ABSTRACT

The purpose of the study was to appraise the level of attainment of MDG-5 (maternal health) in North Central Nigeria. The study is carried in this area as a result of the endemic nature of the region on the issues of maternal mortality rate with an estimated ratio of 1549 per 100000 live births. To investigate this problem, six research questions were formulated to determine the extent to which family planning, antenatal and postnatal services were delivered in NCN. The  study also determine the strategies put in place to reduction childbearing adolescent birth rate, adequacy of skilled health personnel and extent of maternal mortality rate reduction in NCN. Three null hypotheses were formulated to guide the study and tested at an alpha level 0.05. Evaluative design was adopted for the study with a population of 10,610 consisting of 1,315 Doctors, 6,039 Nurses, 1,739 Midwives and 1,517 expectant/nursing mothers. A sample of 1070 respondents was drawn from the population using multi stage sampling procedure, purposive, proportionate and simple random sampling techniques. Structured questionnaire instrument was used for data collection titled maternal health questionnaire (MAHEQ). It was face validated by three experts and trial tested with an overall reliability index of 0.83 using cronbach alpha.  Mean, standard deviation and percentages were used in the analysis of the data collected. The real limit of numbers at which the responses were accepted was at 2.50-3.49 and above. The three null hypotheses were analysed using ANOVA and tested at an alpha level of 0.05. The findings of the study show that the need for family planning services, antenatal care services, and post‑natal care services were delivered to a high extent in North Central Nigeria.  The findings of the study also show that strategies were adopted to reduce adolescent birth rate and rated to a high extent in North Central Nigeria. This result shows that high effort was made in reducing the high maternal mortality ratio. The adequacy of skilled health personnel was to low extent. This result shows some degree of hindrance in the effort to achieve the desired result of 75% reduction by 2015. However the rate at which maternal mortality rate reduced from 2005 to 2013 was to a high extent. It is based on the above result that the following recommendation were made: that more medical personnel should be recruited, enlightenment campaigns should be intensified to show the advantages of MH services, continuous training of medical personnel on various methods of contraceptives use and administration for optimum service delivery should be intensified, introduction of sex education through outreach programmes to help the adolescents and improving laboratory facilities to reduce the burden of cost on the poor pregnant mothers.

 

 

TABLE OF CONTENTS

      TITLE PAGE                                                                                                                                 i

APPROVAL PAGE                                                                                                                       ii

CERTIFICATION                                                                                                                         iii

DEDICATION                                                                                                                              iv

ACKNOWLEGEMENTS                                                                                                              vi                          TABLE OF CONTENTS                                                                                                                vii                                                                                                                                          LIST OF TABLES                                                                                                                          viii

LIST OF FIGURES                                                                                                                        ix

ABSTRACT                                                                                                                                   x

 CHAPTER ONE: INTRODUCTION

Background of the Study                                                                                                 1

Statement of the Problem                                                                                                 13

Purpose of the Study                                                                                                        14

Significance of the Study                                                                                                 15

Research Questions                                                                                                           16

Hypotheses                                                                                                                       17

Scope of the Study                                                                                                           17

 

     CHAPTER TWO: LITERATURE REVIEW

Conceptual Framework

 

The Concept of Appraisal                                                                                                  18

The Concept of Attainment                                                                                               23

The Concept of Millennium Development Goals                                                              28

The concept of Maternal Health                                                                                        37

Theoretical Framework

 

Human Development Theory                                                                                             44

World System Theory                                                                                                        45

     Theory of Globalization                                                                                                                 47

 

 

 

 

    Appraisal Models                                                                                                                 

 

Scherer’s Multi-level Sequential Appraisal Check Model                                                  49

Structural Model of appraisal                                                                                            49

Roseman’s Model of Appraisal                                                                                          53

 

     Review of Related Empirical Studies                                                                           

 

Family Planning                                                                                                                 55

Childbearing Adolescent birth rate                                                                                    59

Antenatal Services                                                                                                             61

Postnatal Services                                                                                                              62

Skilled Health Personnel                                                                                                    64

Extent of Reduction of Maternal Mortality                                                                      66

 

Summary of Literature Review                                                                                      68

 

     CHAPTER THREE: METHODOLOGY

 

Design of the Study                                                                                                           71

Area of the Study                                                                                                              71

Population of the Study                                                                                                     72

Sample and Sampling Techniques                                                                                     73

Instrument for Data Collection                                                                                          74

Validation of the Instrument                                                                                             74

Reliability of the Instrument                                                                                              75

Procedure for data Collection                                                                                            75

Method of data Analysis                                                                                                   76

  

    CHAPTER FOUR: RESULTS                                                                               

 

    Presentation of Results                                                                                                       77

Summary of findings                                                                                                          90

    

    CHAPTER FIVE:  DISCUSSION, CONCLUSION AND RECOMMENDATION

                                                                                                                           

     Discussion                                                                                                                          91

Conclusion                                                                                                                         100

Recommendation                                                                                                               101

Implications of the Study                                                                                                  102

Limitation of the Study                                                                                                     105

Suggestion for Further Research                                                                                       105

 

REFERENCES                                                                                                               107

APPENDICES                                                                                                                 120                                                                                                                                                                            

 

CHAPTER ONE

INTRODUCTION

Background of the Study

Over the years development has been a major issue especially in the third world countries. This has created disparities from one nation to another and led to grouping of countries like Mali, Niger and Nigeria on one side and United States of America, Great Britain and France on the other. Clear divide has emerged among nations based on their various socio-economic well beings. Countries with developed economies in which the tertiary and quaternary sectors of industry dominate have been designated as developed or advanced countries, while countries ‘christened’ less developed are characterised by relatively low standard of living, an undeveloped industrial base, wide spread poverty, low capital formation and low per capita income (Adinma & Adinma, 2011).

This wide disparity in development has created a lot of problems in and across borders giving rise to global problems in term of crime waves of various dimensions and magnitude in various aspects of human life. Typical among these problems is the issue of poor Maternal Health (MH) in which United Nations Health Metric Report (2010) revealed that Nigeria is ranking second in the world after India with the highest Maternal Mortality ratio. World organisations that are stakeholders in global development such as the United Nations (UN) were not satisfied with the above state of affairs in global development. This dissatisfaction triggered off series of conferences on development in the 90s to tackle the issue globally. The issues discussed ranges from education (Jomtien, 1990), children (New York, 1990), environment (Rio de Janeiro, 1992), human rights (Vienna, 1993), population (Cairo, 1994), social development (Copenhagen, 1995) and women (Beijing, 1995) (Emmerij, Jolly & Weiss, 2001:112). All these conferences centred on the issues of development as it affects the human organism which led to MDGs declaration for global world development.

Owen, (2012) defines development as an emergent property of the economic and social scheme. It is a system-wide manifestation of the way people, firms, technologies and institutions interact with each other within the economic, social and political systems.  Specifically, Owen further indicated that it is the capacity of these systems to provide self-organising complexity in which the system is never designed or deliberately built but comes about from a process of adaptation and evolution. To accelerate and shape development, focus should be directed especially to how the environment can be made most conducive for self-organising complexity to evolve. Furthermore, development is more than improvements in people’s well-being. It describes the capacity of the system to provide the circumstances for that continued well-being. Development is a characteristic of the system. Sustained improvements in individual well-being are the yardstick by which it is judged and this has important implications for development policy, especially for developing countries wishing to put their economy and society onto a path of faster development (Owen 2012).

This concept of development is in consonance with the theory of human development by Sen (1989) which emphasises the development of the human capabilities as an ingredient of development. Cornby (2013) defines development as the process of economic and social transformation that is based on complex cultural and environmental factors and their interactions. In the context of this study, development is the interaction of the social and cultural factors in which a favourable environment is created for the development of the human capacity to bring about the desirable and sustainable changes and development. On this

issue of development, the Millennium Development Goals is a global promise to bring about development by rapidly reducing human deprivation, and advancing human and environmental development.

Historically, the Millennium Development Goals was not the first of such promises that have been made for improved global development especially on individual well being. Antecedents can be found stretching back to President Franklin D. Roosevelt’s ‘Four Freedoms’ speech of January 1941 and to the Declaration of Human Rights of 1948 which declares that ‘Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care’ (UN Declaration of Human Rights, Article 25, 1948).  Toye & Toye, (2005a & 2005b) revealed that the 1960s were declared unanimously in the General Assembly to be the first UN Development Decade for development, sparking off a rash of target setting, but enthusiasm to set targets ran ahead of commitment to action. Hulmes, (2009) reported that the processes for monitoring targets and mechanisms for producing plans of action were not created and the results often fell far short of the rhetoric and this reduced UN’s influence while that of the International Monetary Fund (IMF) and World Bank (WB) increased as they imposed structural adjustment policies on the increasing numbers of poor countries coming to them for loans.

Towards the end of the 1980s, more and more evidence began to emerge that structural adjustment and the associated conditionalities were not delivering the promise of growth and prosperity, and the fiscal restraint they called for were damaging education, health and other essential services in the third world countries (Cornia, Jolly & Stewart, 1987; Mosley, Harrigan & Toye, 1995). This implies a deviation from the MDGs agenda as declared in the initial UN declarations of 1948.  Hulmes (2009) reported that political space began to open up for those with alternatives to structural adjustment, and in the 1990s UN summitry and conferences returned as an option on the issue of development on various aspect of human life. This was amplified by the World Bank (WB) and United Nation Development Programme (UNDP) reports with seven of such conferences held within the space of 1990 to 1996 as a build up to the MDGs agenda.

In May 1996, Development Assistance Committee (DAC) of the Organisation for Economic Cooperation and Development (OECD) met in France where they deliberated on reports of these conferences with the active participation of the developing countries. DAC further stated that ministers, heads of aid agencies and other senior officials responsible for development cooperation came up with a white paper on how to manage global issues on development in the 21^st century and this formed International Development Goals (IDGs) as a prelude to the MDGs with the following goals:

• a reduction by one-half in the proportion of people living in extreme poverty by 2015;
• universal primary education in all countries by 2015;
• demonstrated progress toward gender equality and the empowerment of women by eliminating gender disparity in primary and secondary education by 2005;
• a reduction by two-thirds in the mortality rates for infants and children under age 5 and a reduction by three-fourths in maternal mortality, all by 2015;
• access through the primary health-care system to reproductive health services for all individuals of appropriate ages as soon as possible and no later than the year 2015;
• the current implementation of national strategies for sustainable development in all countries by 2005, so as to ensure that current trends in the loss of environmental resources are effectively reversed at both global and national levels by 2015. (DAC, 1996: 112)

Organisation of Economic Corporation and Development (2011) reported that in May 2000 all world leaders made up of 189 countries including Nigeria adopted the United Nations Millennium Declaration derived from earlier international development targets. It was officially established in combinati on with the UN’s efforts, the World Bank and other international financial institutions to form the MDGs (Naila, Hulmes, & Scot, 2010). Manchester (2010) revealed that the Millennium Summit was presented with the report of the Secretary-General entitled, ‘We the Peoples: The Role of the United Nations in the Twenty-First Century’. It is obvious at this point that the UN viewed the world as a global village in which what affects one country has effect on the other. This perspective is in line with the theory of globalization by Kaplan (1993) which states that “the global mechanisms of greater integration with particular emphasis on the sphere of the economic will enhance transactions”. Based on this understanding, additional input was prepared by the Millennium Forum, which brought together representatives of over 1,000 non-governmental and civil society organisations from more than 100 countries. Naila, Hulmes, & Scot, (2010) indicated that the Forum met in September, 2000 to conclude a two-year consultation process covering issues such as poverty eradication, environmental protection, human rights and protection of the vulnerable which culminated into the Millennium Summit where the MDGs was approved.

According to UN, UNDP (2006) and Andy & Andrew (2004), they indicated that the approved MDGs also emphasises the role of developed countries in aiding developing countries by setting objectives and targets for developed countries to achieve a “global partnership for development” by supporting fair trade, debt relief for developing nations, increasing aid and access to affordable essential medicines and encouraging technological transfer. The above mandates of the MDGs, including other areas important for human development such as education, health and poverty alleviation were coordinated together to form the eight Millennium Development Goals listed below.

1. eradicating extreme poverty and hunger,

1. achieving universal primary education,
2. promoting gender equality and empowering women,
3. reducing child mortality rates,
4. improving maternal health,
5. combating HIV/AIDS, malaria, and other diseases,
6. ensuring environmental sustainability and
7. developing a global partnership for development (World Bank, 2009).

WB (2009) indicated that each of the eight goals has specific stated targets and dates for achieving them. To accelerate progress, World Bank further indicated that the Group of eight developed nations (G8) Finance Ministers met and agreed to allow impoverished countries to re-channel the resources saved from the forgiven debt to social programmes for improving health, education and alleviating poverty. Nigeria’s MDGs report (2010:10) revealed that Nigeria is one of the countries categorized as heavily indebted poor countries and in 2005, Nigeria successfully negotiated debt relief from the Paris Club. The report further stated that the debt relief translated into annual gains of one billion dollars for the country which the federal government invested to stimulate national development, especially in the pro-poor (poverty alleviation) action plans needed to achieve the MDGs. In addition, Nigeria’s MDG report (2013) indicated that Conditional Grant Scheme was introduced to burst the achievement of the MDGs.

Despite the above huge investment by the federal government on MDGs, Nigeria’s Maternal Mortality (MM) statistics has been indicated as one of the highest in the world. Research report by UN World Population Prospects and the Institute for Health Metric Reports (2010) pointed out that Nigeria still ranks high in the list of countries with high Maternal Mortality Rate (MMRate) with a ratio of 545 per 100,000 live births and worse in 2013 with a ratio of 560 per 100,000 live births on the maternal mortality index (UN, 2014). Statistics from United Nations Children Fund (2013) revealed that a woman in Nigeria has 1-in-18 (1 in every 18) risks of dying in child-birth or from pregnancy related causes during her lifetime, which is high compared to the overall 1-in-22 risk for women throughout sub-Saharan Africa. This implies that 144 women die each day and one woman every ten minutes from conditions associated with child-birth in Nigeria. The report also shows that Nigeria ranks second in the world after India, with the highest maternal mortality ratio. This implies a poorer performance by Nigeria in attaining the targets/indicators on improving maternal health, the goal of MDG-5 as indicated below:

• Objective/Target 5_a: reduce by three quarters between 1990 and 2015 the maternal mortality The indicators are: maternal mortality ratio and proportion of births attended by skilled health personnel.

§  Objective/Target 5b: achieve by 2015 universal access to reproductive health. The indicators are: contraceptive prevalence rate, childbearing adolescent birth rate, antenatal care coverage and unmet need for family planning (World Bank, 2008).

However the level of attainment of the above objectives to improve maternal health and reduce maternal mortality in Nigeria varies markedly across geographical zones due to some range of factors such as wealth indices. Disparities abound in the achievement of the MDGs across states and between the six geopolitical zones of the country. Indeed, these are much more dramatic with respect to MDG 5, especially given its immediate impact on human lives. Whereas the South West zone had, on its own, virtually met the target, even as early as at 2008, others, especially the North West and North East and to some extent North Central, showed performances far below the national average. By focusing on MDG 5, lessons from regions with good outcomes can be used in areas of poor outcomes (Nig, MDG report, 2013). Survey conducted in february by Onumere (2010) showed that there were 165 live births per 100,000 in the South and 1549 live births per 100,000 in the Northern part of Nigeria. This wide-gap is also confirmed in MDG Africa report (2014) indicated that while there is 98% skilled health attendant in Imo state, it is 5% in Jigawa state. This wide variation calls for the appraisal of the level of attainment of MDG-5 in North Central Nigeria (NCN). However gaps also exist in the Maternal Mortality Ratio (MMR) of the states that make up NCN based on their variation in culture, religion, education, economic activities and political affiliations. These variations have made Kogi, Kwara and Benue states to be more endemic on the MM index as a result of low scale implementation of maternal health services. These services include family planning, reduction in childbearing adolescent birth rate, antenatal and postnatal care coverage, and skilled health attendant at birth and MMR which calls for comparism of these variables in their appraisal.

Appraisals regularly record an assessment of performance, potential and development needs. Appraisal is an opportunity to take an overall view of work content, loads and volumes, to look back on what has been achieved during the reporting period and agree on objectives for the next phase (ACAS, 2012). In the context of this study, appraisal could be defined as taking stock of the level at which the millennium development goal five has been attained in North Central Nigeria. However, North Central Nigeria consist of Kogi, Kwara, Plateau, Nasarawa, Niger, and Benue states including Abuja the Federal Capital Territory. These states have a dominant Muslim culture which has some inhibiting characteristics on the whole concept of family planning, reducing childbearing adolescent early marriage and birth rate and contraceptive use generally. These practices have led to high maternal mortality. Other contributory factors include the purdah system in which married ladies are kept indoors, low level of education, low level financial income and lack of awareness. Most risky among the above factors is early marriage which sometimes leads to birth complications such as vesico virginal fistula and postpartum haemorrhage. Nigerian maternal health services are aimed at attaining the objectives/targets of MDG-5, which include: reducing the unmet need of family planning, creating wider awareness to improve contraceptive use through improved campaign strategies, improved skilled attendance at birth and improved antenatal and postnatal care.

Attainment is the fact or action of achieving a goal toward which one has worked. It can also be described as something achieved especially a skill or educational achievement (Ask, 2014). In the context of this study, attainment is the achievement of a set objectives or goal within the target limit of MDG-5 set to reduce maternal mortality ratio by ¾ in 2015. A goal is something that you hope to achieve (Hornby, 2005). In this context, it is improvement in maternal health to reduce maternal mortality rate by 75%. The achievement of these objectives are geared towards improving maternal health services based on the bench marks set by various health bodies who are stakeholders on the issues of health. These health bodies include WHO, the International Confederation of Midwives (ICM), the International Federation of Gynaecology and Obstetrics (FIGO) and the International Council of Nurses (ICN).

It is based on the bench marks specified by the above professional health bodies that the measure of the level of attainment for Family Planning (FP) service offered will be appraised. These services have the capability to create a multiplier effect to bridge the gap of unmet need for FP. These services include ascertaining the comprehensive health history of client, offering FP services such as the Intra Uterine Device (IUD), barrier method, natural method, hormonal implant, voluntary surgical contraceptive, adequate record keeping as follow-up to the client and FP counselling. The bench marks for measuring the level of attainment for skilled health personnel according to Anand & Barnighausen (2004) & WHO (2009) estimated that countries should have not less than 23 skilled healthcare providers (i.e., physicians, nurses and midwives) per 10,000 populations. Each Primary Health Care facility (PHC) should have at least four (4) midwives for 24hours service. Asnake & Tilahun (2010) indicated that the bench marks for measuring the level of awareness creation for enhanced contraceptive use include giving classified advert information for female client of reproductive age by the Doctors, Nurses and Midwives. Radio jingle, dramatised presentation on the advantages of FP, using multimedia for awareness creation such as the news media, television, internet and involving communication companies.

The bench mark for measuring the level of antenatal and post-natal care services based on WHO’s recommendation is the provision of services on pre-conception checkups and treatment, carrying out of comprehensive health history of clients on their first visit, comprehensive physical examination, series of tests to determine other health anomalies, education on healthy life style during pregnancy, common pregnancy symptoms, screening for haematological conditions, screening for foetal anomalies and infection/other clinical conditions. Postnatal services include education for FP, provision of Oxytocic drug for postpartum haemorrhage, contraceptive education, safer sex education and counselling on self care at home. Others include provision of Anti-malaria Intermittent Treated Net for malaria prevention, education on breast feeding and postnatal nutrition. It also includes de-worming and assessment of female genital mutilation. The bench marks to measure the reductions in childbearing adolescent birth rate are measured by adolescent birth rate and contraceptive prevalence rate (WHO, 2009).  It is against these benchmarks that the researcher measured the level of attainment for the variables in the specific purposes and the hypotheses in appraising of the level of attainment of MDG-5 in North Central Nigeria.

The level of attainment of reduction on maternal mortality based on MDG report (2014) is 46% which are measured by the reduction on maternal mortality ratio, improved proportion of births attended by skilled health personnel, increase in contraceptive prevalence rate, decrease in childbearing adolescent birth rate, decrease in unmet need for FP and improved antenatal and post-natal care coverage (World Bank, 2008). The above variables are the wheels under which a good maternal health system runs and this is why they are very important in this research study.

The weaknesses in the health system of many developing countries like Nigeria as identified by Druce (2006) are due to inadequate facilities to provide the necessary services in a research carried out on the reproductive health supply and security in four poor countries. He highlighted the draw backs of multiple donors and government procurement due to government system’s lack of oversight capacity on health facilities to enhance family planning. Furthermore, the quality and quantity of skilled health personnel available for the attainment of MDG-5 is a determinant factor to achieve the goal. Dalyop, Josiah, Emmanuel, Joseph & Mariam (2010) in an evaluation research on personnel skills and adequacy discovered the need for revision of regulations and administrative procedures that will ensure a change in policy. This will improve widespread distribution of skilled health providers, training, retraining and deployment of health personnel. However, building of nursing and midwifery schools which are central elements in improving health care system will equally enhance awareness campaign for effective use of contraceptive to space pregnancy and prevent unnecessary abortion especially among adolescent girls. The adolescent girls are vulnerable and contributed to high maternal mortality in the NCN. WHO research finding showed that two-thirds of unintended pregnancies in low-income countries occur in women who have failed to use or have been unable to access any contraceptive method (World Health Organization Guttmacher Institute, 2007).

Gerein, Mayhew & Lubben, (2003) revealed that Antenatal Care (ANC) and Postnatal Care (PNC) provide opportunities for monitoring the well‐being of both the prospective mother and her foetus. It also helps in detecting complications early in their trajectory, and discussing birth’s preparedness. Campbell & Graham (2006) noted that in postpartum period, physical, social, and mental problems can emerge, indicating a need for strategies that encompass both preventive and curative intervention strategies to treat the problem. Furthermore, UN MDG report (2014) indicated that women in developing regions continue to face challenges in regular access to health care during pregnancy. Substantial differences in access to antenatal care are noticeable across regions. In the Caribbean and South-Eastern Asia, 80 per cent of pregnant women reported at least four antenatal care visits in 2012, compared to 50 per cent in sub-Saharan Africa. WHO and UNICEF recommendation of a minimum of four Antenatal Care (ANC) and Postnatal Care (PNC) check‐ups, has a wide variation within the region.  This negative health behavioural attitude of mothers in sub-Sahara Africa on ANC and PNC, which probably has a high practice in North Central Nigeria, necessitates the inclusion of ANC and PNC in the study. It is against this background that the researcher will appraise the level to which MDG-5 has been attained in North Central Nigeria.     The overall objective of millennium development goal five is to reduce the maternal mortality ratio of developing countries like Nigeria. The key factors observed to be the challenges facing the reduction of maternal mortality ratio include the unmet need for family planning, increase in adolescent birth rate, insufficient skilled health personnel, low antenatal care coverage due to low patronage and awareness of these services. It is against this background that this research study is carried out to ascertain the level at which the above challenges has been reduced to meet the target of 75% reduction set for 2015.

Statement of the Problem

From the background of this study it is evident and glaring that the current maternal mortality rate in the country is high. However the federal government on implementation of MDG-5 on MH in Nigeria has made some efforts at reducing the high incidence of high maternal mortality. Report on this effort shows that the federal government budgeted $3m annually to provide free family planning facilities for Nigerians as a means of improving maternal health services (Nig. MDG Report, 2010). Despite this effort the MM statistics in Nigeria according to Research Report by UN World Population Prospects and the Institute for Health Metric Reports (2010) points out that Nigeria still ranks high in the list of countries with high maternal mortality rate with a ratio of 545 per 100,000 live births and worse in MDG report (2014) with a ratio of 560 per 100,000 live birth on the MM index; in fact it ranked second in the world after India with the highest MM ratio. In addition the Count Down Strategy (CDS) adopted in MDGs Accelerated Framework (MAF) were failing due to lack of implementation which created setbacks to the promising progress for the MDGs (MAF report, 2013).

Furthermore WHO and UNICEF report revealed that a woman in Nigeria has 1-in-18 risk of dying in child-birth or from pregnancy related causes during her lifetime, which is high compared to the overall 1-in-22 risk for women throughout sub-Saharan Africa. This implies that 144 women die each day and one woman every 10 minutes from conditions associated with child-birth in Nigeria. In the Northern part where North-Central Nigeria (NCN) is located is highly endemic with high MMR due to early marriages and religious beliefs as hindrances to accept family planning methods. MMR is estimated at 1,549 per 100,000 live births as compared to the south with 165 per 100,000 live births (Onumere, 2010). It is this wide gap between the maternal mortality ratio for North and South that gives an added impetus for this study. Despite the above reports on MMR, an independent appraisal is needed on MDG-5 since the target date of 2015 is here on which 75% target reduction is set. Hence, it is the problem of this study to appraise the level of attainment of MDG-5 (maternal health) in North Central Nigeria to have an overview of the factors responsible for high maternal mortality rate.

Purpose of the Study

The main purpose of this study is to appraise the level of attainment of Millennium Development Goal five in North-Central Nigeria (NCN). Specifically the study seeks to:

1. determine the extent to which the need for family planning services are met in North-Central Nigeria;
2. ascertain the strategies adopted to reduce childbearing adolescent birthrate in North-Central Nigeria;  
3. determine the extent to which antenatal care services are delivered in North-Central Nigeria;
4. ascertain the extent to which post‑natal care services are delivered in North Central Nigeria;
5. identify the level of adequacy of skilled health personnel in North-Central Nigeria;
6. determine the extent of reduction of maternal mortality rate from 2005 to 2013 in

North Central Nigeria

Significance of the Study

The findings of this study will be significant to the family, community, researchers, policy makers, adult educators, non governmental organisations and ministry of health. The family specifically will benefit from the study by being educated on reproductive health thereby assisting the family to benefit from the natural care service of a mother which makes the family more useful to the community. The family will be able to contribute positively to the socioeconomic and political growth of the community.

The community will benefit from social, economic, religious and political development of the family who has been nurtured by a mother that is healthy and alive to the family responsibility. Generally the study will acquaint and educate the community at large on the status of the level attainment of MDG-5 in their various localities and issues relating to maternal health and its associated challenges, thereby benefiting from the proffered solution. Adoption of the recommendations of this study by the community will improve the health status of mothers and elongate their life expectancy and affect positively the life of the entire community members.

The findings of this study will be significant to researchers as a reference point and a reservoir of knowledge in this field of study thereby enhancing their research literature. The study will expose students and academics to the health condition of the country thereby availing them the opportunity to contribute to the well being of the country in general whenever the situation arise base on that your knowledge on your base of maternal health. It will help adult educators to generate programmes on reproductive health to educate the adults and adolescents on issues concerning maternal health especially on maternal mortality, thereby enhancing the well-being of Nigerian citizenry of reproductive age.

This study is important to policy makers in respect of planning since this study will reveal the level and nature of services that are made available in the health sector of the Nigerian economy and its social-political structure. In effect, it will enhance the advocacy of adequate resource allocation to the health sector which will affect positively the overall production sector, improve the Human Development Index (HDI) and the Gross Domestic Product (GDP).  This study will illuminate the adequacy and the inadequacy of the skilled health personnel need in the health sector thereby generating employment for the unemployed graduates in Nigeria. The Non Governmental Organisations (NGOs) involved in finances of the MDG-5 (maternal health) will be acquainted with the level of attainment thereby enlightening them on areas that need support to achieve the desired goal.

Theoretically, the study will bring to limelight the current shift in the theoretical paradigm as regards human development that will ensure the sustainability of development of the Human organism.

Empirically the study will enrich literature on this field of study highlighting the activities of the governmental, Non-Governmental Organisations (NGOs) and donor agencies in improving the health of human life especially on maternal mortality reduction. Based on this scenario, the findings of the research will show the activities that are working and those that are not working based on socio-cultural, religious and environmental disparities.  Finally, this study will help in reducing the maternal mortality ratio of the country if the recommendations of the finding are fully implemented.

Research Questions

The following research questions are formulated to guide the study.

1. To what extent is the need for family planning services met in North-Central Nigeria?
2. What are the strategies adopted to reduce childbearing adolescent birth rate in North Central

Nigeria?

3. To what extent is antenatal care services delivered in North-Central Nigeria?
4. To what extent is post‑natal care services delivered in North-Central Nigeria?
5. How adequate are the skilled health personnel in North-Central Nigeria?
6. To what extent is maternal mortality rate reduced from 2005 to 2013 in North-Central

Nigeria?

Hypotheses

The following null hypotheses were formulated and tested at 0.05 level of significance to guide the study

H0₁There is no significant difference in the mean rating of respondents from Kogi, Kwara and

Benue states on the extent of meeting the family planning needs in North Central Nigeria.

H0₂There is no significant difference in the mean rating of respondents from Benue, Kogi

and Kwara states on the delivery of antenatal care services in North Central Nigeria.

H0₃There is no significant difference in the mean rating of respondents from Kwara, Benue

and Kogi states on the delivery of postnatal care services in North Central Nigeria.

Scope of the Study

This study is limited to the appraisal of the level of attainment of Millennium Development Goal Five in North-Central Nigeria. Specifically it will appraise the family planning services, skilled health personnel, strategies to reduce adolescent birth rate, antenatal and postnatal care services and the extent of MM rate reduction from 2005 to 2013 in North-Central Nigeria. This research study is carried in North Central Nigeria comprising of Kogi, Kwara, Niger, Plateau, Benue and Nasarawa including Abuja the Federal Capital Territory (FCT).

 

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