CHAPTER ONE

Introduction
1.1. Background to the Study
1.2. Home delivery refers to childbirth taking place outside the health facility. It either occurs at
home or on their way to the health facility, without attendance of a skilled health service
provider. The vast majority of women who deliver outside the health facilities give birth at
home, where risks of mortality are on the increase in the absence of professional attendance.
It has been estimated that only (50%) of the women in the world have access to such skilled
care in developing countries, however, still most women deliver at home, (WHO, 2019).
There are many factors that influence home delivery, which includes distance and transport
of which many pregnant women do not even attempt to reach a facility for delivery since
walking many kilometers is difficult in labor and impossible if labor start at night and means
of transport are often not available. The obstacle effect of distance is stronger when
combined with lack of transport and poor roads, (Folashade, et al., 2020). Economic
accessibility is another factor which refers to the relation between financial capacities of the
family and cost of a facility delivery including transportation cost. Financial capability
directly affects whether women can actually reach a facility for delivery. The anticipation of
high costs will affect whether a decision for a facility delivery is made in the first place.
Women who are working and earning money may be able to save and decide to spend it on
facility delivery. However, in many settings, women either do not earn money for their work
or do not control what they e just earn. On the other hand, working may be poverty induced
and indicate recourse constraints which would make working mother less likely to use health
service for delivery. (Folashade., et al., 2020) More than half a million women die of
pregnancy related complications, with ninety-nine percent (99%) of these deaths occurring
in developing regions particularly Africa and Asia. The implication is that every minute, at
least a woman dies from pregnancy and childbirth in these regions. Comparing with other
regions of the world, the lifetime risk of maternal deaths in Sub-Saharan Africa and
Southern Asia accounted for approximately (86%) (254 000) of the estimated global
maternal deaths in 2017. Sub-Saharan Africa alone accounted for roughly two-thirds (196
000) of maternal deaths, while Southern Asia accounted for nearly one-fifth (58 000) (WHO,

1
2019). Ethnicity and religion are also a factor in which traditional belief are often consistent
as markers of cultural background and are thought to influence beliefs, norms and values in
relation to child birth and service use by women. Certain ethnic or religious group maybe
discriminated against by staff making them less likely to use health care services. More
specifically, women in some cultures may avoid facility delivery due to cultural
requirements of seclusion in the household during this period or because specific
requirements around delivery position, warmth and handling of the placenta. Beliefs that
birth is a test of endurance and care seeking is seen as a sign of weakness may be another
reason for delivery at home in some context. (Folashade, et al., 2020). Marital status also
influences the choice of delivery, probably via influence on female autonomy and status or
through financial resources. Single or divorced women may be power to enjoy greater
autonomy than those currently married young single mothers may be cared for by their natal
family which may encourage skilled attendance especially for the first birth. On the other
hand, single at home because they anticipate a negative provider interaction,) Folashade, et
al., 2020). Many complications are bound to occur as a result of home delivery in which
skilled birth attendants are absent. The complications require emergency care in order to
prevent death. They are retained placenta, perineal tear, puerperal pyrexia (puerperal sepsis),
postpartum hemorrhage. (PPH), shock, cervical tear, cervical descent, retained membrane
and Pregnancy Induce hypertension etc., (Tuladhar, et al., 2016). More than half a million
women die of pregnancy related complications, with ninety-nine percent (99%) of these
deaths occurring in developing regions particularly Africa and Asia. The implication is that
every minute, at least a woman dies from pregnancy and childbirth in these regions
comparing with other regions of the world, the lifetime risk of maternal deaths in Sub-
Saharan Africa and Southern Asia accounted for approximately (86%) (254 000) of the
estimated global maternal deaths in 2017. Sub-Saharan Africa alone accounted for roughly
two-thirds (196 000) of maternal deaths, while Southern Asia accounted for nearly one-fifth
(58 000) (WHO, 2019). The five major pregnancy-related complications leading to maternal
mortality globally are postpartum hemorrhage (25%), puerperal infections (15%), unsafe
abortion (13%), hypertensive disorders of pregnancy (12%) and obstructed labor (8%).
About (35%) of women in developing countries receive no antenatal care during pregnancy;

2
and (70%) receive no postpartum care. In these countries, home deliveries are over (60%)
taking place largely in rural areas with unskilled attendants, (WHO,2020).
Despite the global outcry to address the problem of maternal mortality, unskilled delivery
remains an issue in many African countries. Unskilled home delivery is associated with
greater chances of obstetric complications including maternal and child mortality.
Consequently, it can be reasoned that skilled institutional delivery is healthier and safer for
the mother and child. One reason could be the fact that healthcare facilities provide
appropriate attention and hygienic environment during delivery and reduce the risk of
complications and infection (Tittley, al.,2019). In 2015, maternal mortality ratio (MMR) in
Nigeria was 814 per 100,000 live births, the highest rate in Africa and twice the rate in most
other developing countries (WHO, 2020). This rate was disquieting. Nevertheless, the
mortality varies by geopolitical zone and urban or rural settings. MMR is higher in northern
Nigeria particularly north-eastern geopolitical zone which was earlier estimated at 1,749 per
100,000 live births (NPC, 2018). In Nigeria, despite the fact that programs and interventions
are formulated by the Federal Government in an attempt to strengthen and improve Safe
Motherhood, and health programs to reduce morbidity and mortality (e.g. midwives service
scheme), women do not think it wise to utilize the skilled healthcare providers during
delivery. Nigeria is a leading contributor to the maternal death figure in Sub Saharan Africa
with maternal mortality ratio of 1:100. With an estimated 59,000 maternal deaths, Nigeria
which has approximately (2%) of the world’ population contributes almost (10%) of the
world’s maternal death. More than 20 million women each year suffer ill health and death
due to pregnancy and childbirth. Majority of these maternal deaths can be prevented if
deliveries are overseen by skilled birth attendant, (Nwokoro, 2020).All the maternal and
child complications that occur nowadays are related to home delivery. If pregnant women go
to hospitals for delivery, majority of the complications will not occur. This drafted my
attention to write on the assessment of these consequences in my place of community
experience in Alkaleri local government as well as my home town Udubo Community of
Gamawa local government Bauchi state.

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1.2: Statement of the Problem
Home delivery among rural people refers to the practice of giving birth at home, often assisted
by a traditional birth attendant (TBA) or a family member, rather than in a healthcare facility.
This practice is prevalent in many rural areas, particularly in developing countries, among which
is the area of the study, that is Udubo community of Gamawa local Government Area, this is due
to various factors. The persistence of home delivery among rural people is a significant public
health concern that necessitates urgent attention and action. This study aims to explore the
underlying factors contributing to home delivery in rural areas, its consequences on maternal and
neonatal health outcomes, and identify strategies to reduce the practice of home delivery and
promote hospital delivery among rural populations. Factors influencing home delivery include,
Distance and accessibility: Rural women may live far from healthcare facilities, making home
delivery a more practical option. Cultural and traditional beliefs may also influence the decision
to deliver at home. Economic factors: Home delivery may be more affordable for rural families.
Rural women may also be unaware of the risks associated with home delivery or the benefits of
hospital delivery. Rural areas often have limited access to healthcare facilities and trained
healthcare providers. (Okocha, R., et al., 2018). The home care delivery has so many Advantages
among which it is Convenience: Home delivery is often more convenient for rural women, as
healthcare facilities may be far away or difficult to access. Cultural preference: In some cultures,
home delivery is preferred due to traditional beliefs and practices. Cost-effective: Home delivery
is often less expensive than hospital delivery. Comfort: Women may feel more comfortable
delivering at home, surrounded by family and familiar surroundings. (waiswa et al.,2019). In
the other hand, the home delivery has a lot of Disadvantages which include: Home delivery
poses significant risks to both mother and baby, particularly in cases of complications. Lack of
medical care: Home delivery often lacks proper medical care and equipment. Unclean
environment: Home delivery may be unhygienic, increasing the risk of infection. Limited
emergency care: In case of complications, emergency care may be difficult to access. Maternal
mortality: Home delivery increases the risk of maternal mortality due to complications. Neonatal
mortality: Home delivery also increases the risk of neonatal mortality. Morbidity: Home delivery
can lead to health complications for both mother and baby. Long-term health consequences:
Home delivery can have long-term health consequences for both mother and baby. Among

4
others. Despite significant efforts to improve maternal and neonatal health
outcomes, the practice of home delivery remains a persistent and pervasive issue among rural
populations, posing substantial risks to the health and wellbeing of both mothers and newborns.
The prevalence of home delivery in rural areas is attributed to a complex interplay of factor,
including; Limited access to healthcare facilities and skilled healthcare provider; Cultural and
traditional beliefs that prioritize home delivery; Economic constraints that make hospital delivery
unaffordable; Lack of awareness about the risks associated with home delivery and the benefits
of hospital delivery ; Inadequate transportation infrastructure, making it difficult to reach
healthcare facilities in emergency situations among others, The persistence of home delivery
among rural people is a significant public health concern that necessitates urgent attention and
action. This study aims to explore the underlying factors contributing to home delivery in rural
areas, its consequences on maternal and neonatal health outcomes, and identify strategies to
reduce the practice of home delivery and promote hospital delivery among rural populations."
Despite the efforts to improve maternal healthcare, home delivery remains a prevalent practice
among mothers in Udubo Local Government, posing significant risks to both mothers and
newborns. However, there is a lack of understanding of the factors that influence the perception
of home delivery among mothers in this region and the consequences that follow. This study
aims to investigate the perceived benefits and risks of home delivery, the socio-cultural and
economic factors that influence the decision to deliver at home, and the consequences of home
delivery on maternal and newborn health outcomes in Udubo community of Gamawa Local
Government." It has been observed by the researcher that In Udubo Community majority of
women attending ANC do not come to the health facility to deliver their babies or used skilled
healthcare provider during delivery, which lead them to serious consequences associated. This
led to the intention to assess the consequences of home delivery in Udubo Community of
Gamawa Local Government of Bauchi state.

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1.3. Purpose of the Study
The purpose of this study is to assess the perceived consequences of home delivery among
mothers in Udubo Community of Gamawa local government, Bauchi Specifically, the Study will
Seek;
1. To assess the perception associated with home delivery among mothers in Udubo
Community.
2. To find out the consequences associated with home delivery among women of Udubo
community
3. To determine the factors that influence home delivery among women of Udubo
community
4. To identify the strategies against home delivery among mothers in Udubo community

1.3. Research Questions

1. What are the perceptions associated with home delivery among mothers in Udubo
Community.
2. What are the consequences associated with home delivery among women of Udubo
community
3. What are the factors that influence home delivery among women of Udubo community
4. What are the strategies to against home delivery among mothers in Udubo community
1.4 Significance of the Study
Findings of this research was generate information about the consequences of home delivery
among women of child bearing age of Udubo Community. It will also form the basis for
educating women on the importance of hospital delivery. The women of child bearing age will
be enlightened on the consequences of home delivery by Nurses as well as the factors that
influence home delivery. This finding will be useful to some agencies such as UNICEF, and
WHO, who are interested in promoting hospital delivery. Thus, they will use the finding to
evaluate the skill birth attendants’ program so far and also plan strategies for improvement.
The finding of this study will also be useful to government particularly local government health
department to provide initiative that will reduce home delivery and motivate them to deliver in

6
the hospital. It also hopes that the finding of this study will provide a data base that will inform
policy makers about the factors that influence home delivery so that appropriate measures can be
taking to motivate women of child bearing age to deliver in the hospital.
Finally, it will contribute towards forming or reshaping the body of knowledge in nursing
practice by informing the readers on the significance of providing the women of child bearing
age with needed information on importance of hospital delivery.
1.5. Scope of the Study
The study was delimited to assessing consequences of home delivery among mothers of Udubo
Community Gamawa Local Government, Bauchi State. The researcher will investigate
consequences of home delivery within the period under study, factors that influence home
delivery and factors that discourage home delivery.
1.6: Operational Definitions of Terms
Consequences of home delivery˸ Refers to problems that may occur when a women deliver
outside the health facility.
Home delivery˸ Is the delivery outside the health facility.
Women of child bearing age: Women who are in their reproductive years

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 CHAPTER TWO
Literature Review
This chapter will deal with the review of relevant literature as it relates to consequences of home
delivery among mothers of Udubo community. It will be presented and discussed under the
following headings; Conceptual review, Theoretical review, Empirical review
2.1: Conceptual Review
2.1.1 Concept of Home Delivery
Home delivery refers to childbirth taking place outside health facility, either at home or on the
way to the health facility, without attendance of a skilled health service provider. Various factors
such as social-economic conditions, delays in providing adequate Obstetric care and poor
accessibility to maternal health care have been implicated in home deliveries and high maternal
mortality in developing countries among which is Nigeria. Although childbirth is a natural
phenomenon, it is associated with risks and unforeseen complications which may result in death.
Home delivery may only be possible in uncomplicated labors, once there are complications;
these mothers need to be referred immediately to a nearby health facility. Very unfortunately,
when complications arise, it is too late or the mother is so weak that she cannot deliver safely.
(WHO 2020)
As a result, such mothers die before, during or after delivery. If they happen to survive, they end
up with missing babies or/and severe disabilities. Since it is difficult to predict the complications
which may arise during child birth, home delivery carries a high risk. The high Maternal
Mortality Ratios in Udubo community could be attributed to deliveries taking place without
being attended by skilled health service provider either at home or on the way to a health facility.
There is a close relationship between high maternal mortality ratio and home deliveries, delay in
recognizing the problems in pregnancy and late seeking of maternal health care. In Udubo
community women who deliver at home are assisted by Traditional Birth Attendants (TBA’s),
family members, friends or neighbors. Worse still, the deliveries are conducted in unhygienic
environment predisposing the mothers and babies to postpartum and Neonatal sepsis,
(Simfukwe, 2015).

8
1.2 Consequences of Home Delivery
Childbirth in a health facility while attended by trained health professional has been shown to be
associated with lower rates of maternal and neonatal mortality compared to home delivery. In
poor settings, non-health facility deliveries are associated with increased maternal morbidity and
mortality and increased newborn morbidity and mortality
The following are common consequences of home delivery; Postpartum hemorrhage.; Perineal
tear.; Neonatal asphyxia.; Maternal mortality.; Infection
(1) Postpartum Hemorrhage (PPH)
Postpartum hemorrhage (PPH): Is commonly defined as a blood loss of 500 ml or more within
24 hours after birth, while severe PPH is defined as a blood loss of 1000 ml or more within the
same timeframe. PPH affects approximately (2%) of all women who give birth: it is associated
not only with nearly one quarter of all maternal deaths globally but is also the leading cause of
maternal mortality in most low-income countries. PPH is a significant contributor to severe
maternal morbidity and long-term disability as well as to a number of other severe maternal
conditions generally associated with more substantial blood loss, including shock and organ
dysfunction, (WHO,2017). The most common cause of postpartum hemorrhage is uterine atony.
During home delivery, it usually occurs as a complication in which it leads to mild or excessive
blood loss that led to death.
(2) Perineal Tear.
A perineal tear can occur during vaginal delivery. The perineum includes the area containing the
vagina and anus. There are four different types of perineal tear which includes; First degree tear
which tear of the perineal skin only; Second degree tear involves perineal muscles; Third degree
tear extends into the anal sphincter; Fourth degree tear involves the anal sphincter and tissue
underneath it; During home delivery, perineal tear usually occurs because of certain reasons,
such when the baby’s head is big enough to pass through the vagina,
(3) Neonatal Asphyxia.
Is defined as the condition of suspended animation produced by a deficiency of oxygen in the
blood; suffocation. Birth asphyxia is an unsatisfactory term because it has come to mean poor

9
condition of the baby at birth irrespective of cause; there are many causes of a baby being in poor
condition at birth. It can be acute or chronic asphyxia,) obstetrics and gynecology, 2016).
4) Maternal Mortality
Is the death of women while pregnant or within 42 days of termination of pregnancy, irrespective
of the duration and the site of pregnancy, from any cause related to or aggravated by the
pregnancy or its management, but not from accidental or incidental cause,) obstetrics and
gynecology, 2016).
(5) Infection
This is the successful invasion and multiplication of microorganism in the body and reaction of
host tissue to these organisms and the toxins they produce. During home delivery, there are no
use aseptic techniques by the TBA’s during the delivery and therefore infections from the
equipment’s will be transferred to the women. These infections can lead to death of these women
if not treated early,) WHO, 2019).
2.1.3 Factors Influencing Home Delivery.
Distance and Transport: Distance to health services exerts a dual influence on use, as a
disincentive to seeking care in the first place and as an actual obstacle to reaching care after a
decision has been made to seek it (Thaddeus, & Maine, 2016). Many pregnant women do not
even attempt to reach a facility for delivery since walking many kilometers is difficult in labour
and impossible if labour starts at night, and transport means are often unavailable. Those trying
to reach a far-off facility often fail, and women with serious complications may die on route
(Thaddeus, et al., 2022).
Economic Accessibility: Refers to the relation between financial capacities of the family and cost
of a facility delivery including transportation cost. Financial capability directly affects whether
women can actually reach a facility for delivery. The anticipation of high costs will affect
whether a decision for a facility delivery is made in the first place. Women who are working and
earning money may be able to save and decide to spend it on a facility delivery. However, in
many settings, women either do not earn money for their work or do not control what they earn.
On the other hand, working may be poverty induced and indicate recourse constraints who would
make working mother less likely to use health service for delivery (Duong, Binns, & Lee, 2020).

10
Ethnicity and Culture: Ethnicity, culture and traditional belief are often consistent as markers of
cultural background and are thought to influence beliefs, norms and values in relation to child
birth and service use by women. Certain ethnic or religious group maybe discriminated against
by staff making them less likely to use health care services. More specifically, women in some
cultures may avoid facility delivery due to cultural requirements of seclusion in the household
during this period or because specific requirements around delivery position, warmth and
handling of the placenta. Beliefs that birth is a test of endurance and care seeking is seen as a
sign of weakness may be another reason for delivery at home in some context (Kyomuhendo,
2019).
Maternal Age: Is often presented as a proxy for accumulated experience, including the use of
health services. Older women are also possibly more confident and influential in household’s
decision making than younger women and adolescents in particular. Furthermore, older women
may be told by health workers to deliver in facility since older age is a biological risk factor. On
the other hand, older women may be long to older traditional cohorts and thus be less likely to
use modern facilities than young women. Age is highly correlated with parity, and, in some
settings, with educational level. It is also associated with marital status, wontedness of a
pregnancy, socioeconomic status and decision-making power (Magadi, Agwanda, & Obare,
2021).
Marital Status: Marital status influences the choice of delivery, probably via influence on female
autonomy and status or through financial resources. Single or divorced women may be power to
enjoy greater autonomy than those currently married young single mothers may be cared for by
their natal family which may encourage skilled attendance especially for the first birth. On the
other hand, single at home because they anticipate a negative provider interaction. (Duong, et
al.,2020)
2.1.4 Strategies to Discourage Home Delivery
Community Mobilization to Increase Facility Based Deliveries: Community mobilization to
increase facility-based deliveries. This is primarily done through working with traditional
(chiefs) and religious leaders, educating them about safe motherhood. They in turn educate other
traditional leaders and their community members, and they have also taken the initiative to pass
local laws formally prohibiting TBA deliveries. These local bylaws generally include punishment

11
(a fine of a goat or a chicken) for any pregnant woman who delivers with a TBA, and the TBA
who delivers her. The chiefs or community leaders also recruit community volunteers to serve as
“secret mothers” to track all the pregnant women in the community and direct them to attend
prenatal care and deliver at the nearest health facility. Where possible, they have tried to redefine
the role of the TBAs to be “secret mothers” instead, but not all TBAs had the literacy skills
required for the tracking of pregnant women,) Global health group,2019).
Construction/Expansion of Maternity Waiting Homes at Health Facilities: Maternity waiting
homes—in either a 24bed or 36 bed design—are being constructed or expanded across the
country so that women can come to the health facility when they reach their 9th month of
pregnancy (36 weeks) wait there until labor happens and they deliver. This eases the burden of
women in labor trying to find transport. Women are frequently accompanied by a female relative
who stays in the facility’s guardian shelter—a simple shelter designed to provide housing for
family members of inpatients. The time during which women are residence at the waiting homes
facilitates their regular check up in the final weeks of pregnancy and presents an opportunity for
additional health education) Global health group, 2019).
Community Midwives: Final strategy being implemented is training of a new cadre of midwives
Known as “community midwives”. This program is shorter than the traditional midwifery
training program—18months rather than 3 years. As these midwives will be less experienced, the
plan is that they be placed where they can be supervised by fully qualified midwives. There are
some challenges related to this as there is an overall high vacancy rate in the midwifery posts.
Furthermore, when the program was initiated, it was envisioned these midwives would be placed
in the community, but there is no infrastructure at that level—no buildings for them to use as
delivery centers, no connection to ensure quick safe referral when needed. So, the actual role and
how they will be used seems to be part of an ongoing discussion. At least two cohorts have
completed training so far, and to date it appears these are being placed at health facilities,) Global
health group, 2022).
2.2. Theoretical Review
Health Belief Model (HBM).
This study was guided by the health belief model (HBM). This model explains the relationship
between individual's beliefs and health behaviors. This theory has been used as a planning tool

12
for promoting adherence with preventive health behaviors and health care recommendations
(Nutbeam & Harris, 2020).
The health belief model (HBM) is a psychological health behavior change model developed to
explain and predict health-related behaviors, particularly in regard to the uptake of health
services. (Siddiqui, Taranum Ruba; Ghazal, 2019) The health belief model was developed in the
1950s by social psychologists at the u s public health services and remains one of the best known
and most widely used theories in health behavior research. (Carpenter, Christopher, 2022)
The health belief model has six constructs: Perceived susceptibility, Perceived severity,
Perceived benefits, perceived barrier, cues of action and self-efficacy. (Glanz, myles,2018)
Perceived Susceptibility
As the first component of the Health Belief Model (HBM), perceived susceptibility is defined as
a subjective perception of the risk of an illness. One’s belief regarding the chances of being
diagnosed with a medical condition can be applied by defining populations at risk and risk levels.
Individual risk may be based on personal characteristics or behavior. Comparisons of perceived
susceptibility with action risk can also be conducted. Related to cervical cancer screening
behaviors, perceived susceptibility may include the risk of a cervical cancer diagnosis in the long
term or immediate future.
Perceived Severity
Perceived severity is the second construct of the HBM. Perceived severity is one’s belief about
the seriousness of a medical condition and the sequence of events after diagnosis and personal
feelings related to the consequences of a specific medical condition. Possible medical
consequences may include death, disability, and pain; possible social consequences consist of
effects on work, family life, and social relations. The merging of susceptibility and severity is
also called perceived threat. Perceived severity, formerly known as perceived seriousness, is seen
as perceived morbidity and mortality of cervical cancer.
Perceived Benefits
According the HBM, perceived benefits refer to one’s belief in the various disease reducing
actions’ effectiveness. Perceived benefits are one’s belief in the efficacy of the advised action to
reduce health risk. Also termed as perceived benefits of taking health action, the attitudes of
health behavior changes are reliant on one’s view of the health benefits for performing a health

13
action. Perceived benefits of cervical cancer screening behaviors include Pap smear test, visual
inspection with acetic acid, Human Papilloma DNA isolation, for prevention and early detection
of pre-invasive cervical cancer.
Perceived Barriers
Perceived barriers refer to the potential negative aspects of or obstructions to taking a
recommended health action. This is the belief about physical and psychological costs of taking
health action. An internal cost benefit analysis occurs, weighing the health action’s expected
effectiveness against perceptions that it may become an obstacle. Potential barriers may include
financial expense, danger, pain, difficulty, upset, inconvenience, and time-consumption.
Perceived barriers to practice of cervical cancer prevention (screening) were Socio-cultural,
socio-economic, and technical.
Cues to Action
Cues to action are the strategies taken to activate one’s readiness to take health action. Cues to
action, formerly known as motivation, refers to internal incentive for living a healthy lifestyle.
Self-Efficacy
Self-efficacy was introduced in 2016 by Bandura, defined as the conviction or confidence to take
health action and perform a health action. In 2018, Rosenstock, Stretcher and Becker suggested
that self-efficacy be added to the HBM as a separate construct from the original concepts of
susceptibility, severity, benefits, and barriers. The self-efficacy construct states that confidence in
lifestyle alteration is essential before successful change is possible. Thus, as the HBM claims,
behavior change can only be successful if the individual feels threatened by her current
behavioral patterns through perceived susceptibility and severity and believes that a specific
behavioral change will result in a valued outcome at acceptable cost. Individuals must also feel
competent or self-efficacious to overcome perceived barriers in taking action.
Health belief model best suit this research work because it describes health seeking behavior of
individuals which is influenced by perception of a threat posed by a health problem and the value
associated with actions aimed at reducing the threat. Health belief model is applied thus:
Knowledge of the consequences of home delivery will determine the attitude of women towards
attending hospital delivery. If they know the consequences of home delivery, they will be afraid
of the consequences (perineal tear, PPH, infection etc.) that may happen to them and hence prefer

14
to attend hospital delivery. If women are aware of the consequences of home delivery and how
the consequences affect their health status, they will prefer hospital delivery whenever they will
deliver. If women know the benefits of attending delivery in the hospital, they will go to hospital
for delivery when they are in labor.
2.3 Empirical Review
The vast majority of women who deliver outside the health facilities give birth at home, where
risks of mortality are on the increase in the absence of professional attendance. It has been
estimated that only (50%) of the women in the world have access to such skilled care in
developing countries, however, still most women deliver at home (Folashade, et al., 2015).
Maternal mortality is unacceptably high. About 295 000 women died during and following
pregnancy and childbirth in 2017. The vast majority of these deaths (94%) occurred in low-
resource settings, and most could have been prevented. (WHO, 2019)
Sub-Saharan Africa and Southern Asia accounted for approximately (86%) (254 000) of the
estimated global maternal deaths in 2017. Sub-Saharan Africa alone accounted for roughly two-
thirds (196 000) of maternal deaths, while Southern Asia accounted for nearly one-fifth (58 000).
At the same time, between 2000 and 2017, Southern Asia achieved the greatest overall reduction
in MMR: a decline of nearly (60%) (from an MMR of 384 down to 157). Despite its very high
MMR in 2017, sub-Saharan Africa as a sub-region also achieved a substantial reduction in MMR
of nearly (40%) since 2000. Additionally, four other sub-regions roughly halved their MMRs
during this period: Central Asia, Eastern Asia, Europe and Northern Africa. Overall, the maternal
mortality ratio (MMR) in less-developed countries declined by just under (50%). (WHO, 2019)
In addition, nearly 4 million stillbirths occur annually, and most of them are close to the time of
delivery (WHO, et al., 2014). Of the neonatal deaths, nearly (50%) occur among children
delivered at home. Perinatal mortality (stillbirths and neonatal deaths) is often related to
intrapartum complications, and is thus higher in countries where highest deliveries are conducted
at home environment. It has been estimated that decreasing the proportion of deliveries
conducted at home reduces perinatal and maternal deaths by nearly half (WHO, 2019).
The five major pregnancy-related complications leading to maternal mortality globally are
postpartum hemorrhage (25%), puerperal infections (15%), unsafe abortion (13%), hypertensive
disorders of pregnancy (12%) and obstructed labor (8%). About (35%) of women in developing

15
countries receive no antenatal care during pregnancy; and (70%); receive no postpartum care. In
these countries, home deliveries are over (60%) taking place largely in rural areas with unskilled
attendants (WHO et al., 2015; Simfukwe et al., 2021).
The continuing rise of maternal mortality ratio (MMR) is mostly affecting the developing
countries. It is estimated that (47%) of global maternal mortalities occur in Africa with highest
levels in sub-Saharan countries. (85%) are direct results of complications arising during
pregnancy, delivery or puerperium. In these countries, home deliveries are over (60%) taking
place largely in rural areas with unskilled attendant’s,) Simfukwe, 2015).More than (90%) of
births occur at home with unhygienic conditions and without assistance of trained birth
personnel, (Sychareun, 2019).
In Ethiopia, according to the latest estimate of United Nations, the MMR has declined from
676/100,000 live births in 2011 to 420/100,000 live births in 2013 (UNDP, 2014).In a study done
by Bolam (2015) in Kathmandu, (81.0%) had an institutional delivery and (19%) delivered at
home. Bolam have reported that multiparity and lower maternal education are associated with
home delivery. In this study, (58.8%) women had planned for home delivery whereas only
(41.2%) had chosen hospital delivery. The study conducted in Koupéla District, Burkina Faso by
Moran et al., 2016) has reported that (46.1%) had a plan for transportation, and (83.3%) had a
plan to save money. This finding is also similar to that of study done in Pokhara city of Nepal,
planned home deliveries were (58.3%) and (41.7%) were unplanned,) Steamered, et al., 2016).
The most common complication in this study was retained placenta with or without postpartum
hemorrhage. Puerperal pyrexia was the most common reason in women attending after 24 hours
of delivery. The rate of home births within the United Kingdom remains low at approximately
(2.0%,)21-23 where the most serious reasons for transfer to hospital are maternal hemorrhage,
concerns about fetal wellbeing and the neonate born in an unexpectedly poor condition. Delay in
transfer under these circumstances may have serious consequences.
Regarding home deliveries, it was observed that, out of 400 study subjects, 260 (65%) reported
to have delivered at home or on the way to a health facility. Of those who had delivered at home
or on the way to health facility, about 160 (62%) had been delivered by Traditional Birth
Attendants. About 177 (44.3%) respondents were living 5 – 10 km from a health facility. 227
respondents (56.8%) used cart and bicycle. A small number of respondents 47 (11.8%) used a

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car/bus to reach a health facility. Of the 400 interviewed respondents, about 184 (46%) spent
more than 1 – 2 hours to reach the nearest health facility) Simfukwe, 2019).
A study conducted in Gamawa indicates that majority (83%) of the respondents would prefer to
deliver in the hospital, while only (12%) prefer to deliver at home. majority (54%) of the
respondents mentioned safety of mother and child as a determinant of place of delivery. Also,
(23%) said financial capability is a determining factor to their place of delivery, while 17%
opened to the fact that quality of services offered in the last delivery determined their place of
delivery) Folashade, et al., 2019).
Furthermore, as to whether culture influence the place of delivery, (65%) of the respondents said
it does, while (35%) said culture does not influence place of delivery. From the data, (65%) of
the respondents affirmed that culture has influence on the choice of place of delivery. This means
that majority of the respondents in Kaduna South agree that their culture determines where
women usually deliver when they are pregnant. The culture of Hausa people does not encourage
their women to deliver in the hospital rather, it encourages them to always deliver their babies at
home. This is the reason why most Hausa women still give birth at home till today reveal that
about (89%) of the respondents affirmed that there are risks associated with home delivery, while
(10%) had a contrary opinion. Reasons for their answers above were sought. In this vein, (19%)
of the respondents said there is lack of professionalism, which may lead to long hours of
delivery; (48%) said excessive bleeding is a risk associated with home delivery. Also, (21%) of
the respondents mentioned maternal death as one of the risk factor) Folashade, et al.,2022).

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 CHAPTER THREE
Research Methodology
This chapter will deal with method of research to be employed for study the sample size and
sampling techniques, method of data collection, instrument for data collection and its validity,
method of data analysis, and ethical considerations
3.1: Research Design
The study was adopted descriptive cross-sectional study design. This design is concerned with
the Explanation of a phenomenon and tells how people feel or react to the phenomenon under
investigation.
3.2: Setting
This research was carried out in Udubo Community of Gamawa Local Government Area, Bauchi
State. Udubo Community is located in the northern part of Bauchi state, about 28 kilometers to
Gamawa local Government, most of the people are Hausa and Fulani, by tribe, Majority of
people residing there are engaging in farming, Rearing and business, practicing Islam as their
religion. The total area of the community is 3,455km square with the population 5,532 according
to National Population Census 2012 (NPC). Their sources of water are tap, well, boreholes and
river. The community has 4 primary and 4 secondary school, as well as Islamic oriented schools.
3.3: Target Population
The target population for this study is mothers of child bearing age in Udubo Community. The
population of Udubo Community is 5,532 (Census, 2006) with the prediction of 3.2 percent
annually according to national Bureau of Statistic Bauchi State branch, 2019 population
prediction of Udubo Community is 5,532 out of this, women attending ANC are approximately
2000 people.
3.4: Sample Size
Using fisher formula sample size is calculated as follows: - (Sabin, 2017).
n =Z2pq/d2
N = minimum sample size
Z = Standard normal deviation at 95% confidence interval on the normal
distribution and is given as 1.645.

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 D = desired precision or margin of error tolerable, for this study will be 5%
which is equal to 0.05.
P = Prevalence 84.3% = 0.843 (Bedilu & Nibuse, 2017)
q = Complementary probability
q = 1 – p = 1 – 0.843
q = 0.157
Therefore
n = 1.6452 x 0.843 x 0.157 = 2.71 x 0.132
0.052 0.0025
n = 143.09 = 143
Using 10% attrition rate, the actual sample size is
n = 143 + (143 x 0.1)
n = 157.3 = 157

3.5: Sampling Technique

Stratified Simple Random sampling was used in which one area was selected from the whole
community. Systematic sampling will be used in order to reach the respondents at home.
3.6: Instrument for Data Collection
The instrument for data collection was questionnaire which was developed by the researcher; the
questionnaire was made up of four (4) Sections. Section (A) (bio-data), Section B (Factors
influencing home delivery), section C (perception of home delivery) section D (Consequences of
Home delivery), section E. (Factors influencing home delivery (and Section F (Strategies against
home delivery).
3.7: Validity of the Instrument
The researcher presented the draft of questionnaire to the supervisor for suggestion and
modification before incorporating in to final draft.
3:8 Reliability
Test-retest method was used in determining the reliability of the instrument, where the
questionnaire administered twice to the sample, and correlate to obtain the coefficient.

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3.9 Method of Data Collection.
The data was collected by the researcher. The instrument was designed in English language and
administered in the same language. Interpretation was done where necessary. Pregnant women to
participate in the study was selected by convenience sampling. Questionnaires was administered
to every respondent that is accessible and available, the Respondents were given an explanation
about the purpose and objectives of the study before being asked for consent and to fill in the
questionnaire. Completed questionnaires was collected immediately after completion.
To improve on the content and facilitate the delivery of the instrument, the instrument was given
to two research experts from the department of nursing and one from department of midwifery
Abubakar Tafawa Balewa University Teaching Hospital, Bauchi and all the correction was
affected before the instruments was administered.
3.8: Reliability of the Instrument
Test and re-test method was established by exposing the questionnaire to a pilot study using
(10%) mothers from Udubo in different community of the study with similar characteristics.
3.9: Method of Data Collection
An introductory letter collected drafted from the school and submitted to District Head of Udubo
for permission to obtained data. The questionnaire was distributed to sample by the researcher
and two research assistant, formal introduction was made to entire sample before giving the
questionnaire so as to obtain their consent.
3.10: Method of Data Analysis
The data that was generated using the questionnaire was coded and analyzed with the aid of
statistical package for social sciences (SPSS) version 20. Descriptive Statistics (Frequency,
percentages, and means) was used to summarized the data.
3.11: Ethical Consideration
Norms and Cultural values of the respondents was respected. All the information receives from
the respondents was strictly kept with utmost confidentiality, anonymity and non-maleficent was
obtained during the study.

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