. It seems that men accepted to cater for the wives‘ 
pregnancies but when they were unable they felt guilty. 
  Isiugo-Abanihe (2003) claims that the women sampled indicated that male 
partners should be actively engaged in the pregnancy, antenatal, and provision of 
adequate financial support for their wives. Research on promoting male responsibilities 
for gender equality from Bangladesh, India and Vietnam revealed that men were reluctant 
to play any significant role in reproductive health, child care, or household work; 
believing that their roles are mainly income-generation and social relations.  The result 
from India revealed that men played limited role in reproductive issues and were more 
189 
                                                                                
 
likely than women to spend their money on themselves rather than the family members 
(Thomas et al., n.d). However, more recent study in Jammu and Kashmir in India 
revealed that men are willing to be involved in pregnancy care.  
 To buttress the important role which men play in reproduction, faith homes did 
not take deliveries that were not supported by husbands. Many faith homes did not take 
delivery for teenagers because ―they have no root‖ that is, they were not married. There 
were no husbands to stand in for them. If there were complications, the FBBAs might be 
in trouble. However, where the teenager had no alternative, her parent would be made to 
sign an undertaking that they would make no trouble if any complication occurred. 
FBBAs‘ rejection of teenage pregnancy is a blessing in disguise because researches have 
shown that teenagers are prone to high-risk pregnancy complications. So, if they were 
rejected in faith homes, they might be forced to go to hospital where they would receive 
adequate care. Hospitals do not reject any pregnant woman on the grounds of marital 
status. As a matter of policy, FBBAs reported that husbands must give their consent 
before their wives could be allowed to attend prayers and deliver. Some faith homes 
insisted that husbands must bring their wives and register their phone numbers on the first 
day of visit. Husbands must append their signatures to the registration card and visit the 
FBBAs at least 4-5 times during pregnancy to assure the FBBAs of their support. If any 
complication arises on the day of delivery, the husband decides where next the wife 
should be referred. 
 Whenever a woman did not come for prayers on any of the meeting days, FBBAs 
called the husband to enquire why she was not there. The pregnant woman would also be 
called to find out why she was not at the prayer meeting. This strategy kept the women 
coming regularly. Hospitals do not have this strategy.  
 Where husbands proved to be irresponsible, and did not take care of their 
pregnant wives, some FBBAs devised methods of making them responsible. The FBBAs 
advised the women to give in sexually to their husbands so that they would be happy and 
supply their needs. They believed this would make the birth passage open up early for 
delivery. A faith caregiver said that, if she discovered that some husbands showed signs 
of irresponsibility because of ill behaviour of their wives.  
190 
                                                                                
 
I advise the wives to be of good behaviour and admonished the 
husbands to endure with their wives (Female, Ilesa East, Oct. 2009).  
 
The FBBAs invited the husbands individually if they noticed any irregularity in the 
wives‘ health. They advised such husbands to make their wives happy to avoid high 
blood pressure and provide balanced diet to avoid anaemia and blood transfusion that 
may predispose the women to being transfused with HIV-infected blood. Husbands 
usually dreaded the disease and took care of their wives. A particular FBBA said she told 
the husbands to surprise their wives with gifts and sweet words.  
  However, when any husband persisted and refused to take responsibilities for his 
wife, one of the FBBAs told the wife to fake illness, faint and pretend she was about to 
give up. The neighbours would be afraid and rush her to the church for prayer and care. 
The FBBA would call the husband to come urgently to the mission. The woman would be 
in the room for bed rest. When he arrived, the FBBA would demand for some money 
enough to do all tests and buy things urgently needed by the wife, which the husband 
usually provided in his panicky state. The FBBA said they might or might not do any test. 
She also ensured that the man went to buy milk and other food items. The FBBA would 
then give the money to the woman when the husband had left. Such husbands were 
warned not to allow their wives‘ health to deteriorate to warrant referral to OAUTH 
where they would have to pay more than ₦50,000 naira for CS. No husband wanted CS, 
so they always adhered. This FBBA said in situations where she was forced to use this 
strategy, it really worked. 
 Another FBBA gave her strategy of dealing with irresponsible husbands and 
relations. Whenever they brought any woman for delivery and she perceived that the 
woman had not been taken care of, she would tell them: 
For this delivery you are going to give me five tubers of yam, 
five measures of rice and beans, one gallon of kerosene and palm 
oil, large dried fish, pepper and melon. Before I finish with your 
wife let them be ready. The men usually looked for and got them 
(Female, Faith Care Provider, Ilesa West, Sept. 2009). 
 
191 
                                                                                
 
The FBBA said she kept the women after delivery for some days cooking the food items 
for them to make sure they recuperated well and whenever they were going back to their 
houses, she packed the remaining food items for them. These methods were not exploited 
by orthodox medical practitioners. These methods would only solve immediate problems. 
How long will the money or food items last? The best method is to make husbands see 
reasons for continuous care of their wives and encourage them to spend their money on 
their families. Fatubarin (2008) avers that Ijesa men who go to university to study 
Business or Economics have gone to do higher degrees because they already naturally 
had a Bachelor‘s degree from their upbringing. By training and upbringing, the Ijesa are 
scrupulous in spending money. They sometimes transfer this to their home management. 
       However, there were times when husbands would refuse to show up when they 
were sent for. A midwife mentioned a case of a pregnant woman who underwent a CS 
and was advised not to be pregnant again. She became pregnant again and when she had 
complications, the husband abandoned her and went to marry another person. A woman 
reported an incident of a woman who quarrelled with her husband so that he could take 
responsibility at home. The friend of the husband advised him thus:  
Why should you become a woman‘s apron and your wife will be 
quarrelling with you for soup and food money.  Follow my example, 
marry a second wife and you will see both wives struggling to take care 
of themselves and  their children  None of them will worry you again 
and you will be free. (Female, Ilesa East, Oct. 2009).   
 
While a few husbands refused to take care of their wives, others took their wives to ANC 
and prayer sessions in their cars and on their motor bikes and returned to pick them after 
prayer or ANC.  A care giver said: 
some women are not working but are looking good because their 
husbands are taking good care of them (Caregiver, Female, Ilesa West 
Oct. 2009).  
 
A Chief Nursing Officer affirmed that many of her patients were students who had 
unplanned pregnancies and the men-friends usually rejected the pregnancies. When 
pregnancies were unplanned and unwanted, and the partner refused to show up or provide 
192 
                                                                                
 
delivery materials the caregivers usually improvised materials that were needed. One 
said: 
They don‘t pay and yet treat their wives badly.  Many are only 
responsible to contribute the pregnancies and ask their wives to 
take care of their children.  They go ahead and marry more wives 
(Caregiver, Female, Ilesa West Oct. 2009).   
 
CRERD (2001) reported similar attitudes among their respondents and FGD in Odeomu 
and Otan Ayegbaju in Osun State, Nigeria. Men refused to take responsibilities for their 
wives‘ pregnancies. However, in other places, credits were given to husbands for the care 
of their wives as husbands cooperated and even agreed to family planning suggested by 
caregivers.  
 Table 4.46 reveals that among categories of pregnant women, primigravidals 
(41.9%, 37.2%) received the most assistance from their husbands; followed by 
multigravidals (37.1%, 28.6%) and the least assisted were the grand multigravidals 
(22.2%, 22.2%). This could be owing to the fact that primigravidals‘ husbands were in 
their ―first love‖ and are eager to become fathers but as time went on, their love began to 
wane or the husbands thought that their wives had enough experience than when they 
were pregnant for the first time. It could also be that the husbands thought that they have 
grown-up children who could assist their mothers. This is rather unfortunate because as 
grand multigravidals are getting old, they might be unable to cope with challenges and 
pressure of pregnancy. They, therefore, need encouragement from their husbands. The 
result shows significant relationship between the number of children and quality of 
assistance rendered by the husbands. 
193 
                                                                                
 
 
Table 4.46: Assistance Rendered by Husbands and Number of Pregnancy/ (ies) 
Other things that Number of pregnancy/(ies) 
Total 
husbands do to assist in Prim Multigravidals Grand multi. 
pregnancy  
Housework 80 (41.9%) 79 (37.1%) 2 (22.2%) 2 (22.2%) 
Fetch water only 71 (37.2%) 61 (28.6%) 2 (22.2%) 2 (22.2%) 
Give money only 3 (1.65%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 
All areas 26 (13.6%) 52 (24.4%) 4 (44.4%) 4 (44.4%) 
Prayers 3 (1.6%) 1 (0.5%) 0 (0.0%) 0 (0.0%) 
None/ Does not care 8 (37.5%) 20 (9.4%) 1 (11.1%) 1 (11.1%) 
Total 191(100%) 213 (100%) 9 (100%) 413(100%) 
2
X cal    23.654 df 12 P 0.023 
Source: Fieldwork, (2009) 
 
4.7.4 Influence of marital status on other assistance husbands/partners rendered 
in pregnancy 
Pregnant women were requested to state other things that their partners did for 
them in pregnancy. Only 35 (52.3%) singles got only money and the widow got nothing. 
This indicates the conditions of many widows in our society. At the demise of the 
husband, the widow is left in the lawns. She has to fend for herself and if she is lucky 
enough not to be shared along with the husband‘s properties. The married got the best 
assistance followed by the cohabiting. 
194 
                                                                                
 
 
Table 4.47: Other Assistance Husbands/ Partners Rendered in Pregnancy 
Other Marital Status  
helps Single Married Cohabiting Divorced/ Widow Total 
paetners Separated 
render 
All house - 167 26 - - 193 
chores (86.5%)  (13.5%) (100%) 
Fetch - 130 12  - - 142 
water (91.5%) (8.5%) (100%) 
Money 35 24  8 - - 67  
only (52.3%) (35.8%)  (11.9%) (100%) 
None 30 52 5  10 1   98 
(30.6%)  (53.1%) (5.1%)  (10.2%) (1.0%) (100%) 
Total 65 373 51 10  1 500 
13.0%) (74.6%)  (10.2%) (2.0%) (0.2%) (100%) 
 
 The study revealed that even when a woman is sick or needs medical attention, 
the express permission of the husband must be sought in 282 (56.4%) cases before she 
could attend hospital. Jegede (2010) notes that male-headed household predominate. 
However, when a child is sick, more respondents−296 (59.2%) −would take their 
children to hospital, while they would wait for the permission of their husbands when 
they were sick. The respondents placed higher price on their children‘s health than theirs, 
although, in both cases, the husbands still took the higher percentage of decisions. Jegede 
(2010) observes that regardless of women‘s involvement in decision making, the final 
decision is still subject to the husbands‘. According to him, Ibadan husbands often 
describe their wives as disobedient because they seek treatment for themselves and their 
children without consulting with them. 
 The IDIs revealed that husbands insisted that their wives take permissions from 
them before they went to hospitals.  However, most of the husbands said that their wives 
195 
                                                                                
 
could go to hospital if they were not around or had travelled but they must inform them 
on phone.  None of the husbands insisted that their wives should wait for them in case of 
emergency and none of the wives was ready to wait. Three hundred and nine (62%) 
women could decide to refuse sex when nursing their babies but when they are tired only 
253 (50.6%) would decide to refuse. If the husband ran around with other women, only 
193 (38.6%) would decide to refuse sex. Most of the respondents would not refuse so that 
he would not be lost completely to the other woman. The respondents reported that they 
would use sex to draw him from the other woman. However, when it is confirmed that 
the man has STIs, 304 (60.8%) would decide to refuse and wait for him to treat himself. 
They could not see the relationship between extra-marital affairs and STIs. They wanted 
to wait until the man manifested symptoms of a disease but by the time it became evident 
that he had a disease she too would have been infected.  Yet, 196 (39.2%) of the women 
would not decide to refuse sex even if they were aware of the presence of STIs in their 
men. This explains why many women are plagued with sexually transmitted infections 
and HIV/AIDS. The literature confirms that women are powerless to negotiate sex or use 
of condom with their partners. When it comes to far-reaching decisions on sexual 
activities the woman becomes less able to make decisions.  
 Other people that play significant roles in pregnancy care are mothers-in-law as 
well as other pregnant women who introduce caregivers to their friends. The respondents 
were at liberty to bring other pregnant women to the place where they believed they 
received adequate care. The FBBAs allowed the respondents to guarantee their friends. 
All caregivers need someone to run errands and bring food during labour and after the 
pregnant woman has been delivered. All FBBAs have different occasions when women 
that delivered were abandoned. Apart from the fact that they had no money to pay, the 
FBBAs fed, clothed, and sometimes had to take them home or pay their transport fares. 
The FBBAs prayed for such people while hospitals retained them after delivery or 
refused to take them in at all. Of course, free facilities are not available in hospitals.  
 Men‘s role was reported to be significant when women intend to reduce the 
number of pregnancy; health caregivers instructed that women should take permission 
from their husbands. Many husbands usually refused, claiming that the wives would 
engage in extra-marital affair if she used family planning device. To be able to reduce 
196 
                                                                                
 
frequencies of pregnancies, women should be able to take independent decisions on 
family planning as they carry and nurse the babies and know the state of their health. 
Many men just want many children without corresponding care and support. More men 
than women desire more children (Isiugo- Abanihe, 2003). 
 The IDIs revealed that many husbands were ignorant about the dos and don‘ts in 
pregnancy as well as signs and symptoms of pregnancy complications. However, they 
commented that if there was any complication, the woman should go to the hospital, 
while the men pray. Many husbands believe in the efficacy of prayers to solve such 
problems. A husband said he believed his wife should do all tests prescribed at the 
hospital while he prays. When husbands are ignorant of signs and symptoms of 
pregnancy complications, they may not be able to assist their wives at critical times; this 
may be a reason for delay in seeking help. CRERD (2001) also found husbands‘ 
knowledge of dos and don‘ts in pregnancy inadequate.  
     The respondents recognised the roles men (husbands) play in pregnancy care. This 
was reflected in the extensive prayers they usually made for their husbands and their 
work during their prayer meetings, such as:   
Oh Lord, do not allow the crown of my head to be removed; Do not allow 
Satan to take my husband; O Lord, do not let me have ill luck To 
experience death of husband or /and children.  
 
Husbands are regarded as the crowns, beauty, and dignity of women‘s heads. A woman is 
regarded as having ill luck when the husband dies. This belief does not hold if the woman 
dies. It is regarded as natural occurrence or at best an accident and the men are 
encouraged to remarry soon to be able to overcome the misfortune. But for the woman, 
she is shared out as part of the husband‘s property.  
 
 
 
 
 
197 
                                                                                
 
 
4.7.5 Discussion  
   Data on demographic and socio-economic profile revealed that the majority of the 
pregnancies occurred between ages 19-24 (32.0%) and 25-29 (36.6%). Only 4.2% of the 
pregnancies occurred before 18 years and only 2.2% occurred after 40 years. NDHS 
(2003) states that the best years for pregnancy and childbirth is ages 20 and 30 years 
when the children are evenly spaced. Pregnancy should be discouraged among 
adolescents and women above 35 years to avoid complications that are associated with 
these age brackets. Much as it is desirable and of a great socio-economic advantage to 
encourage girl education and delay of childbearing to a later age, so as to empower 
women, the risk of being elderly primigravidals should be considered along the line so as 
not to endanger the lives of the ladies in difficult and high-risk pregnancies. Delay in 
childbearing until a girl finishes higher institution should be considered alongside this 
risk, especially in Nigeria where students enter into tertiary institutions and one cannot be 
sure of when they would graduate owing to incessant strike actions in these institutions. 
The result revealed that 74.6% of the respondents were married; 13.0% were 
single; while 10.2% co-habited. Both single parenthood and co-habitation are aberration 
to the norms and mores of traditional Yoruba settings. Both teenage pregnancy and co-
habitation do not receive any positive social, economic and psychological supports and 
are totally discouraged in Yoruba society (Oyefera, 2005). In Yoruba society, conception 
and childbearing should take place within the institution of marriage. The prevalence of 
unemployed graduates and long stay in school due to incessant strike actions in the 
institutions could be an explanation for the high rate of co-habiting couples.  
As for the educational status of the respondents and their husbands, 37.8% of the 
men and 30.6% of the women had tertiary education. Although both groups acquired 
some form of education, more men than women had formal educations. Women‘s 
education should be encouraged so that it can be at par with that of the men. This could 
be done if women could have their babies and still continue with their education. In 
addition, if day care centres could be established in all educational institutions so that 
nursing mothers could put their babies there. However, even where women acquire 
formal education, patriarchy and social norms make women depend on their husbands for 
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health and major decisions. Parent place less emphasis and less invest on female‘s 
education (Adebowale, 2009). 
   About three quarters (75.8%) of the respondents earned less than ₦10,000 a 
month, thus earning less than USD1 a day. This could be a hindrance to accessing 
orthodox medicine because of users‘ fees. Although, the respondents were literate, they 
could not enjoy the economic privileges of education. Economic empowerment should 
encourage women to acquire more education so as to be in the best standing to take care 
of their pregnancies. Poverty, procrastination and stinginess were some economical 
problems that encouraged the respondents to deliver in FBBHs and made some husbands 
to abscond on the days of delivery of their wives. The Ijesa people are known for austere 
financial management which some take too far into health management. Some couples 
kept postponing purchase of delivery materials until the babies arrived and these women 
entered delivery rooms empty-handed; delivery materials and baby clothes had to be 
supplied by churches or FBBAs or neighbours. In maternity centres, nylon bags where 
used as gloves to take delivery of some children, as the mothers could not afford hand 
gloves.   
Monogamy was the prevalent (90.4%) marriage type. This could be due to the 
predominance of Christianity (86.6%) in the study area and the impact of ministers of 
God, like late Apostle Babalola, of CAC; Pastors E. A. Adeboye, of the Redeemed 
Christian Church  and W. F. Kumuyi, of the Deeper Life Bible Church; and other 
religious leaders that are from this area. 
The study revealed the knowledge of pregnant women on aetiology of pregnancy 
complications as follows: 41.6% attributed pregnancy complication to witches and 
wizards; 43.4% attributed complications to adultery; while 43.8% attributed pregnancy 
complications to women‘s physique. However, more women that had tertiary education 
(73.5%) attributed complication to infection and physique of women rather than witches 
and wizards. Orji et al. (2001) assert that labour complications are blamed on labouring 
women; they accused them of being unfaithful to their husbands. Hospital care givers 
revealed that women with heights and weights below 1.5 metres and 40 kilogrammes, 
respectively are perceived high risk and being predisposed to complications. Drug abuse 
and carelessness of nurses were also perceived as causes of complication. Oscillating 
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between caregivers was reported to be another source of pregnancy complications. The 
study further revealed that attitudes of nurses and orthodox care providers can hinder 
their patronage. 
When complications, such as haemorrhage occur, 31.8% of respondents would 
not give themselves for blood transfusion. This should be a source of concern and people 
should be sensitive to the need to prevent anaemia. In religious houses, however, 
haemorrhage would be treated with concoction. 
Breech presentation is believed to be essentially the machination of witches and 
wizards and such is treated with leaves, special concoction, blessed water, prayers and 
spiritual baths. Most of the services rendered by FBBAs were free but recipients were to 
attend annual children thanksgiving service in the church and make donations. 
Prayers and secrecy were perceived to be means to avoid complications. Pregnant 
women were warned against advertising their pregnancies and to be careful in the use of 
their tongues. The respondents identified the following as symptoms of pregnancy 
complications: breech baby (42.6%), convulsion (50.8%), excessive bleeding (66.2%), 
high fever (61.6%), labour of more than 12 hours (66.2%), and swollen legs (60.0%). 
Data from OAUTH Ilesa confirmed that 40% of maternal loss in the hospital was due to 
haemorrhage, 13.4% was due to obstructed labour and eclampsia was responsible 13.3%. 
Adebayo (2013) states that haemorrhage accounted for 25% of maternal loss in Nigeria. 
He is of the opinion that if all hospitals were well-equipped, maternal mortality will 
reduce by a quarter worldwide. Lack of adequate knowledge of symptoms of pregnancy 
complications would cause pregnant women to seek help late. Ransome-Kuti, (1990) 
states that, all pregnancy problems are preventable and easily cured if identified and 
managed early. 
Pregnancy is perceived as a secret which only God knows and understands. The 
respondents believed that God alone gives children to whomsoever he wishes. They 
viewed pregnancy from spiritual rather than from medical angle. Belief in malevolent 
spirit thrived and so the women patronized churches for care and delivery of their babies. 
They attended faith homes religiously and were engaged in rigorous prayers against 
maternal and neonatal mortality. Prayers were said against all types of enemies that 
would make delivery difficult. It was observed that these pregnant women were more 
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relaxed in mission houses but when they attended ANC, they were always anxious and in 
a hurry to leave, always complaining that their time was being wasted.  
One fourth of the respondents had their last deliveries at FBBHs, 35.8% hoped to 
deliver their current pregnancies in FBBHs, while 13.4% were undecided on which care 
provider will deliver their current pregnancies. A total of 50% of these chose their 
caregivers because of prayers. When complications occur, referrals may be from one faith 
home to the other, then to a private hospital or the General Hospital and lastly to 
OAUTH, Ilesa. This kind of referrals causes delays in getting adequate help for women 
who may have complications. Some faith homes kept trying to help women in 
complications until things were almost out of control. Orji et al. (2001) note that late 
referral predisposes women to maternal morbidity and mortality. All FBBAs, except one, 
claimed that maternal mortality had never occurred among them. The only one that 
agreed to have had maternal mortality blamed the pregnant woman for it, claiming that 
she had familiar spirit. When complications have reached critical stage, FBBAs usually 
advise the woman‘s family to take her to any hospital of their choice. Some of such 
women die on the way or in the hospital before any help could be rendered. 
There was no significant relationship between religious affiliation and delivery in 
FBBAs. All adherents of the three religions patronised FBBAs for care and delivery. 
Population References Bureau (2005) claims that 65% of Nigerians still employ the 
services of traditional healers. 
The study revealed that different measures were put in place in faith birth homes to avoid 
complications: 
Prayers were said by the whole congregation for safe delivery and pregnant 
women met one day every week between 9 a.m and 12 noon for rigorous prayer against 
any form of complications and evil imagination of wicked people. Prayers were 
accompanied with reading of psalms of victory into water they drink and use for bathing. 
The Psalms they read reveals their fears and believe that God‘s supernatural intervention 
can deliver from all forms of wickedness.  
Anointing oil was also used to prevent pregnancy complications. Psalms were 
read and prayers said into oil. These were believed to be sacred and more efficacious than 
hospital drugs. Durkheim (1961) claims that society sets apart some items as sacred and 
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others as profanes. The Psalms and prayers made these items sacred and pregnant women 
had strong faith in them to drive away evil. 
Pregnant women came to church with kegs of water to which pastors read psalms 
and upon which they prayed. They used this to bath and drink throughout the week. But 
pregnant women that were perceived to have serious problems took spiritual baths in 
flowing rivers and sometimes with special easy-delivery sponge, soap and oil which 
FBBAs had prayed upon. 
Pregnant women submitted their materials for delivery at the mission houses for 
corporate and FBBAs‘ private prayers and fasting. This practice compelled such women 
to deliver in mission houses, as it was difficult to retrieve these materials at the point of 
delivery if the pregnant woman intended to utilize another care giver. 
Vision and prophesies were used in religious houses. Sometimes, the prophets and 
seers in these religious houses saw visions for these women. They saw troubles in their 
lives and wicked ones trying to harm them. They also proffered solutions to these 
problems. 
One of such solution was for faith care givers to take such women to mountain 
tops for prayers. This could be every month or twice in a month. There they read psalms, 
prayed and held vigils. 
Another coping strategy was exclusive prayer camping for the weary. Pregnant 
women that were perceived to have problems were camped exclusively in the church for 
special prayers which would be said for them on regular basis as long as the prayer 
camping lasted. These prayers allayed their fears of witches and wizards and other evil 
imagination and gave them spiritual and emotional comfort. 
The FBBAs took delivery and circumcised children with bare hands and also did 
no test for HIV. This way, FBBAs could be easy agents in spreading diseases. There is 
need to train FBBAs on the use of gloves. 
The result further revealed that 73.3% of maternal loss were unbooked women 
who were referred to the hospital in moribund conditions. Also 35.4% of all deliveries in 
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OAUTH were Caesarean Section (CS). This could also be because pregnant women were 
referred to the hospital at times when only emergency CS could save their lives. 
The result revealed that women of all levels of education attended FBBAs for care 
of their pregnancies. As for places where pregnant women perceived pregnant 
complication should be treated, 46.0% of the respondents would go to religious centres, 
while 39.0% would go to hospitals. Among the respondents that earned between ₦40,000 
and ₦50,000 and above, 28.6% would treat pregnant complications in religious centres. 
Among those who earned ₦50,000 and above, 22.2% would treat complications in 
religious centres. This revealed that among all categories of earning, not less than 22.2% 
would treat their complications in religious centres. When there is stress, or anxiety, the 
income of the individual may not be taken into consideration. The foremost thing is 
where to get relief and many find religious centres as a place to find solution. In times of 
stress, anyone may find attraction in the support of healing churches (Jedege 2010). 
Attending care giving centres is not as important as adhering to the instructions 
given. The level of adherence will determine the benefits that accrue to the adherents. 
Among the 79.6% that ever attended ANC, 51.6% did ultrasound diagnostic test and 
76.0% did blood test. Among all categories of pregnant women 75.2% of the 
primigravidals would accept blood transfusion if there was a need and 50.0% of grand 
multigravidals would accept blood transfusion. The literature as shown that grand 
multigravidals are high risk pregnancies, yet half of them will not accept blood 
transfusion if there is a need. Women should be discouraged from having so many 
children. When they do, they should be ready to take appropriate health actions. The 
people should be sensitized on the health hazards of high parity and the need to take extra 
care when an individual is pregnant after the fourth time. Such women should be 
sensitized to deliver in hospitals so as to avoid complications. Further, 77.4% of the 
primigravidals attended ANC early, followed by 50.0% of the multigravidal and lastly by 
28.6% of the grand multigravidal. Early attendance of ANC by primigravidals is 
commendable as they do not take things for granted. Delaying early attendance, like 
grand multigravidals, can be dangerous and costly. 
Respondents also claimed to adhere to eating balanced meals, as 69.6% of them 
reported that they took fruits daily. When pregnant women eat balanced meals, 
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complications, like anaemia, are kept at bail. Health care providers would also have less 
work to do. Radio, television and other means of mass mobilization can be used to 
enlighten pregnant women and even everyone on the importance of healthy food. When 
pregnant women eat balanced meals, there will be low complications for mother and 
child. 
Equally important is the need for good sleep and exercise. The majority (71.0%) 
of the respondents reported that they slept for at least 6 hours a day. Pregnant women and 
everybody need sound sleep to function normally. Sleeplessness can predispose pregnant 
women to hypertension and some pregnancy-related problems. Fortunately, most of these 
women slept well. 
As much as respondents would want to adhere to instruction, marital disunity 
sometimes discouraged adherence. In a patriarchal society like Ilesa, men are perceived 
as heads of their families and are expected to pay for maternity materials. But when a 
man cannot afford it and the wife does, if there is no unity in the family, the woman may 
still not adhere. There is role segregation in pregnancy care. The woman is to bear the 
burden of carrying the baby while the man supplies the materials. A man that is incapable 
of this is regarded as ‗oku guro‘ (a standing corpse) or ―oku aaye” (the dead among the 
living). He is regarded as dead, yet walking on the street. Lack of financial power erodes 
the social status of the man as the head of the family. Nwokocha, (2006) reported that ―an 
Ibani woman feels very reluctant to pay for the cost of her prenatal care services‖. His 
respondent argued that ―no matter how poor a man is, he should be able to to handle 
some family responsibilities‖. 
Generally, FBBAs encouraged women that patronized them to combine FBBA 
with hospitals especially to do scan and blood tests. One FBBA even employed a nurse to 
assist in complicated delivery. 
The result revealed that 64.2% of respondents got drugs from hospitals but 30.8% 
of them did not take the drugs as prescribed. Bosworth (n.d) asserts that non-adherence to 
prescription has grave consequences on public health, as it has enormous burden on the 
world health system. Quoting McCarty, Bosworth (n.d) states, that 125,000 died in U.S.A 
annually owing to non-adherence to medication. Osterberg and Blaschke (2005) aver that 
between 33-66% of medication-related hospital admission are due to poor adherence. The 
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total cost of non-adherence ranges from $100-300 billion each year. The study revealed 
that where the husbands encouraged their wives to take their drugs, there is less of non-
adherence; but, where the husband is nonchalant, adherence is poor. There is need for 
husbands to encourage their wives to adhere. They should take it upon themselves to do 
this to reduce pregnancy related-complications.  
The study further revealed that adherence to drug varies according to number of 
pregnancy ever had. A total 88.9% of the primigravidals, 73.4% of the multigravidals and 
66.7% of grand multigravidals adhered to drug prescription. Generally, adherence to 
instruction is lowest among the grand multigravidals in all instances. Unfortunately, those 
that are most vulnerable are the ones that cared less. Grand multigravidals should be 
sensitized on their high risk status. During the visits to ANC in hospitals, the researcher 
noticed that many of the grand multigravidals were not happy with their pregnancies. 
Some complained that they made a mistake and were unwilling to have an abortion. This, 
however, should not make them expose their lives to danger. 
Men as heads of their families are expected to be financially sound and 
responsible to procure all or most of the materials for delivery. They are expected to 
render other services to assist their pregnant wives. The result revealed that 61.8% of the 
husbands paid fully for maternity materials; 50.2%; chose health care providers for their 
wives. The wives paid for 20.4%; while 13.4% were paid jointly. The IDIs revealed that 
husbands who paid fully for maternity materials tended to dictate where care was 
received, while those that paid jointly seemed to decide jointly on care providers. 
Paying medical bills is one thing, providing what money cannot buy is another. A 
total of 37.8% of the husbands helped their wives in household chores; 34.0% fetched 
water; while 21.8% were reported did nothing. Most of the husbands claimed that they 
prayed intensively during their wives‘ pregnancies and deliveries. Also, 54.8% of the 
husbands went with their wives to places where their deliveries were taken and 53.8% 
stayed until their wives were delivered. Thomas et al. (n.d.) reported that 54.8% of the 
women they sampled reported that their husbands accompanied them during pregnancy 
and check-ups and 63.6% of the husbands gave money for medicine. Similarly, 27.3% of 
the women sampled reported that their husbands helped in house chores. Many husbands 
reported that they empathized with their wives during stress of pregnancy and labour. To 
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make a pregnancy is the joint efforts of two people. It should follow, therefore, that the 
husbands should encourage their wives/ partners during the stress of pregnancy and 
delivery. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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CHAPTER FIVE 
SUMMARY, CONCLUSION AND RECOMMENDATIONS 
5.1  Introduction  
 The main findings of this study is as follows: This study provided insights into the 
relationship among social and religious factors, perception of aetiology of pregnancy 
complications, adherence of women to health caregivers‘ instructions and men‘s roles in 
pregnancy care. Health Belief Model (HBM) and Functionalist Theory were triangulated 
for the study. The study was descriptive and was conducted among pregnant women, 
their husbands and care providers. Both quantitative and qualitative approaches were 
utilised. Semi-structured questionnaire, IDIs and observations were used for data 
collection. This was to ensure that the weaknesses of one method were catered for by the 
strengths of the other. 
 The respondents were five hundred and ten pregnant women. Ten in-depth 
interviews (IDIs) were conducted among some of the women‘s husbands while 24 among 
Key Informants Interviews (KIIs) were done among their caregivers. The IDIs provided 
better understanding of data generated from the survey. These were corroborated with 20 
sessions of observation in care-giving centres. 
 It is obvious that a lot of social and cultural elements work together to determine 
pregnancy care. People‘s belief and practice bear relationship with their decision on 
where to seek help. The people continued patronising FBBAs in pregnancy care because 
of religious influences, finance, as well as favourable treatment given to them. The results 
showed that availability and accessibility of health centres did not necessarily ensure 
qualitative utility. This study established that pregnancy in Ilesa, South Western Nigeria 
could not be divorced from the society‘s socio-cultural environment. The general finding 
of the study was that religion played dominant role in care seeking during pregnancy and 
that belief system dictated where the people sought and accessed health care delivery in 
pregnancy. Above all, the underlying factor for deliveries in mission houses is poverty. 
No pregnant woman would venture into standard hospitals without delivery materials and 
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money. The embarrassment would be too much. Apart from these general findings, the 
following findings were on specific objectives. 
 
5.2  Summary of Findings 
The main findings of the research are summarized under the basic objectives of 
the study. 
 
5.2.1.  Influence of Socio-demographic factors on decision on care during 
pregnancy   
Respondents‘ ages were between 13 and 40 years. Their mean age was 29.54. The 
most productive age range was 25-29, where 36.6% of the pregnancy took place; the next 
prolific age range was 19-24, where 32.0% of the pregnancies occurred. Above 74% were 
married. 
Respondents were a fairly literate group, as above 78% of the men and 68% of the 
pregnant women completed secondary level education and above. All levels of 
educational groups attended ANC in hospitals (61.8%) and FBBHs (24%). Some 
respondents were found to combine hospital care with FBBHs (13.4%). 
 Finance was a major determinant of Caregiver. Poverty was found to be rampant 
among the respondents and their spouses such that many could not afford delivery 
materials. It was a major hindrance to pregnancy care in hospitals. About 76% of the 
respondents earned less than ₦10,000.00 a month (less than one dollar a day) far below 
what was needed for daily survival, and could not afford materials required for delivery 
in hospitals. When finance was inadequate, FBBAs were found to be friendly and tolerant 
of pregnant women. When materials for deliveries were in short supply, the FBBAs 
reported that they provided for the women from their personal effects and materials from 
other pregnant women. Orthodox care providers also reported that they used nylon bags 
as gloves to take delivery. 
 The majority (86.6%) of the respondents were Christians and 57.4% of them were 
in the Pentecostal movement. Monogamy (90.4%) was the prevalent type of marriage. 
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There were no religious barriers to delivery in religious houses; 26.2% Christian, 15.8% 
Muslims had their last babies in religious centres. Further, in their current pregnancies, 
36.5% Christians, 29.6% Muslims and 38.5% traditional worshippers intended to have 
their babies in mission homes. Thirteen percent of all religious groups were undecided on 
where they hoped to deliver their current babies. 
 
5.2.2 Women’s perception of aetiology of pregnancy complications  
 The respondents perceived activities of witches, wizards, familiar spirits (41.6%) 
infection (38.8%), adultery (43.8%) and women‘s physique as major causes of pregnancy 
complications. They perceived efficacy of prayers, anointing oil, blessed water, soap, and 
spiritual baths as solutions to such complications. Church and hospital were perceived to 
be places of treatment of complications. 
 The physique of respondents was perceived as dangerous to their sound health, 
46.3% primigravidal; 42.3% multigravidals, and 37.5% grand multigravidals perceived 
that women‘s physique could cause pregnancy complications. 
 Above 41% of the primigravidals, 36.7% of the multigravidals and 43.8% grand 
multigravidals perceived infection as a cause of pregnancy complications.  
FBBAs perceived consumption of sugary food as a source of complication; therefore, 
they instructed pregnant women to consume less of sugary food to avoid having big 
babies. Some caregivers blamed pregnancy complications on carelessness of some nurses 
who would not attend to pregnant women on time. For instance, while this research was 
on the researcher visited some maternity centres and found them under locks and keys for 
reasons of weekends and public holidays; while others were on incessant strike actions. 
The IDIs revealed that dereliction of duty of caregivers can occasion pregnancy 
complications. The IDIs also revealed that the respondents believed in wandering evil 
spirits that can cause pregnancy complication. Therefore, pregnant women were 
instructed to avoid being outside 1-3 a.m. and p.m.; pregnant women were instructed not 
to expose their tummies to those who might wish to touch them, as they were perceived 
to be a source of complication. To avoid complications, FBBAs instructed the 
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respondents not to advertise their pregnancy. They were not to allow people to touch 
them. 
 Non-attendance at ANC or FBBHs was perceived as a source of complication. 
The IDI revealed that oscillating between traditional and orthodox caregivers could be a 
source of complication, as there could be conflict of instruction. 
 Among the respondents, breech babies (57.4%), convulsion (50.8%),   haemorrhage 
(66.2%), high fever (61.6%), prolonged labour (66.0%) and swollen legs (60.0%) were 
perceived as symptoms of pregnancy complications. Educational qualification was not 
significant in recognition of convulsion and breech babies as symptoms of complications. 
However, 31.8% of the respondents would not accept blood transfusion. When 
complications occurred 46.0% would treat them in religious houses. FBBAs would treat 
haemorrhage and other complications with concoctions, prayers, psalms and spiritual 
births. Maternal mortality in OAUTH Ilesa branch from 2004-2008 revealed that 40% of 
MM was caused by haemorrhage. 
 The respondents perceived pregnancy as the work of God. To avert pregnancy 
complications, respondents resulted to spiritual practices, such as vigils, praying on 
mountain tops, spiritual baths in flowing rivers, using anointing oil and blessed water, 
reading of psalms and prayers. These were perceived as efficacious means of warding off 
pregnancy complications. Visions and prophecies were common features in these 
spiritual places. The IDIs revealed that, when complication occurs, attitudes of 
nurses/midwives can discourage pregnant women from seeking help in the hospitals 
early. 
 Uniform reports from caregivers revealed that, when treatment failed among other 
caregivers, the final place of reference was the OAUTH, Ilesa. Many got there when they 
could be helped, while others got there in morbid conditions. If pregnancy complications 
will eventually end in the OAUTH, it would be profitable that women go to this hospital 
for care of their pregnancies from the outset. 
 
 
 
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5.2.3 Influence of religious belief system on pregnancy care 
  Religion was important and determined pregnancy care sought in the community. 
Beliefs in the supernatural were prevalent. Pregnancy was perceived as a mystery from 
God and, therefore, seen as spiritual rather than biological. Therefore, women did 
patronize faith homes for pregnancy care and delivery of their babies, though they 
attended hospitals to take immunization and had a card in case of emergency.  
 A quarter (24.6%) of the last deliveries was in mission houses; religious reasons, 
such as prayers, were given for such decision. In their current pregnancies, 35.8% hoped 
to deliver their babies in FBBHs, while13.4%were yet to decide where to deliver. 
It was observed that the respondents made rigorous prayers in faith homes for safe 
delivery and against any form of complication and imagination of wicked people. 
Religious leaders and FBBAs reported that they fasted, prayed and read psalms on water, 
oil, sponge and soap as well as delivery materials. The women perceived ‗blessed‘ items 
more efficacious than hospital drugs. These items were for bathing and drinking while the 
pregnancy lasted. Different psalms were read at different trimesters of pregnancy. These 
were perceived to bring about safe delivery and ward off evil.  
 As pregnant women bought their delivery items, they were encouraged to submit 
them to FBBAs for safe keep and prayers. The FBBAs claimed that they continued to 
pray and read Psalms on the items until the women finally came for delivery. 
 Visions and prophecies were common features with many religious caregivers. 
Women knelt before such care providers to listen to fortune-telling. 
 In religious centres, women were taken to mountain tops for prayers at regular 
intervals. Vigils were also held in religious centres for the women. Women whose 
religious leaders perceived as having serious problems and special needs were camped in 
the religious centres for special and exclusive prayers that might last for 1 to 21 days 
depending on the magnitude of the perceived problems. They may be taken to flowing 
rivers for ritual baths as well. Women patronised religious centres to allay their fears of 
witches, wizards and other household challenges. 
 Pregnant women submitted kegs or bottles of water on the altar for special prayers. 
They drank and used part of it for bathing. Spiritual influence was also manifested in 
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hospitals as songs of praises and prayers were said there for safe delivery, though more 
time was spent on prayer in religious centres than in hospitals. 
 Some faith based birth homes (FBBHs) cooperated with orthodox medicine. They 
allowed nurses to give health talks and deliver babies that the nurses described as high-
risk pregnancies while those perceived to be at low risk were taken by FBBAs. 
 However, all was not always well at religious centres, as more MM occurred 
among unbooked patients than those that booked in hospitals. The study identified fifteen 
(15) maternal mortality (MM) in OAUTH, Ilesa between 2004 and 2008: 73.3% of the 
deaths were unbooked women, 40% of them delivered their babies elsewhere. Both Ante 
Partum and Post Partum Haemorrhage (PPH) were responsible for 45.5% of all MM. 
Amiable relationship was observed to exist among FBBAs and pregnant women. 
The FBBAs did not only provide pregnancy care, but they also provided counselling 
services for pregnant women and their spouses and were more sympathetic to their 
causes. 
The FBBAs instructed women on peaceful co-existence with their husbands and in-
laws. They invited husbands for discussion to know whether their wives‘ characters and 
marital relationship were good and suggested improvement where necessary. If any 
husband complained about his wife‘s behaviour, such a wife was reprimanded by the 
FBBAs. This was to enlist the co-operation of the husbands and ensure peace of the 
pregnant women. 
 
5.2.4  Adherence of pregnant women to basic instructions 
The result revealed that 79.6% of the respondents attended ANC but only 39.8% 
attended up to the recommended four visits. Attendance of ANC at the right time is 
essential for effective care. About fifty one percent of the respondents attended ANC at 
the first trimester in their last pregnancy. At the current pregnancy, 34.8% attended ANC 
at the first trimester. Above 18% attended ANC for the first time at the third trimester in 
their last pregnancies and 10.4% in their current pregnancies. Those who attended only at 
the third trimester could neither complete all the immunization nor undertake all the tests. 
The result revealed that 18.2% of the respondents took no immunization, 34.6% took 
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only one, 37.6% took two, and only 5.8% completed the immunization. Among the 
respondents, 35.3% Christians, 55.6% Muslims and 38.5% traditionalists took two shorts 
of tetanus toxoid. 
Only 51.6% of the respondents did ultrasound diagnostic examination and 24.9% 
did no blood tests. About 36% did not accept routine drugs and, among those who 
accepted, 30.8% did not take the drugs as prescribed. The IDIs revealed that women did 
not adhere to drug use because they did not like drugs and for religious reasons. Holy or 
blessed water got from FBBAs was perceived to be more efficacious than hospital drugs. 
In some faith homes, attendance at hospital for ANC was regarded as having ―no faith‖. 
Civil servants in such assemblies attended ANC just to collect hospital paper to enable 
them to obtain maternity leave. 
The result revealed that although women attended ANC, took immunization and 
take other precautions, at the point of delivery, 24.6% resorted to FBBAs, while 63.3% 
delivered in hospitals. 
The respondents were found to adhere to sleep instruction. Seventy-one percent of 
them claimed that they slept for at least 6 hours a day. They also adhered to instruction on 
eating fruits, as 82.0% of them claimed that they ate fruits daily. Adequate consumption 
of fresh fruits and vegetables will enhance good health for mothers and babies. 
 
5.2.5 Men’s roles in pregnancy care 
 Men were found to play dominant roles in pregnancy care. Husbands took major 
decisions in their homes and single-handedly determined the health care providers for 
their wives. About 62% of the men single-handedly paid for maternity materials. 
Husbands who single-handedly paid for maternity materials claimed that they dictated 
their wives‘ caregivers. But where they had joint account, the husbands reported that they 
made joint decisions on caregivers. They also bought drugs, food, fruits and vegetables 
for their wives. Husbands that could not afford these or refused to pay for them were 
regarded as irresponsible. The IDIs revealed that such husbands absconded on days of 
their wives‘ delivery. 
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 A few husbands reported that they took their wives to ANC and prayer meetings 
while others waited for the wives to return and give reports. The FBBAs saddled the 
husbands with the responsibility of reminding their wives of next ANC or prayer 
meetings. They were to encourage their wives to adhere to instruction at ANC and prayer 
meetings, especially those on drugs and food. All husbands claimed that their wives had 
to take permission from them to attend ANC or prayer sessions.  
 All husbands, regardless of the religious affiliation, claimed that they prayed 
earnestly for safe delivery for their wives. Some claimed that they wept bitterly when 
they saw their wives in labour pains. Some husbands said they went to mountain tops to 
pray for safe delivery of their wives. 
 Muslim husband asserted that he gave special offering to the needy to ensure his 
wife‘s safe delivery. One claimed that he read portions of Qu‘ran into water for his wife 
to drink for safe delivery.  
 About 38.8% of the husbands did house chores while their wives were pregnant. 
And 34.0% helped their wives to fetch water from the wells, while 6.4% gave money 
only. The husbands had to append their signatures to the wives‘ cards before they could 
be fully registered in faith homes. They also had to visit FBBAs at least 4-5 times for 
progress report concerning their wives. The FBBAs did not attend to pregnancies that 
were not supported by husbands. 
 The husbands were found to be ignorant of signs and symptoms of pregnancy 
complications but believed in the efficacy of prayers when such occurred. 
 Whenever there were needs for referrals in FBBAs, the husbands determined 
places their wives were referred to. They usually preferred private hospitals to teaching 
hospitals because of promptness of attention and poor attitudes of nurses in teaching 
hospitals. 
 About 55.0% of the husbands went with their wives to places of delivery and 
53.8% stayed around until their wives were delivered of their babies, giving them 
emotional and spiritual support.  
 
214 
                                                                                
 
5.3  Conclusion 
 This study provided information on pregnancy care in Ilesa, Osun State. It 
highlighted the social and religious background that determined pregnancy care. It 
brought to the limelight the influences of religion and patriarchy in family relationship on 
pregnancy care.  
 Finance was found to be constraining in accessing pregnancy care in hospitals, as 
many women were unable to afford maternity materials. The FBBAs were found to take a 
quater of all deliveries. When we understand the socio-cultural context of pregnancy care 
in the society, there is therefore the need to train FBBAs on better ways to manage 
women. A ban on mission houses would not bring the desired solution because the people 
are poor and cannot afford the cost of the materials that are demanded even in 
government hospitals and maternity centres where deliveries are claimed to be free. The 
reality is that the people find FBBAs more easily available and accessible when fund is in 
short supply. Although, the respondents and their husbands were literate, they could not 
access hospital care. It is imperative to upgrade the people‘s financial status and make 
them enjoy commensurate financial benefits of education. When people go to school but 
could not enjoy the benefits of education, they are discouraged from increasing their 
knowledge. To improve hospital deliveries, the economic status of the people should be 
raised and the cost of delivery materials in orthodox hospital reduced.  
 Pregnant women and their spouses were found to be ignorant of causes and 
symptoms of pregnancy complications. They attributed complications to activities of 
witches, wizards and adultery. Therefore, they sought spiritual solution to prevent and 
treat such complications. 
 Husbands‘ influences as heads of their families cannot be ignored. They paid for 
maternity materials and dictated caregivers to their spouses. Their financial and 
emotional supports were essentials for successful outcome.  
 
 
 
215 
                                                                                
 
5.4  Recommendations 
The study has shown that pregnancy care among the people of Ilesa cannot be 
separated from the social and factors of the environment. Government and NGO 
intervention strategies should recognise the religious and social factors that are prevalent 
in Ilesa.  
1. Education of adolescent girls and elderly mothers on risks associated with 
childbearing in their age brackets should be promoted. 
2. It is, therefore, recommended that various levels of government should spend 
money on training FBBAs and sensitization programmes. Such training should be 
to educate FBBAs on referrals, hygiene, family planning, drugs and food 
prescription, prevention of HIV, prevention as well as signs and symptoms of 
pregnancy complications and early referrals. They would be able to know those 
they can handle and those they must refer urgently. Retraining should be 
organized from time to time. 
3. Deaths that are orchestrated by FBBAs but take place at orthodox hospitals should 
be investigated and handled according to the law of the land. Whichever caregiver 
a pregnant woman opts for; there should be mutual cooperation among the 
caregivers.  
4. Government and orthodox caregivers should monitor and inspect faith houses 
with the aim of making them more hygienic and less risky.  Government should 
attach doctors and midwives to the FBBAs. There should be some conditions that 
birth houses should fulfil before they are allowed to take delivery. Failure to fulfil 
these conditions should make these birth houses culpable. 
5. Church leadership should be sensitized on the number of maternal losses 
associated with activities of FBBAs. Churches with birth houses should be 
inspected and licensed by government before they are allowed to practise. It 
should be made mandatory for such churches to have trained health workers to 
manage pregnant women.  
6. Referrals should be prompt and to the Teaching Hospital. Prayers can be offered 
while the pregnant women go to hospital. There is no barrier to prayer. Since the 
respondents see pregnancy from spiritual angle, they can be sensitized to pray in 
216 
                                                                                
 
religious houses but be determined to give birth in hospitals. There should be a 
way to sanction FBBAs or other caregivers that keep pregnant women unduly till 
life is wasted or almost wasted. 
7. Society has to address the poverty level of its citizenry to reduce maternal 
mortality. Cost of maternity services should be reduced for the benefit of the poor. 
8. Amiable disposition of caregivers in government hospitals will go a long way to 
encourage patronage and early referrals. 
9. Husbands should give balanced diets, financial and emotional support to their 
wives.  
10. Husbands need to be sensitized on the causes, symptoms, and signs of pregnancy 
complications. They should be sensitized to know how to prevent and detect 
complications, as well as the need to seek early help. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
217 
                                                                                
 
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APPENDICES 
 
Appendix I 
Sociology Department, University of Ibadan, Nigeria 
Research Questionnaire 
Dear Madam,  
I am Mrs M.O. Ayanleke, a postgraduate student at the Department of Sociology of the 
University of Ibadan. I am conducting a research on the maternal health of pregnant 
women in Ilesa, Osun State. This research is purely for academic purpose. Please feel 
free to answer questions about your health. However, you are free to decline any of the 
questions you do not want to answer. Your answers will be kept strictly confidential. In 
addition, any information you give will not be used to identify you. Your willingness to 
participate in this survey will be appreciated.  
Thank you. 
Section A: Socio-demographic Profile of Respondents 
S/N Questions Coding Categories 
1 How old were you on your last birthday?  
 (Give age in completed years.) 
2 What is your marital status?  
3 If married, what is your husband‘s No Schooling………………1 
educational qualification? Primary…………………….2 
Secondary (Uncompleted)…3 
Secondary (Completed)……4 
Tertiary (specify) ………….5 
4 What is your husband‘s occupation?  
232 
                                                                                
 
5 What is your highest educational No Schooling………………1 
qualification? Primary…………………….2 
Secondary (Uncompleted)…3 
Secondary (Completed)……4 
Tertiary (specify) ………….5 
Other (Specify) …………..5 
6 What is your estimated income per Less than 10,000……………..1 
month? 10,001- #19,999……………...2 
#20,000-#29,999……………..3 
#30,000 –#39,999…………….4 
#40,000 –#49,999…………….5 
#50,000 and above .…………..6 
7 What is your religious affiliation? Christianity………………..…..1 
 Islam……………………….….2 
African Traditional Religion…..3 
Other (specify)………………..4 
8 Catholic……………………….1  
If a Christian, your denomination? Protestant……………………..2 
Pentecostal……………………3 
Jehovah‘s witness…………….4 
Other Specify………………..5 
10 What is your ethnic group?  
 
Section B: Pregnant Women’s Compliance with Regimes and Husbands’ Roles in Pregnancy 
        QUESTIONS    Coding Categories 
12 Did you ever attend an antenatal clinic?  Yes…….1…………No………2 
13 Where? (Tick as many as are applicable) Govt hospital /maternity /clinic .….1 
 Private maternity/clinic/ hospital….2 
Church/Mission…….….….……….3 
Pharmarcy/drug store…………..….4 
233 
                                                                                
 
Stay at home.........................….5 
15 Who chose your centre for you?  
16 How many pregnancies have you had?  
17 How old was your last pregnancy when you  
first received ante-natal care? 
18 How old was this pregnancy when you first  
received ante-natal care? 
19 How many times have you attended?  
19 If not all, why did you miss out?  
20 Did you do ultrasound during this Yes           No 
pregnancy? 
21 Did you do blood sample Examination? Yes            No 
22 Apart from ante /post natal clinic days do you Yes            No 
also go to hospital? 
23 Did you take immunisations? Yes            No 
24 Did you take them at the time you were Yes            No 
supposed to? 
25 How many did you take?  
26 If not complete, why?  
27 What types of exercise do you do?  
28 What type of food and fruits did you take in  
the last two days? 
29 How often do you take fruits? Daily……………1 
Weekly……….…2 
Once in a while….3 
Seldom…………..4 
Never…………….5 
30 Were you always given drugs anytime you Yes                     No 
visit the clinic? 1                             2 
234 
                                                                                
 
31 Did you always take the drugs as you were Yes                      No 
told? 1                           2 
32 If no, why? I forgot………………….….1 
I do not like drugs………….2 
I did not have money to  
purchase them……..…….….3 
Religion.................................4 
Other specify …………..….5 
33  Husband only……..………1 
Who pays for your maternity materials? Husband partially….……...2 
Self fully………………….3 
Self partially ………….….4 
Jointly…………………….5 
In laws……………………6  
34 When you had your last baby did your Yes                      No  
husband go with you to where you delivered?                                 
35 Did he stay with you? Yes……1        No ………..2 
36 If he did not, why?  Lack of time due to work…………..….1 
Not interested….…………………….…2 
Saw no need…………………………….3 
Not permitted by hospital authority.,…..4  
Fear of the experience………………….5 
37 What other things does your husband do to  
help you in pregnancy? (e.g. domestic 
chores) 
38 Where did you deliver your last baby?  
39 Where do you hope to deliver this one?  
40 Why do you make that choice?  
 
Section C: Decision Making In Pregnancy 
41 Who decides on the number of children to have? Husband…………..1 
Self………………..2 
Jointly …………….3 
In laws…………….4 
God………………..5 
235 
                                                                                
 
Others Specify……..6 
42 Can a woman go to hospital without taking husband‘s Yes                             No                                 
permission? 
   
Can a woman refuse sex with husband if:  
                                                                    
She has a new baby?  1                                    2 
She is tired?  1                                    2 
The husband runs after other women?   1                                    2 
The husband has sexually transmitted infection? 1                                    2 
1                                    21                                    21                                    21      
43 Whenever your child is sick, can you decide alone  Yes                             No 
to take the child to hospital? 1                                  2 
Section D: Women’s Perception of Pregnancy Complications  
44 Which of these will you regard as Labour of more than 12 hours Yes        
pregnancy complications? (Tick as No 
many as applicable.) 
Excessive bleeding before or    1            2 
after delivery 
High fever                                 1            2 
Swollen legs                              1            2 
Bridged baby                             1           2 
Convulsion                                 1           2 
45 What do you think can cause any of Infection          
these above complications? 
Woman‘s physique                    1            2 
Witches and wizards                  1            2 
Adultery by the woman             1            2 
(State others) 
46 When a woman has any of these  Go to church……………..1 
complications where should she go?  
Go to Mosque…………….2 
 Go for FBBAs……….…..3 
 Go to maternity……....….4 
 Go to hospital………….….5  
236 
                                                                                
 
47 If there is need for blood transfusion in Yes                            No 
pregnancy or delivery, should one get 
1                                 2 
transfused? 
48 What are the other do‘s and don‘ts for  
pregnant women that you know? 
  Thank you for your cooperation.  
 
237 
                                                                                
 
 
APPENDIX II 
In-depth interview with Orthodox Health Workers and Faith Based Homes 
Good day Sir/Ma, 
My name is Mrs M.O.Ayanleke and I am a postgraduate student of the University of 
Ibadan. I am carrying out an investigation on pregnant women‘s maternal health in Ilesa 
East and West Local Government Areas. I will like to ask you some questions about your 
patients and operations. Your answers are strictly confidential and the information you 
give will never be used to identify you. The information you and others give will help us 
identify health related behaviour of women in this area. I will appreciate very much your 
willingness to participate in this survey. You are free to decline any of the questions you 
do not want to answer. Do you want me to begin the interview now? 
Signature of Interviewer …                                                            Date……………….. 
If consent is granted; the interview was conducted. If consent is denied interview ends. 
 In-depth Interview Identification No…………….. 
Care giver Identification No……………………… 
 Interview will be conducted in Yoruba or English where applicable 
  Probe for: 
1 Demographic characteristics of respondents  
2.  When he / she started taking deliveries.                        
3 Number of deliveries taken per month in the last six months. 
4.  The basic instructions that she/he gives to pregnant women. 
5.  Types of food prescribed and proscribed for them. 
6.  Conformity to these instructions.  
7.  Whether women come for antenatal clinics / prayer meetings regularly. 
8.   Roles played by husbands of pregnant women during pregnancy. 
9.  The dos and don‘ts handed over to pregnant women. 
10.  Common pregnancy complications that have been experienced in the course of 
duty. 
11.       Belief on causes of pregnancy complications. 
12 What they do when such complications arise. 
13.  What they think can help pregnant women make the best use of their services. 
14.  Their opinions about other health care providers patronized by these women. 
Thank you for your cooperation.  
238 
                                                                                
 
 
APPENDIX IIIa 
Husbands’ In-depth Interview Guide 
Good day Sir, 
 My name is M.O. Ayanleke and I am a postgraduate student of the University of 
Ibadan. I am carrying out an investigation on pregnancy care in Ilesa East and Ilesa West 
Local Government Areas. I will like to ask you some questions about your knowledge 
and care of your wife‘s pregnancy. Your answers are strictly confidential and the 
information you give will never be used to identify you. The information you give will 
help us to identify health- related behaviours of women in these areas. I will appreciate 
very much your willingness to participate in this survey. You are free to decline any of 
the questions you do not want to answer. Do you want me to begin the interview now? 
 
Signature of Interviewer …                                                            Date……………….. 
If consent is granted, the interview was conducted.  If consent is denied interview ends. 
In-depth Interview Identification No…………….. 
Care giver Identification No……………………… 
Interview will be conducted in Yoruba or English where applicable 
Probe for: 
1. Who recommends health care delivery for their wives? 
2.  Whether husband will allow their wives to go to hospital without their permission. 
3. Who pays for hospital bills and materials? 
4. What husbands do to encourage wives to attend any care giver that the wives 
patronize? 
5. What husbands do to encourage compliance to caregiver‘s instructions? 
6. Whether they will like to follow their wives to hospital /mission /TBAs‘ house 
and actually witness the delivery process. 
7.  Who should determine the number of children to have in the family? 
8.  What they would do if their wives refuse sex because they have sexually 
transmitted disease/ she is tired. 
9.  Husbands‘ knowledge and perception of causes of pregnancy complications. 
10.  What husbands think should be done. 
11.  Husbands‘ knowledge of food prescribed and proscribed in pregnancy. 
 
Thank you for your cooperation.  
 
239 
                                                                                
 
APPENDIX III b 
Itonisona fun iforowanilenuwo awon oko  
Oruko mi ni Olaitan Ayanleke. Mo je akeko gboye imo ijinle ni eka imo ibagbe eka 
ni Fasiti ti Ibadan. Mo n se iwadi lori itoju awon aboyun ni ijoba ibile Ila-Oorun ati Iwo 
Oorun Ilesa. Mo nife lati beere awon ibeere lori itoju ati ilera iyawo yin. Awon idahun 
yin ni yoo je ki a mo ipo ilera awon obinrin ni agbegbe yi. Inu mi yio dun gidigidi si 
ijowo ara yin fun iforowanilenuwo. E ni anfani lati dahun tabi ko lati dahun eyikeyi ninu 
awon ibeere naa.  
Ifowosiwe Oluwadi----------------------------Ojo iforowanilenuwo------------------------ 
Bi o ba gba iforowanilenuwo n te siwaju 
Numeri idanimo iforowanilenuwo 
Numeri idanimo Olutoju 
Iforowanilenuwo yoo je ni ede Yoruba tabi ti Geesi nibi ti o ti ye. 
 
Iwadi lorii: 
1.  Taani o n yan eto itoju (ile iwosan) awon aya ninu ebi? 
2.  N je awon oko le gba ki awon aya won lo si ile iwosan lai gba aase lowo won?. 
3.  Tanni o n san awon owo itoju ati awon ohun elo? 
4.  Kini oun ti awon oko n se lati ru awon aya won soke fun lilo sibi itojuti nwon maa 
nlo?  
5.   Oun ti awon oko nse lati mu ki awon aya se bi liana ti awon Olutoju la sile? 
6.  Se awon oko yoo fe lati tele awon aya lo si  ile iwosan/ Mission/ile itoju ati lati 
wa ni ibiti awon aya won ti nbimo. 
7.  Tanni o ye lati yan iye omo ti o ye ki ebi ni. 
8.  Kini awon oko yio se   ti awaon aya won ba ko ibalopo nitori ti won ni asan ti 
nranni nibi ibalopo tabi ti o ba re awon aya won.  
9.  Imo awon oko nipa eko ati ero a won oko nipa awon okunfa awon isoro aaboyun. 
10.  Oun ti awon oko ro pe o ye ki won se ti alaboyun ba ni wahala. 
11.  Imo awon oko lori awon ounje ti a yan fun alaboyun. 
  
E seun fun ifowosopo yin. 
 
  
 
 
240