ATTITUDE TO AND PRACTICES FOR SAFE MOTHERHOOD INITIATIVES AMONG WOMEN OF CHILDBEARING AGE ATTENDING HEALTH FACILITIES IN IGBO-EZE SOUTH LGA OF ENUGU STATE.

Abstract

The study investigated the attitude to and practices of Safe Motherhood Initiative (SMI) among women of childbearing age (WCBA) attending health facilities in Igbo-Eze South LGA of Enugu State. Eight specific objectives were formulated with eight corresponding research questions and six null hypotheses were postulated to guide the study. Literatures relevant to the study were reviewed. Population for the study was 7210 registered WCBA who attended health facilities in Igbo-Eze South LGA of Enugu State. The study adopted a cross sectional survey research design, Multistage sampling procedure was used to select the sample which was 144. A three section (27 item) researchers designed questionnaire was the instrument used for data collection. Face validity of the questionnaire was established by five experts and split half method of spearman’s Rank difference correlation method was employed to test the reliability of the study. The instrument was administered to respondents by the researcher by hand. Mean scores, frequencies and percentages were used to answer the research questions while t-test and ANOVA were used to test the hypotheses at .05 level of significance. Results of the study among others show that there was significant difference in attitude and practices of WCBA towards prenatal as it regards age, level of education and level  of  monthly  income.  The  study recommended  that  Health  Education  programmes should be established and intensified at the grass-root level to increase and promote the utilization of SMI services among childbearing mothers

Background to the Study

CHAPTER ONE Introduction

1

Safe motherhood is very crucial for making pregnancy and childbearing safe and enjoyable for the childbearing mothers. Pregnancy and childbirth are natural processes but they are by no means risk-free. They pose a lot of challenges to human-kind and medical science, both in the developed and developing countries of the world. Globally, a large number of women die due to factors related to pregnancy and child birth. World Health Organization-WHO (1998) submitted that more than half a million women die each year as a direct result of pregnancy-related complications such as severe bleeding which accounts for

25 per cent; indirect causes 20 per cent; infection 15 per cent; unsafe abortions 13 per cent; eclampsia 12 per cent; obstructed labour 8 per cent; and other direct causes 8 per cent. The above report further indicated that at least another 20 million mothers suffer serious and long lasting illnesses or disabilities. Ara and Islam (2013) observed that worldwide, about one woman dies  in every single  minute of the day  and that  for each woman who  dies, an estimated 100 women survive childbearing but suffer from serious disease, disability, or physical damage caused by pregnancy-related complications. These statistics are startling. It appears this is also the case with infant deaths and morbidity.n

The number of deaths and morbidities of newborn babies globally is still high. WHO (2012) noted that every year, 4 million newborn infants die and millions more are disabled because of poorly managed pregnancies and deliveries. Requejo (2013) indicated that 43 per cent of child deaths occur during the first month of life. In 2011 alone, 6.9 million children under the age of five died (United Nations Children Fund-UNICEF, 2012). The trend of maternal and child mortality and morbidity appears to be worse in the developing countries.

Reports show that there is high rate of maternal mortality and  morbidity due to pregnancy and child birth in developing countries compared to their developed counterparts. World Bank (1993) notes that of all the human development indicators, maternal mortality rate  (MMR)  represents  the  greatest  disparity  between  the  developed  and  developing countries.  Nigussie, Mariam and Mitike (2004) submit that the risk of dying from pregnancy- related complications is highest in Sub-Saharan Africa while in some countries the maternal mortality ratios are more than 1,000 deaths per 100,000 live births. According to WHO (2012), 99 per cent of global maternal mortality   occur in developing   countries, where a woman’s  lifetime risk of dying from pregnancy-related complications is 45 times higher than

that of her counterparts in developed world. Even among the countries in the developing world, there appears to be disparity in the rates of maternal mortality.

Some countries in the developing world record low maternal mortality rates while others rate high. Nigeria has been named as one of the countries in Sub-Saharan Africa with very high MMR. Nigeria constitutes 10 per cent of the world’s maternal and child deaths (Kusiako, Ronsmans & VanDer, 2000). According to Hill, Thomas, AbouZahr. Say, Inoue and Suzuki (2007), Nigeria’s maternal and child mortality ratio of 1,100 is higher than the regional average. Okonofua (2010) reports that Nigeria has been ranked as the number two country (after India) with the highest absolute number of maternal deaths in the world. The foregoing reports indicate that MMR is very high in Nigeria. Undermeath the foregoing statistics  lies the pain of human tragedy,  for thousands of families who  have  lost  their children and/or mothers especially in developing economy, including Nigeria. Maternal mortality has far reaching socio-economic implications.

A mother’s death carries profound consequences not only for her family, especially her  surviving children,  but  also  for her  community and  country.  Ara and  Islam (2013) observe that in some developing countries, if a mother dies, the risk of death for her children under the age of 5 is doubled or tripled. They add that because a woman dies during her most productive years, her death has a strong social and economic impact, her family and community lose a productive worker and a primary care giver. Daly, Azefor and Nasah (1993) note that women  produce most of the food necessary for a household, cook for the family, fetch water, clean the house and care for the children, the sick and the elderly at home. Therefore, their death appears to be a very big loss to their families and friends. A mother’s ill-health condition may also affect her baby and by extension, her household. At least 7 million pregnancies worldwide result in stillbirths or infant deaths as a result of maternal illness (Daly,  Azefor & Nasah,  1993). The above report further  indicated that among infants who survive the death of the mother, fewer than 10 percent live beyond their first birthday. It is regrettable to note that these maternal and child health mishaps are still high when they can be prevented.

It is devastating to know that intervention reaching these women and babies on time would  have averted  most of these deaths and  morbidities. The  World Bank (1993) has estimated that 74 per cent of maternal deaths could be averted if all women had access to interventions that address complications related to pregnancy and childbirth, especially emergency obstetric care. Suffice this to say that maternal and child mortality rates would

drop  if  there  were  sufficient  maternal  and  child  health  services,  interventions  and programmes.

It seems that there are insufficient maternal and child health services and programmes in the developing world. WHO (2012) observe that poor women in remote areas are the least likely to receive adequate health care. WHO maintain that this is especially true for regions with low numbers of skilled health workers, such as Sub-Saharan Africa. According to the above report, while levels of antenatal care have increased in many parts of the world during the past decade, only 46 per cent of women in low-income countries benefit from skilled care during childbirth. This means that millions of births are not assisted by a midwife, a doctor or a trained nurse. In low-income countries including Nigeria, Just one third of all pregnant women have the recommended four antenatal care visits and only 31 per cent of all deliveries take place in a health care facility (WHO, 2012). A study conducted by WHO (2013) in northern Nigeria indicated that 25 per cent of all deliveries took place at home with no assistance or attendant present. The report further revealed that facilities including antenatal care, prenatal care, post-partum and obstetric care facilities in the country were generally in poor condition with chronic shortages of essential equipment, drugs and human resources. This problem has created an emergency need for programmes and policies aimed at accelerating  progress towards  addressing  the  menace.  One  of such programmes  is  Safe Motherhood Initiative.

Safe  Motherhood Initiative  (SMI)  is  a  programme  of activities  directed  towards ensuring that child-bearing mothers and their children do not face the risk of mortality or morbidity in pregnancies, child births, and post partum period. Daly, Azefor and Nasah (1993) defined SMI as a concerted set of interventions designed to reduce maternal mortality and to improve the reproductive health status of women. It is a means of saving the lives of women and improving the health of millions of others (Jatau, 2000). SMI has been conceptualized  as  a  means  of  ensuring  women’s  accessibility  to  needed  care  through antenatal programme in order to facilitate their safety and optimal health throughout pregnancy and child  birth (Price, 2002). According to Ara and Islam (2013), SMI is  a programme aimed at enhancing the quality and safety of women’s lives through the adoption of a  combination of health strategies  which  include:  ensuring women’s right  to  decide whether  and  when  to  have  children  by  providing  access  to  family  planning  services; increasing the numbers of healthcare providers (midwives, doctors, nurses and traditional birth attendants); and improving training for healthcare service providers. Definitions can go on but they have central conceptual focus: ensuring the safety and health of mothers and that

of their children during pregnancies and child birth. In the context of the present study, SMI

is a programme while safe motherhood is the goal of the programme (SMI).

Safe motherhood may be described as actions taken by mothers, relatives and healthcare providers in order to  make pregnancy and childbearing risk-free for mothers. Chinwuzie, Braimoh, Unigbe and Olumeko (1995) noted that safe motherhood included: family planning services to prevent unwanted pregnancies; safe abortions, where legal, and efficient  management  and  treatment  of complications  of unsafe  abortions; prenatal and delivery care at the community level with quick access to first-referral services for complications; and postpartum care, including family planning services, promotion of breastfeeding, immunization and nutrition services. Suffice it to say that when one practices the components of SMI, one is said to have practiced safe motherhood. In this study, safe motherhood means actions or roles taken by mothers, relatives and healthcare providers in order to make pregnancy and childbearing risk-free for mothers.

Safe Motherhood Initiative is achieved through a programme of inter-linked components which are pulled together to ensure the safety, health and happiness of child- bearing mothers. According to Partnership for Transforming Health Care System-PATHS (2005), and Ara  and Islam (2013) SMI comprises pre-conception care; antenatal care; post- partum care; post-abortion care; emergency  obstetric care/life saving skills; and care of the new  born.  PATHS (2005), Ara    and  Islam (2013), and the  United    Nations’ Fund  for Population activities-UNFPA (2014) describe these components thus: Pre-conception care is the information and services (such as screening for and managing conditions which may complicate pregnancy, childbirth and health of the mother and child) given to an individual or couple who intend to biologically father or mother a child.

During pregnancy, it is very important that a mother takes good care of her own health and that of her unborn baby. This is known as antenatal care. Antenatal care is the care of the women during pregnancy (UNFPA, 2014). Other cares such as post-partum care, post- abortion care; emergency obstetric care/life saving skills are targeted towards saving the life and promoting the health of the mother and her child in the course of and after delivery (PATHS, 2005). UNFPA (2014) advise that since up to 50 per cent of maternal deaths occur after delivery, a midwife or a trained and supervised traditional birth attendant (TBA) should visit all mothers as soon as possible within the first 24-48 hours after birth. Ara and Islam (2013) advised that the midwife or TBA should assess the mother’s general condition and recovery  after  childbirth  and  identify  any  special  needs.  This  attention  is  particularly important especially when the woman is alone or as the head of the family.

A child-bearing mother and her child are supposed to benefit from SMI in a variety of ways. Daly, Azefor and Nasah (1993), and Jatau (2000) agree that the health risks that confront childbearing women especially teenage mothers are serious and they include: pre- eclamptic toxiaemia, anaemia, malnutrition, cephalopelvic disproportion, obstetric fistulae, obstructed labour, low birth weight and perinatal mortality. These complications and abnormalities according to the above report are preventable through valid motherhood programmes in maternal and child health (MCH) clinics. World Bank (2013) adds that SMI promotes family planning practice and  ensures that  unwanted or unplanned pregnancies which can interfere with women’s social and economic activities and cause emotional and economic hardship not only to women but also to their families are avoided. WHO (2012) submits that SMI lessens the burden associated with frequent pregnancies, poor maternal health, pregnancy complications, and caring for sick children which drains the productive energy of women, jeopardizes their income-earning capacity, and contributes to their poverty. Jatau (2000) observes that SMI reduces the number of children who have drastically diminished prospects of leading a productive life following the death of a mother. In order to reduce life-threatening risks, mortality and morbidity among childbearing mothers, good quality maternal health services by trained health workers must be available and must be used by childbearing mothers.

A childbearing mother is a woman in her reproductive age (i.e. between puberty and menopause). Child-bearing age has been described as the period in a woman’s life between puberty and menopause (Williams & Wilkins, 2006). Experts, as reported by Medical News Today-MNT (2005), advise that the best age for childbearing remains 20-35. Medical News Today (2005) warns that age-related fertility problems increase after 35 and dramatically after 40. Under-aged mothers also are at the high risk of pregnancy-related complication. WHO (2012) reports that young adolescents face a higher risk of complications and death as a result of pregnancy than older women. Studies like Jatau (2000), and Williams and Wilkins (2006) show that adolescent pregnancy is an exploding problem in Sub-Saharan Africa. Young women under age 20 in Africa are more likely to have a child than those in other regions (Daly, Azefor  & Nasah, 1993). For example, by age 18 more than 40 percent of the women in Africa have given birth already (Senderwitz 1993). Daly, Azefor and Nasah (1993) reported that in Africa, 1 in 5 adolescent women would have a birth in a given year. They note that most of the births to teenagers are first births and women having their first child carry higher risk of serious medical complications. The above report further reveals that babies who are first births face a higher infant mortality rate than higher order births and this

risk is even greater among teenage mothers. Childbearing mother in this study is a woman who is in a period between her puberty and menopause. How the childbearing mothers would benefit from SMI depended on their attitude to it.

Attitude is a hypothetical construct that represents an individual’s degree of like or dislike for something which in turn influences his/her behaviour to that thing. Hornby (2005) defined attitude as the way that you think and feel about somebody or something which influences the way you behave to the person or the thing. It is a mental position relative to a way of thinking or being (Looper, 2006). According to Wyohannes (2010), it is defined as an opinion or way of thinking which reflects in the person’s behaviour. If childbearing mothers feel that safe motherhood is for their own good, they may develop positive attitude towards it and vice-versa. In the present work, attitude refers to childbearing mothers’ feeling about safe motherhood which influences their behaviour towards it. Positive attitude to safe motherhood may make mothers to put it into practice.

Practice means doing a particular thing over and over again. According to Hornby (2005),  practice  means  doing  something  regularly  as  part  of  one’s  normal  behaviour. Merriam-Webster (2012) adds that to practice means to do or perform often, customarily, or habitually.  In this  study,  practice  refers  to  the  habitual actions applied  by  childbearing mothers which are directed towards ensuring that they and their babies do not face the risk of mortality or morbidity in their pregnancies, child births, and post partum periods. According to  Ara and Islam (2013), practice  for safe  motherhood may be  interrupted by common problems in rural settings such as poverty, inadequate and/or poor quality health facilities and ill-equipment of the existing ones. Others are inadequate knowledge and lack of women education  among  families,  poor  utilization  of  available  health  services,  negligence  and attitude of health personnel, cultural practices, traditional values and belief system. This may be the case with Igbo-Eze South LGA. Part of the interest of the present work is to investigate the practice of safe motherhood among childbearing women in Igbo-Eze South LGA. Childbearing women’s attitude to and practice for safe motherhood have been consistently reported  to  be  influenced  by  a  number  of  socio-demographic  factors  such  as  level  of education, location, age, economic status among others.

Mother’s level of education appears to wield strong influence on her attitude to and practice for safe motherhood. More educated mothers may acquire greater knowledge concerning  health outcomes of their  every action and this  might  make  them to  imbibe positive attitude to and consistent practice for safe motherhood. Becker, Peter, Gray, Gultiano and Blake (1993) note that mother’s education may also act as a proxy variable of a number

of background variables representing women’s higher socioeconomic status; thus, enabling her to seek proper medical care whenever she perceives it necessary. According to UNICEF (1997), education is positively associated with increased utilization of health services. Nisar and White (2003) observe that there are a number of explanations why education is a key determinant of demand. According to the authors, education is likely to enhance female autonomy; therefore, women develop greater confidence and capabilities to make decisions regarding their own health, as well as their children’s health. The above report indicates that it is likely that more educated women seek higher quality services and have greater ability to use health care inputs to produce better health outcomes. That may be why Rossiter et al (2005) emphasize that formal education has the key to improved utilization of maternal and perinatal health services. Sharma and Sharma (2012) note that it is believed that women’ education is important for understanding health messages and to be able to make decisions regarding their health and care.

Female literacy level and women’s economic status appear closely interlinked with maternal attitude to  and practices  for safe  motherhood as reported in most  studies. For instance, WHO (1990) report that in all countries where female literacy rates and economic status have been high, the birth rates and reproductive mortality rates like MMR and IMR have been low. To buttress the relatedness of a mother’s level of education and her economic status in increasing safe motherhood practices, Agarwal and Reddaiah (2005) recommend that it  is very important to  raise the status of women in terms of education and socio- economic status. From the foregoing, a woman’s level of education has been shown to be strongly connected with her economic status in promoting positive attitude to and practice for safe  motherhood. Irrespective of her  level of education, a woman’s level of income  or economic status appears to be a strong determinant of her attitude to and practice for safe motherhood.

Women who have access to  money are likely to  have a positive attitude to  and practices for safe motherhood. Elo, (1992), and Fosu, (1994) note that increased income has a positive effect on the utilization of modern health care services. Nisar and White (2003) find income level to be a significant factor affecting utilization of MCH services and they report that  women of higher  income were  two times  more  likely to  use antenatal services  as compared to the lower income group. WHO (2012) note that poor women in remote areas are the least likely to receive adequate health care and that this is especially true for regions with low numbers of skilled health workers, such as Sub-Saharan Africa and  South Asia. Those indicators were more adverse in rural areas.

Modern health facilities and services may be lacking in short supply or ill-equipped in the rural communities. Nigussie, Mariam and Mitike (2004) note that place of residence influences utilization of delivery services as urban women have more access to health care services than their rural counterparts. SIHFW (2008) report that rural women were far less likely to receive three ANC contacts (32%) compared to their urban counterparts (75%). SIHFW maintained that only 43 per cent of births in rural settings were attended to by a health professional, and urban women were more than twice as likely to seek such assistance. Utilization of MCHS may also depend on mother’s age.

As years pass by, one naturally accumulates experiences. This means that as a mother grows older in her child-bearing life, her level of puerperal experiences also increases. An older or more experienced mother may utilize MCHS which will reduce her chances of exposure to pregnancy-related complications unlike young inexperienced mothers. Studies like Fiedler (1994) notes that mother’s age may sometimes serve as a proxy for the women’s accumulated knowledge of health care services, which may have a positive influence on the use of health services. Daly, Azefor and Nasah (1993) report that few adolescent mothers seek   reproductive   health   services   than   older   mothers   because   few   teenagers   are knowledgeable about sexual behaviour: few services are available for teenage mothers. The above report further revealed that because adolescents seek anonymity or do not have the money to pay for services, they conduct abortion by themselves or resort to unsafe abortion by people who have no medical training; therefore, they often delay seeking treatment for complications of illegal abortion for fear of revealing their identity and intention, or due to lack of access to health services.

Some studies argue that younger mothers may practice safe motherhood more than the older ones. Normon, Lopez, Carcamo and Galindo (1993) report that because of development of modern medicine and improvement in educational opportunities for women in recent years, younger women might have an enhanced knowledge of modern health care services and place more value upon modern medicine. This appears to be true especially when it has been reported in literature that the practice for safe motherhood is more among the educated mothers than the uneducated ones.

Some authors believe that one would naturally seek care irrespective of one’s age. This means that mother’s age has no connection with the attitude to and practice for safe motherhood. Igbokwe and Adama (2011) reported that age had no significant influence on child-bearing mother’s practice of SMI components. The authors maintained that the age of

an individual does not necessarily influence the individual’s capacity to effectively practice health-related behaviour which is of immense to the individual.

In addition to mothers’ age, other factors have been implicated to influence attitude to and practice for safe motherhood. Factors such as culture, parity and marital status have been reported to influence mothers’ attitude to and practice for safe motherhood (Daly, Azefor, Nasah, 1993; Nigussie, Mariam, and Mitike, 2004; WHO, 2012; Ara, S. & Islam, 2013). The aforementioned socio-demographic factors may also influence the attitude to and practices for safe motherhood in Igbo-Eze South LGA. These factors are rooted in some theories for better comprehension since every scientific research appears to be built on given theories.

Theories are constructs and postulations that guide or suggest a way in which individuals perceive phenomena and act or behave which in turn may influence the nature and the level of what they know or practice. Philips (1991) noted that the desire to effect change in behaviour for reducing the risk of future illness should be based upon theoretical models  that  identify  predictors  of  behavioural  change.  According  to  Microsoft  Encarta (2009),  theory  is  an  idea  or  belief  about  something  arrived  at  through  peculation  or conjecture. Therefore, the present study will be anchored on the theory of Health Seeking- Behaviour and Theory of Attachment.

Igbo-Eze South is one of LGAs in Enugu State. It is a rural setting predominantly made up of farming communities.  Some  health- related harmful practices such as early marriages with attendant health risks, female genital mutilation, desire for many children, male children preference, and use of unhygienic objects for cord cutting and circumcision may still be observed in the area. These practices have negative health consequences on the mothers and their babies. There are numerous patent medicine shops and many herbal homes while formal health facilities are few. According to Igbo-Eze South LGA Ministry of Health- ISMH (2013), there are only 15 health facilities for the whole LGA. Judging from the proliferation of these  herbal homes and  chemist  shops,  it  appears that  Igbo-Eze people including child-bearing mothers rely so much on them than the formal health facilities for their health care. One wonders at the attitude to and practices for safe motherhood among these child-bearing women since no study, to the best of knowledge of the present researcher, has reported it. This calls for a research such as the present one to fill the backdrop in the literature.

Statement of the Problem

Safe motherhood was initiated so that pregnancy-associated complications among child-bearing mothers will be minimized or total avoided, thereby reducing the trend of maternal and child mortality and morbidity. Studies show that 74 per cent of maternal deaths could be averted if all women should engage in safe motherhood practices which address complications related to pregnancy and childbirth, especially emergency obstetric care. Following from this, it becomes necessary for child-bearing mothers to demonstrate positive attitude to and meticulous practice for safe motherhood in other to preserve their own health and life, and that of their infants.

In  Igbo-Eze  South  LGA,  some  health-related  harmful  practices  such  as  early marriages with attendant heath risks, female genital mutilation, desire for many children, male children preference, and use of unhygienic objects for cord cutting and circumcision may still be observed. These practices have negative health consequences on the mothers and their babies. There are numerous patent medicine shops and many herbal homes while formal health facilities are few.  There are only 15 health facilities for the whole LGA. Judging from the proliferation of these herbal homes and chemist shops, it appears that Igbo-Eze people including  child-bearing  mothers rely  so  much  on them more  than the  registered  health facilities for their health care.

This situation is bothersome. The problem is, what would the attitude to and practices for safe motherhood among the childbearing mothers in Igbo-Eze South LGA in the context of the above features? Since no study, to the best of knowledge of the present researcher, has been conducted to answer the above question, the present one poises to do so.

Purpose of the Study

The  purpose of this  study is  to  determine  the  attitude  to  and  practices  for  safe motherhood among women of child-bearing age (WCBA) attending health facilities in Igbo- Eze South LGA of Enugu State. Specifically, this study will determine the:

1.  attitude of WCBA to safe motherhood;

2.  practice for safe notherhood among WCBA;

3.  influence of age on WCB’s attitude for safe motherhood;

4.    influence of age on WCB’s practices for safe motherhood;

5.    influence of level of education on WCB’s attitude for safe motherhood;

6.    influence of level of education on WCB’s practices for safe motherhood;

7.  influence of level of imcome on WCB’s attitude for safe motherhood;

8.  influence of level of income  on WCB’s practices for safe motherhood.

Research Questions

The following research questions were posed to guide the present study.

1.  What is the attitude of WCBA to safe motherhood initiatives?

2.  What are the practices for safe motherhood initiatives among WCBA?

3.  What is the influence of age on WCB’s attitude for safe motherhood initiatives?

4.  What is the influence of age on WCB’s practices for safe motherhood initiatives?

5.  What is the influence of level of education on WCB’s attitude for safe motherhood initiatives?

6.    What is the influence of level of education on WCB’s practices for safe motherhood initiatives?

7.  What is the influence of level of income on WCB’s attitude for safe motherhood initiatives?

8.  What is the influence of level of income  on WCB’s practices for safe motherhood initiatives?

Hypotheses

The following null hypotheses were postulated to guide the present study. Each of them was tested at .05 level of significance.

1.  There  is  no  significant  difference  in  the  childbearing  women’s  attitude  to  safe motherhood initiative based on age.

2.  There  is  no  significant  difference  in  the  childbearing  women’s practices to  safe motherhood initiative based on age.

3.  There  is  no  significant  difference  in  the  childbearing  women’s  attitude  to  safe motherhood initiative based on educational level.

4.  There  is  no  significant  difference  in  the  childbearing  women’s practices to  safe motherhood initiative based on educational level.

5.  There  is  no  significant  difference  in  the  childbearing  women’s  attitude  to  safe motherhood initiative based on income level.

6.  There  is  no  significant  difference  in  the  childbearing  women’s practices to  safe motherhood initiative based on income level.

Significance of the Study

The present study will generate data on the attitude to and practices for safe motherhood among women of child-bearing age attending health facilities in Igbo-Eze LGA of Enugu State. The findings of the study will be of immense benefit to the government at all levels, families, health educators, researchers, health care providers.

Findings form the attitude to components of SMI among WCBA will also be useful to the governments, UNICEF and WHO. If mothers are found to have negative attitude to SMI, the government, UNICEF and WHO may be prompted to strengthen their campaigns, workshops, adverts and every other programmes which will glamourize  the essence of SMI. With this in place, the child-bearing mothers may be attracted and they may begin to develop positive attitude to SMI. The health educators will also find this an opportunity to educate mothers on the benefits of practices for safe motherhood. With this, mothers may begin to develop healthy attitude to safe motherhood.

Findings  from  the  practices  for  safe  motherhood  among  WCBA  will  be  very important to governments, health educators, WHO and UNICEF who are interested in propagating the principles of safe motherhood. The government may strengthen the Free Maternal and Child Health Services (MCHS) so that more mothers will have access to health care and may be able to optimally practice safe motherhood. These findings may spur health educators to intensify the teaching of the benefits of practices for safe motherhood. WHO and UNICEF  may  use  the  findings to  evaluate  the  SMI  practices  so  far  and  then  institute strategies for improvement.

The findings from the influence of age on WCBA’s attitude to SMI will help the health educators to appropriately plan their teaching of tenets of SMI. Attention of those mothers who are at most risk of pregnancy-related complications like adolescent mothers and those approaching menopause will be drawn in order to make them develop positive attitude to safe motherhood. Attention may also be given to all mothers irrespective of age.

Data generated from the influence of age on WCBA’s practice of SMI will be of immense benefits to the families, nurse and health educators. The health educators and the nurses may  appreciate the  need to  intensify efforts towards teaching  the principles and practice for safe motherhood to the mothers including their husbands and relations. This may make the mothers to practice safe motherhood. Even when they backslide in the practice of safe motherhood, their relations will reinforce them to continue because they have received scientific information about SMI through Health Education. With this, mother may unconsciously develop the habit of practicing safe motherhood.

The findings from the influence of level of education on WCBA’s attitude to SMI will benefit various facilities. They may see the need for woman or girl-child education as often discouraged in the developing countries. This finding may make the health educators to extend their teachings beyond mothers to other members of society to see the need and benefits of girl child education. If a woman is educated, she is likely going to be positive about life. The findings will also help the curriculum planners to appropriately and compulsorily make the knowledge of SMI part of relevant subject in all levels of education.

The findings from the influence of level of education on WCBA’s practice of SMI will be of immense benefit to the health educators, governments, WHO and UNICEF. They may grant free education to child-bearing mothers knowing that with education, a mother stands a better chance of appreciating the importance of SMI.  Also, the health educators will find this an opportunity to educate mothers on the benefits of practices for safe motherhood. With this, mothers may begin to develop positive attitude to safe motherhood. As a result, she may see the need to practice safe motherhood.

The findings from the influence of level of income on WCBA’s attitude to SMI will be of great benefit to the health educators, families and government. The health educators may as result of the findings educate families especially the husbands on the need to always support their wives financially as regards their medication and personal needs. The families especially the husbands may learn that it is very important to support their wives financially, or create for them income earning ventures so that they may be self dependent in terms of financing their health services. The government may also strengthen the free maternal and child health services knowing that it will promote positive attitude to safe motherhood among the child-bearing mothers.

Data generated from the influence of level of income on WCBA’s practice of SMI may also benefit the health educators, government, WHO and UNICEF. Following from these  findings,  the  health  educators  may  consistently  educate  families  on  the  need  for women’s financial autonomy. The government, WHO and UNICEF may be prompted by the findings to find a way of empowering women to be financially self sufficient so that they may improve in their practice of safe motherhood initiative.

Finally, the theory and model applied in this study will promote the understanding of the need for SMI among the WCBA. This will be tangential to the attitude to and practice of SMI among the WCBAs, the age, level of education notwithstanding. The theory and model have constructs and tenets that may guide thw WCBAs to break the barriers of demographic differences in order to attain the optimal realization and benefits associated with SMI. The

theories and models may therefore be used by researchers to make predictions or analysis of expected outcomes in related studies. More so, SMI planners and faciliotaors may utilize the theory or model in explaining some concepts of SMI that has to do with attitude and practice in order to promote attitudinal change and very high and consistent practices among WCBAs.

Scope of the Study

This study was delimited to Igbo-Eze South LGA of Enugu State. It focused on all the childbearing mothers attending health facilities in the LGA. It also investigated the attitude to and practices for safe motherhood among this population. The study covered level of education, age and level of income which were the socio-demographic factors that impinged on and influencing attitude to and practices for safe motherhood among childbearing mothers.

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