Experiences with facility delivery services within the context of a maternal neonatal health project in Gombe State, Northeast Nigeria: a qualitative study.

Introduction: a maternal neonatal health (MNH) project implemented in Gombe State improved uptake of facility delivery services from 27% to 65%. The project supplied health commodities to health facilities, provided women with cost-free transportation, and implemented the Village Health Worker program. Village health workers are lay indigenous women trained to provide community-based maternal and newborn care and to facilitate linkage to health facilities. We explored women's experiences with facility delivery services within the context of the MNH project.

Methods: qualitative data were obtained through focus group discussions with women who delivered within the last 12 months. Participants were asked questions related to their experiences with the access and use of facility delivery services. Data were organized with NVivo 12 (Pro for Windows) and analyzed using directed content analysis.

Results: six focus group discussions were conducted with 58 participants. Mean age was 25.1 (± 5.3) years old. All the women preferred facility delivery over home delivery for quality care. Most women reported experiencing immediate and respectful care with facility delivery services, and healthcare workers' competence and attitude were more important than the gender of the healthcare worker. However, for some women use of facility delivery services was limited due to the use of traditional birth attendants, absent husbands at the onset of labor, imminent delivery, long distance to the facility, expensive transportation fees, healthcare worker absenteeism and long clinic wait times.

Conclusion: maternal neonatal health projects should be designed to ameliorate the effects of socio-economic and facility level factors that limit use of facility delivery services.