Birth Preparedness and Complication Readiness: Attitude and Level of Preparedness among Pregnant Women in Benin City, Edo State, Nigeria

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*Corresponding author: E-mail: andrew.obi@uniben.edu;
British Journal of Medicine & Medical Research
15(6): 1-14, 2016, Article no.BJMMR.25127
ISSN: 2231-0614, NLM ID: 101570965
SCIENCEDOMAIN international
www.sciencedomain.org
Birth Preparedness and Complication Readiness:
Attitude and Level of Preparedness among Pregnant
Women in Benin City, Edo State, Nigeria
Obi Andrew Ifeanyichukwu
1,2*
, Okojie Hilda Obehi
1,2
and Keshi Richard
3
1
Department of Community Health, University of Benin, Benin City, PMB 1154, Edo State, Nigeria.
2
Department of Community Health, University of Benin Teaching Hospital, Benin City, PMB1111,
Edo State, Nigeria.
3
Department of Emergency Medicine, Homerton University Hospital, NHS Trust, London, UK.
Authors’ contributions
This work was carried out in collaboration between all authors. Author OAI designed the study, wrote
the protocol and wrote the first draft of the manuscript and analysis of the study. Authors OAI, OHO
and KR managed the literature searches, subsequent manuscript drafts with proof reading. All authors
read and approved the final manuscript.
Article Information
DOI: 10.9734/BJMMR/2016/25127
Editor(s):
(1)
Yinhua Yu, Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University,Shanghai Key Laboratory
of Female Reproductive Endocrine Related Diseases, China.
Reviewers:
(1) Simone Regina Alves De Freitas Barros, University Hospital of Alberto Antunes Maceio Alagoas, Brazil.
(2)
C. Sunil Pal Singh, Kamineni Academy of Medical Sciences and Research Centre, Hyderabad, India.
(3)
Charbell Miguel Haddad Kury, Medical School of the Municipality of Campos dos Goytcazes, State of Rio de Janeiro, Brazil.
Complete Peer review History:
http://sciencedomain.org/review-history/14390
Received 19
th
February 2016
Accepted 12
th
April 2016
Published 29
th
April 2016
ABSTRACT
Lack of advance planning for use of skilled attendants at birth contributes significantly to delays in
receiving obstetric care. This study assessed attitude and level of birth preparedness and
complication readiness (BPACR) plan among pregnant women in Benin City, with a view to
improving utilization of skilled attendants at birth and health facility deliveries.
Materials and Methods: A community based analytical cross sectional study was conducted,
involving interviewer administration of pretested structured questionnaires to 252 consenting
pregnant women in Benin City, Edo State.
Results: The mean age of pregnant women studied was 28.9±4.9 years. Two hundred and thirty
eight (94.4%) respondents had positive attitude towards BPACR. Furthermore, 197 (78.2%) and
Original Research
Article

Obi AI et al.; BJMMR, 15(6): 1-14, 2016; Article no.BJMMR.25127
2
218(94.4%) of respondents were well prepared with regard to intended and actual birth plans
respectively. Awareness of BPACR (OR=0.337; 95%CI=0.128-0.891; p=0.028) and Antenatal Care
(ANC) registration (OR=0.016; 95%CI=0.002-0.127; p˂0.001) were significant predictors identified
that influenced BPACR plans.
Conclusion: Majority of pregnant women studied had positive attitude towards BPACR and were
well prepared with regards to intended and actual birth plans respectively. There is need to
strengthen Antenatal Care (ANC) registration practices to sustain the improved utilization of skilled
attendants at birth and health facility deliveries identified among pregnant women in Benin City,
Edo State.
Keywords: Attitude; birth preparedness and complication readiness; Edo State; Nigeria; pregnant
women.
1. INTRODUCTION
Nigeria accounts for nearly 14% of global
maternal deaths reported [1-2]. Ninety-nine
percent of these 358 000 global maternal deaths
occur annually in the less developed countries1.
The situation is particularly very worrisome for
women in Sub-Saharan Africa, where 1 in every
16 women dies of pregnancy related causes
during her lifetime, compared to 1 in 2,800
women in developed regions [3].
Every pregnant woman faces the risk of sudden
unpredictable complications that could end in
death or injury both to the woman and or her
infant, with an estimated 15% of most
pregnancies ending up in death or injury to
mother and or her baby [4]. It is therefore
necessary to employ strategies to overcome
such challenges as they arise. Birth
Preparedness and Complication Readiness
(BPACR) is a comprehensive strategy that
addresses delays in obtaining appropriate
obstetric care and is aimed at promoting timely
utilization of skilled maternal and neonatal health
care, based on the theory that preparing for
childbirth and being ready for complications
reduces delays in obtaining care and thereby
impacting positively on birth outcomes [4]. The
key elements in birth preparedness include:
identification of skilled care provider; knowledge
of danger signs; planning on where to give birth
and making the necessary plans to receive
skilled care for all births while complication
readiness include; saving money as emergency
funds; planning for transport; identifying potential
blood donor and designated decision-maker.
Although, antenatal care (ANC) represents a
window of opportunity for information, education
and communication to help empower pregnant
women to make appropriate and informed
choices especially during emergencies [5-6], the
level of ANC registration remains poor in Nigeria,
as only 36% of pregnant women register for ANC
[2].
Attitudinal concerns are well documented factors
that can influence the level of utilization of health
services and interventions, this is attributable to
perceived benefit of such intervention possibly
due to underlying belief systems and formed
impressions on the attitude of health care
providers to their clients and work, this has been
reported to result in negative attitude towards
BPACR resulting in preference for out of health
facility care and services as have been reported
in previous studies [7-8]. Poor levels of birth
preparedness and complication readiness plan
have been reported among women in developing
countries with prevalence ranging between 4.8 to
17% [9-11].
Inadequate human resources for health;
inadequate and poor political commitment; poor
financial support especially in meeting
transportation challenges; antenatal care,
delivery care and post natal care cost;
coordination and partnership problems; poor
male and community involvement; increasing
poverty status of the citizenry compounded by
the low socio-economic status of women; the use
of inappropriate strategies to stem the growing
tide of maternal mortality etc are well
documented factors contributing to the growing
challenges to maternal care not only in Nigeria
but in other developing countries [2,12-14].
In Nigeria most pregnancies are unplanned as
the birth preparedness and complication strategy
is not well embraced [15]. In spite of the great
potential of birth preparedness and complication
readiness (BPACR) strategy as a cost effective
tool in reducing maternal and new born deaths,
its status in this regard is not well known and
practiced in most of sub-Saharan Africa [4]. This
study will help provide relevant information on

Obi AI et al.; BJMMR, 15(6): 1-14, 2016; Article no.BJMMR.25127
3
BPACR that will help policy makers and
significant others review existing health programs
and interventions for improved utilization of
skilled attendants at birth and health facility
deliveries by pregnant women in Nigeria. This
study was therefore carried out to assess attitude
and level of birth preparedness and complication
readiness (BPACR) plan among pregnant
women in Benin City, Edo State, Nigeria.
2. MATERIALS AND METHODS
This study was carried out in Benin City, the
capital of Edo State. Benin City comprises three
Local Government Areas:-Egor, Oredo and
Ikpoba-Okha Local Government Areas
respectively [16]. Benin City is bounded to the
west by Ovia North East Local Government Area
and the North-East by Uhunmwuode Local
Government Area and South by Ethiope – West
Local Government Area of Delta State. It has an
estimated population of 1,086,882 people
consisting of 542,545 and 544,337 males and
females respectively [17], with 300,797 of the
total population comprising women in the
reproductive age group (15-49 years).
Benin is the predominant ethnic group; others
include Esan, Etsako with other indigenous and
non-indigenous tribes. The industrial
undertakings in the State include farming,
carving, saw milling, rubber processing, cement,
textile production, brewing, flour milling etc [18].
There is a high literacy rate [19] (75.6%) in the
State, supported by the large distribution of
public and private primary, secondary and
tertiary educational institutions. Benin City has a
local airport with a good network of roads with
variable level of motorability, especially in rainy
season [18]. There is a large distribution of public
and private health facilities in the study area
offering a wide range of maternal health services,
but the patronage of traditional birth attendants’
services is common [20].
A community based analytical cross sectional
study was conducted involving pregnant women
in Benin City, Edo State between February 2012
and June 2012. Interviewer administered
pretested structured questionnaires, adapted
from the safe mother hood questionnaire [21]
was utilized for data collection from consenting
currently pregnant women in their third trimester
this category of respondents were identified
based on their last menstrual period (LMP) [22]
with regards to socio-demographic
characteristics, attitude towards birth
preparedness and complication readiness and
BPACR plans. The minimum sample size of 239
pregnant women was calculated using the
Cochran formulae for simple proportion in a
descriptive cross sectional study [23] based on a
17% prevalence of being well prepared for birth
from a previous study [24]. A multistage sampling
technique was utilized to recruit consenting
pregnant women from the three LGAs (i.e Egor,
Oredo and Ikpoba-Okha respectively) in the
Benin City. Using 5% of the derived population
estimate based on the 2006 census figures [17]
as those who were currently pregnant, a
population estimate per LGA for currently
pregnant women was obtained as (i.e 5061,
5248 and 4731) respectively for Ikpoba-Okha,
Oredo and Egor LGAs. Thus, the total population
of currently pregnant women in Benin City was
estimated at 15,041; subsequently applying
sampling fractions of 0.337, 0.349 and 0.315 for
Ikpoba-Okha, Oredo and Egor LGAs respectively
to the calculated minimum sample size estimate
of pregnant women (i.e 239) aided obtaining the
sample size estimate of currently pregnant
women per LGA for study (i.e 87 from Oredo, 84
from Ikpoba-Okha and 81 from Egor LGAs
respectively).
Data collected was sorted for completeness,
coded, entered and analyzed using SPSS 20.0
statistical software with results presented as
statements, frequency tables and figures.
Bivariate analyses was conducted using Chi
square and fishers’ exact test to identify
independent variables that influenced attitude
and level of BPACR, subsequently logistic
regression analysis was carried out to identify
significant predictors and eliminate possible
confounders. Statistical significance was set at p
˂0.050 and 95% confidence interval.
Attitude towards BPACR was computed based
on nine attitudinal questions, a maximum point
score of one was given for every correct positive
or negative attitudinal response to a positive or
negative attitudinal question while a score of zero
for every incorrect positive or negative attitudinal
response to negative or positive question
respectively, thus making a total point score of 9.
This scoring system had a reliability (Cronbach’s
alpha) score of 0.781. A total percentage score
of 0-6.2 points (≤69.9%) was graded as negative
attitude towards BPACR while 6.3-9 points
(≥70%) graded as positive attitude towards
BPACR.
The level of BPACR plan was graded as well
prepared, partially prepared and not prepared

Obi AI et al.; BJMMR, 15(6): 1-14, 2016; Article no.BJMMR.25127
4
based on a scoring system developed by
researcher. This was computed based on five
practice questions involving a maximum point
score of one given to each of the five key
elements of birth preparedness practiced which
included; plan for transportation, saving money
as emergency fund, identifying skilled birth
provider, identifying a health facility for
emergency and identifying potential blood donor
in case of emergency. Taking at least three steps
with at least three (3) point score was considered
as being well prepared while taking one to two
steps (i.e 1-2 point score) was considered
partially prepared and taking no step at all (i.e 0
point score) was considered as not prepared.
Socio-economic classification (Upper and Lower
socio-economic class) of pregnant women was
based on Oyedeji recommendation [25].
Ethical approval was sought and obtained from
the Ethics and Research Committee of the
University of Benin Teaching Hospital, Benin
City, Edo State before the commencement of the
study. Institutional approval was also obtained
from the Department of Hospital Services Edo
State Ministry of Health, the three Local
Government Area Councils respectively.
Informed consent was sought and willfully
obtained from the respondents before the
commencement of the study. There was no
inducement (financial or otherwise) for
respondents who agreed to participate in the
study and all pregnant women including those
that did not meet inclusion criteria and those who
declined participation were given haematinics at
point of exit and encouraged to register and
attend antenatal clinic regularly.
2.1 Limitation of Study
The findings of this study were based on self-
report, so it was not possible to validate the
claims made by respondents in the course of
questionnaire administration. Some of the
pregnant women (21 pregnant women earlier
interviewed) were lost to follow-up and could not
be traced; as such useful information that could
have enriched result findings may have been lost
as a result of this.
3. RESULTS
The mean age of pregnant women studied was
28.9±4.9 years, Christianity 247(98.0%) was the
predominant religion while 106(42.1%)
respondents had completed secondary level of
education. Furthermore, 211 (83.7%) of
respondents were married, 24(9.5%) single and
1(0.4%) widowed. In relation to the socio-
economic classification, 180(71.4%) were in the
Lower (Socio-Economic Class) SEC while 72
(28.6%) in the Upper SEC. Benin constituted 100
(39.7%) of total ethnic group of respondents,
followed by Esan 41(16.3%) and Igbo 30
(11.9%), the least being (i.e Hausa 4(1.6%),
Igala 3(1.2%) and Ebira 2(0.8%) respectively). In
relation to obstetric characteristics of
respondents 83(32.9%) of respondents were
pregnant for the first time in index pregnancy,
while 169(67.1%) had been pregnant previously.
In relation to parity 150(59.5%) were
primiparous, 91(36.1%) multiparous and
11(4.4%) grand multiparous. Furthermore,
228(90.5%) of the respondents had previous
history of stillbirth while 24(9.5%) had no such
history. Finally, in relation to the gestational age
118(46.8%) respondents were in the 27-30 week
of gestation, 82(32.5%) in 31-35 week of
gestation while 52(20.6%) in 36-40 week of
gestation as at the time of study.
A total of 197(78.2%) of respondents studied had
heard of the term “birth preparedness” while
55(21.8%) had never heard; health care
providers 172(87.3%) were their predominant
source of information followed by family
133(67.5%) with least being media 21(10.7%)
(See Table 1). In relation to attitudinal score
towards BPACR (see Table 2) 238(94.4%)
pregnant women had positive attitude towards
BPACR while 14 (5.6%) had negative attitude.
Table 1. Awareness and source of
information on birth preparedness (BPACR)
among pregnant women in Benin City, Edo
State
Variable Frequency
(252) Percent
Awareness of BP
Ever heard 197 78.2
Never heard 55 21.8
Source of
information*(197)
Health provider 172 87.3
Family 133 67.5
Friends 101 51.3
School 24 12.2
Media 21 10.7

Obi AI et al.; BJMMR, 15(6): 1-14, 2016; Article no.BJMMR.25127
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Table 2. Attitudinal scores for responses towards BPACR among pregnant women in
Benin City, Edo State
Attitudinal score/response
Positive response
i.e strongly agree
and agree
(point score=1)
Negative response
i.e strongly disagree,
disagree and indifferent
(point score= 0)
Total
Plan place of delivery 240(95.2) 12(4.8) 252(100.0)
Transport plan for delivery 248(98.2) 4(1.6) 252(100.0)
Husband attend ANC 64(25.4) 188(74.6) 252(100.0)
Cost of care 37(84.7) 215(85.3) 252(100.0)
Bad roads 44(11.2) 208(82.8) 252(100.0)
Poor security 39(15.5) 213(84.5) 252(100.0)
Poor attitude of HCPs 19(7.5) 233(92.5) 252(100.0)
Spouse Present during Labour 19(7.5) 233(92.5) 252(100.0)
Men contribute little during labour 24(9.5) 228(90.5) 252(100.0)
In relation to factors associated with attitude
towards BPACR, Table 3 shows a significant
association between previous history of
pregnancy (p=0.040) and awareness of BP
(0.016) and attitude towards BPACR as positive
attitude towards BPACR. In contrast parity, ANC
registration, previous history of still birth, Number
of ANC visits, Trimester of ANC registration,
counseling on BPACR, age group of
respondents, Educational status, marital status
and Socio economic status of respondents were
not significant factors associated with attitude of
pregnant women towards BPACR.
In relation to the actual components of BPACR
(See Table 4); Identifying health facility 246
(97.6%) was the most mentioned followed by
identifying skilled care provider 245(97.2%) then
saving money 244(96.8%), identifying a mode of
transport 231(91.7%) with least mentioned being
identifying a potential blood donor 172(68.3%).
Furthermore, in relation to level of preparedness
towards intended and actual birth plans,
197(78.2%) and 218(94.4%) pregnant women
studied were well prepared, 46(18.3%) and
13(5.6%) of respondents were partially prepared,
while 9(3.5%) were not prepared respectively
(See Fig. 1).
In relation to factors associated with level of birth
preparedness for intended birth plans (see Table
5) educational status of respondents (p<0.001),
marital status (p<0.001), age group of
respondents (p=0.02), ANC registration
(p<0.001), receiving counseling on BPACR
(p<0.001) and number of ANC visits (p=0.010)
were significant factors associated with level of
preparedness for intended birth plan.
Furthermore, history of previous pregnancy,
socio-economic status, parity, history of still birth
and trimester of ANC registration were not
significant factors. Furthermore, multivariate
analysis identified awareness of BP as a
significant predictor for level of preparedness for
intended birth plan (OR=0.337; 95% (CI) =0.128-
0.891; p=0.028); pregnant women who were not
aware of BP were 67 times less likely of being
better well prepared than those who were aware
of BP.
In relation to factors associated with level of
preparedness for actual birth plan, Table 6
shows that history of previous pregnancy,
educational status of respondents, marital status,
parity, age group of respondents, history of still
birth, awareness of birth preparedness and
complication readiness, ANC registration,
Number of ANC visits, trimester of ANC
registration, receiving counseling on BPACR and
Socio-economic classification were not
significant factors associated with level of
preparation for actual birth plan among
respondents. Finally, multivariate analysis
identified ANC registration as a significant
predictor for level of preparedness for actual birth
plan (OR=0.016; 95% CI =0.002 -0.127;
p<0.001); pregnant women who did not register
for ANC were 99 times less likely of being well
prepared during delivery than those who
registered for ANC.
4. DISCUSSION
This study identified that majority of respondents
studied were aware of BP and had registered for
antenatal care; as such could have benefitted
from health education opportunities derived from
ANC attendance on birth preparedness and
danger signs in pregnancy, labour and delivery.
The free antenatal care and delivery services
offered by Edo State State Government [26]
might have contributed to the high level of ANC

Obi AI et al.; BJMMR, 15(6): 1-14, 2016; Article no.BJMMR.25127
6
registration among respondents, as most of the
respondents studied reported health care
providers as their major source of information.
The high awareness of BP identified in this study
is similar to findings reported from a study [27] in
South-Eastern Nigeria. Other study findings from
Ile-Ife western Nigeria [10], North Ethiopia [9]
and Kenyetta, Kenya [28] among nursing
mothers and pregnant women also buttressed
that antenatal care sessions provides a good
avenue for information dissemination and
communication that could possibly influence
positive behavior changes to help improve
maternal health indices in developing countries.
Table 3. Factors associated with attitudinal score towards BPACR among pregnant women in
Benin City, Edo State
Variable
Negative
attitude
Freq. (%)
Positive
attitude
Freq. (%)
Total
Freq. (%)
(n=252)
Test
statistic
p
Obstetric factors
History of
previous pregnancy
Yes 13(7.7) 156(92l.3) 169(100)
No 1(1.2) 82(98.8) 83(100) Fisher’s exact = 4.465 0.040
Parity
≤ 1 6(4.0) 144(96.0) 150(100.0)
2-4 7(7.7) 84(92.3) 91(100.0)
>4 1(9.1) 10(90.9) 11(100.0) χ
2
=1.746 0.418
History of stillbirth
Yes 1(4.2) 23(95.8) 24(100.0)
No 13(5.7) 215(94.3) 228(100.0) Fishers exact =0.098 0.755
Number of ANC
visits
(n=238)
≤ 4 7(5.5) 120(94.5) 127(100.0)
˃ 4 6(5.4) 105(94.6) 111(100.0) χ
2
=0.001 0.971
Trimester of ANC
registration
1
ST
Trimester 8(11.3) 63(88.7) 71(100.0)
2
ND
Trimester 5(3.2) 149(96.8) 154(100.0)
3
RD
Trimester 0(0.0) 13(100.0) 13(100.0) χ
2
=1.746 0.418
Awareness of BP
Yes 7(3.6) 190(96.4) 197(100.0)
No 7(12.7) 48(87.3) 55(100.0) Fishers exact =6.897 0.016
ANC
registration
Yes 13(5.5) 225(94.5) 238(100.0)
No 1(7.1) 13(92.9) 14(100.0)
Fisher’s
exact=0.071
0.561
BPACR
counseling
(n =238)
Yes 13(6.4) 191(93.6) 204(100.0)
No 0(0.0) 34(100.0) 34(100.0) Fisher’s exact= 2.292 0.130
Socio
-
demographic factors
age group
(
years
)
15-24 3(6.8) 41(93.2) 44(100.0)
25-34 9(5.2) 164(94.8) 173(100.0)
35-44 2(5.7) 33(94.3) 35(100.0) Fishers exact =0.470 0.838
Educational status
None 0(0.0) 5(100.0) 5(100.0)
1
0
Completed 3(5.2) 55(94.8) 58(100.0)
2
0
Completed 11(8.3) 121(91.7) 132(100.0)
3
0
Completed 0(0.0) 54(100.0) 57(100.0) Fisher’s exact = 5.734 0.109
Socio
-
economic
class
(SEC)
Upper SEC 2(2.8) 70(97.2)
Lower SEC 12(6.7) 168(93.3) Fishers exact = 1.482 0.361
Marital
status
Single 0(0.0) 9(100.0) 9(100.0)
Married 10(4.7) 201(95.3) 215(100.0)
Others 4(14.3) 24(85.7) 28(100.0) Fishers exact = 3.922 0.136

Obi AI et al.; BJMMR, 15(6): 1-14, 2016; Article no.BJMMR.25127
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Fig. 1. Level of birth preparedness and complication readiness plan among pregnant women in
Benin City, Edo State
This study also identified that majority of
pregnant women that participated had positive
attitude towards birth preparedness and
complication readiness. It is possible that the
high antenatal registration and attendance
among respondents may have created the
necessary platform for positive attitudinal
changes among pregnant women studied
towards BPACR, possibly resulting from positive
reinforcement of health information and shared
experiences from health providers and other
pregnant women during their ANC visits. There is
no doubt that antenatal care provides enormous
opportunity for health education in relation to
pregnancy, delivery and newborn care, this was
equally reported in a recent study in Benin City
[26], and this ANC opportunity could have
positive influences on respondent’s attitude
towards pregnancy, child birth and emergency
care.
This study also identified that ANC registration
was higher among pregnant women who were
married women than others, who also might have
received counseling on birth preparedness.
Married persons are usually less likely to conceal
their pregnancy status and may take all
necessary steps to ensure that the pregnancy is
properly cared for. This may explain the better
attitude towards birth preparedness and
complication readiness identified among married
pregnant women than other women studied;
although this association was not statistically
significant. Marriage is known to instill some
measure of responsibility on pregnant women
and as such they could be more objective in
decision making than the unmarried women, who
may try not only to conceal such pregnancies but
also in extreme situations to terminate them.
Thus making services provided by quacks and
unskilled hands inevitable among the unmarried
in their attempt to cover up from the potential
social stigma and shame attached to such
unplanned pregnancy. This can expose these
pregnant women and unborn children to
complications and in extreme situations death
resulting from services provided by these
unqualified care providers.
Furthermore, the positive attitude reported in this
study is similar to that observed from a study in
rural Tanzania7 were it was reported that
improvements in health care provider attitudes
towards their clients coupled with availability of
drugs and medical equipment resulted in a two-
fold increase in women's preference to use the
available health units for delivery, this was
equally reported in another study [29]. It is worthy
of note, that the attitude of health care providers
towards their client is an important factor which
can influence the level of utilization of health
facility services. Attitudinal concerns relating
to health care providers have been widely
reported in other studies [30-32], this can
negatively influence the attitude of pregnant
women, their spouse/male partners and family
members towards health facility deliveries and
care. They may then seek health care from
197 (78.2%)
46(18.3%)
9 (3.5%)
218 (94.4%)
13 (5.6%) 0(0.0%)
0
10
20
30
40
50
60
70
80
90
100
well prepared
partially
prepared
not prepared
FREQUENCY (%)
FREQUENCY (%)
FREQUENCY (%)
FREQUENCY (%)
intended birth plan
actual birth plan

Obi AI et al.; BJMMR, 15(6): 1-14, 2016; Article no.BJMMR.25127
8
sources were they are better accepted and this
may not necessarily be of better quality or
cheaper but could also be from unqualified
sources with the attendant negative health
consequences, possibly resulting in
complications and deaths.
In relation, to level of birth preparedness and
complication readiness plan majority of the
respondents were well prepared and this
increased during labor among respondents
although a very low proportion of respondents
were not prepared for birth in this study. This is in
keeping with findings from a study [7] in Northern
Nigeria which equally showed high level of health
facility deliveries and skilled attendant presence
at birth and interestingly among the out of health
facility delivery most of the deliveries were
conducted by nurses/midwives. Other studies
have also stressed on the need to identify and
seek skilled birth providers during delivery
especially when home deliveries are inevitable
[7,33]. Similarly, other studies in Kenya [10] and
Benin City [34] showed high level of birth
preparedness among pregnant women as
majority of them had made adequate
transportation plan and set aside savings as
emergency funds towards labour or any
emergency situation.
This study identified increasing educational
status, increasing age group of respondents in
years, ANC registration and increasing ANC
visits, awareness of BP and receiving counseling
on BP as significant factors associated with high
level of birth preparedness among pregnant
women. This highlights the importance of early
preparation towards childbirth and possible
emergency that can occur as majority of
respondents studied had registered for antenatal
care, identified health facility for care, identified
skilled care provider, made transportation plan as
at the time of study; although only a low
proportion of them reported to have made saving
plans and identified potential blood donors.
The role of ANC registration cannot be
overemphasized as it creates the right platform
for information dissemination and clarification on
any area of doubt in relation to antenatal care,
thus affording health care providers the right
opportunity to impart correct information to their
clients in relation to maternal and child care.
Clients must be reminded on the importance of
presenting early for health care; such
opportunities enable health care providers
intervene early and address any health problem
or condition they may be passing through. This
study showed that younger pregnant women
than their older counterparts registered for ANC,
this may be explained by the fact that the
younger women may be less experienced and
may be more cautious in relation to source, type
of health information and care to be received and
as such register earlier and attend ANC more
frequently.
Table 4. Birth Preparedness and complication
readiness (BPACR) practices by pregnant
women in Benin City, Edo State
Variable
Frequency
(n=252)
Percent
ANC registration
Yes 238 94.4
No 14 5.6
Identify health
facilities for
ANC(n=238)
Yes 234 98.3
No 4 1.7
Save
money
(Emergency funds)
Yes 74 29.4
No 178 70.6
Transport plan
Yes 165 65.5
No 87 34.5
Plan for
skilled
birth
provider
Yes 245 97.2
No 7 2.8
Identified
blood
donor
Yes 21 8.3
No 231 91.7
Intended place of
delivery
Health facility 229 90.9
Home 13 5.2
TBA home 7 2.8
Undecided 3 1.2
Place of actual
delivery (n=231
)
Health Facility 204 88.3
Church 10 4.3
TBA Home 16 7.0
Home 1 0.4
Skilled
birth
provider present for
delivery (n=231)
Yes 207 89.6
No 24 10.4

Obi AI et al.; BJMMR, 15(6): 1-14, 2016; Article no.BJMMR.25127
9
Table 5. Factors associated with level of preparedness for intended birth plan among pregnant
women in Benin City, Edo State
Variable
Not Well
Prepared
Freq. (%)
Well prepared
Freq. (%)
Total
Freq.(%)
(n=252)
Test
Statistic P
Obstetric factors
History of previous
Pregnancy
Yes 33(19.5) 136 (80.5) 169(100)
No 22(26.5) 61(73.5) 83 (100) χ
2
=1.59 0.210
Parity
≤ 1 35(24.7) 113(75.3) 150(100.0)
2-4 17(18.2) 74(81.5) 91(100.0)
>4 1(9.1) 10(90.9) 11(100.0) χ
2
=2.28 0.320
History of
stillbirth
Yes 4(16.7) 20(83.3) 24(100.0)
No 51(22.4) 117(77.6) 228(100.0) χ
2
=0.41 0.520
Number of ANC Visits
(N=238)
≤ 4 30(23.6) 97(76.4) 127(100.0)
>4 12(10.8) 99(89.2) 111(100.0) χ
2
= 6.69 0.010
Trimester of ANC
Registration (n=238)
1
st
Trimester 14(19.7) 57(80.3) 71(100.0)
2
nd
Trimester 24(15.6) 130(84.4) 154(100.0)
3
rd
Trimester 4(30.8) 9(69.2) 13(100.0) χ
2
=0.39 0.330
Awareness of BP
Yes 23(11.7) 174(88.3) 197(100.0)
No 3(5.5) 52(94.5) 55(100.0) χ
2
= 1.80 0.180
Awareness of BP(No)
OR=0.337
95%CI= 0.128
-
0.891
p = 0.028
ANC registration
Yes 42(17.6) 196(82.4) 238(100.0)
No 13(92.9) 1(7.1) 14(100.0) χ
2
=43.84 <0.001
Received bpacr
counselling (n=238)
Yes 29(14.2) 175(85.8) 204(100.0)
No 13(38.2) 21(61.8) 34(100.0) χ
2
=11.57 <0.001
Socio
-
demographic
factors
Age
group
(Years)
15-24 14(31.8) 30(68.2) 44(100.0)
25-34 39(22.5) 134(77.5) 173(100.0)
35-44 2(5.7) 33(94.3) 35(100.0) χ
2
= 7.95 0.020
Educational
status
None
1(20.0)
4(80.0)
4(100.0)
1
0
Completed 16(27.6) 42(72.4) 58(100.0)
2
0
Completed 34(25.8) 98(74.2) 106(100.0)
3
0
Completed 4(7.0) 53(93.0) 57(100.0) Fishers
exact
=11.01
<0.001
Socio
-
economic class
Upper SEC 10(13.9) 62(86.1) 72(100.0)
Lower SEC 45(25.0) 135(75.0) 180(100.0)
χ
2
=3.721 0.054
Marital
status
Single 14(58.3) 10(41.7) 24(100.0)
Married 36(17.1) 175(82.9) 211(100.0)
Others 5(29.4) 12(70.6) 17(100.0) χ
2
=22.13 <0.001

Obi AI et al.; BJMMR, 15(6): 1-14, 2016; Article no.BJMMR.25127
10
Table 6. Factors associated with level of preparedness for actual birth plan among pregnant women in Benin City, Edo State
Variable Partially prepared Freq. (%) Well prepared Freq. (%) Total Freq.(%) (n=252) Test statistic P
Obstetric factors
History of previous pregnancy
Yes 10(6.4) 147(93.6) 157(100)
No 3(4.1) 71(95.9) 74 (100) χ
2
= 0.51 0.480
Parity
≤ 1 7(5.1) 129(94.9) 139(100.0)
2-4 5(5.9) 80(94.1) 85(100.0)
4 1(10.1) 9(90.0) 11(100.0) Fisher’s exact =1.06 0.660
History of stillbirth
Yes 0(0.0) 23(100.0) 23(100.0)
No 13(6.2) 195(98.1) 208(100.0) χ
2
= 1.52 0.220
History of stillbirth
Yes 0(0.0) 23(100.0) 23(100.0)
No 13(6.2) 195(98.1) 208(100.0) χ
2
= 1.52 0.220
Number of ANC visits
≤ 4 8(6.7) 112(93.3) 120(100.0)
> 4 4(4.1) 93(95.9) 97(100.0) χ
2
= 0.66 0.420
Trimester of registration
1
st
Trimester 3(4.3) 67(95.7) 135(100.0)
2
nd
Trimester 7(5.2) 128(94.8) 135(100.0)
3
rd
Trimester 2(16.7) 10(83.3) 12(100.0) Fisher’s exact =2.99 0.230
Awareness of BP
Yes 12(6.7) 166(93.3) 178(100.0)
No 1(7.1) 52(98.1) 53(100.0) χ
2
= 1.81 0.180
ANC registration
Yes 12(5.5) 205(94.5) 217(100.0)
No 1(7.1) 13(92.9) 14(100.0) χ
2
= 0.06 0.800
ANC
registration
(No)
OR=0.016 95%CI=0.002 -0.127 P ˂ 0.001

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11
Variable Partially prepared Freq. (%) Well prepared Freq. (%) Total Freq.(%) (n=252) Test statistic P
Received BPACR counseling
Yes 9(4.9) 175(95.1) 204(100.0)
No 3(9.1) 30(90.9) 33(100.0) χ
2
= 0.95 0.330
Socio-demographic factors
Age group (Years)
15-24 2(4.9) 39(95.1) 41(100.0)
25-34 9(5.6) 153(94.4) 162(100.0)
35-44 2(7.1) 26(92.9) 28(100.0) Fisher’s exact = 0.41 0.900
Educational status
None 0(0.0) 5(100.0) 5(100.0)
1º Completed 5(9.8) 46(90.2) 51(100.0)
2º Completed 7(5.7) 115(94.3) 122(100.0)
3º Completed 1(1.9) 52(98.1) 53(100.0) Fisher’s exact =2.99 0.350
Socio-Economic class (SEC)
Upper SEC 2(2.9) 66(97.1) 68(100.0)
Lower SEC 11(6.7) 152(93.3) 163(100.0) χ
2
= 1.31 0.355
Marital status
Single 0(0.0) 23(100.0) 23(100.0)
Married 12(6.3) 179(93.7) 191(100.0)
Others 1(5.9) 16(94.1) 17(100.0) Fisher’s exact =1.07 0.620

Obi AI et al.; BJMMR, 15(6): 1-14, 2016; Article no.BJMMR.25127
12
This study also revealed high level of health
facility deliveries among respondents. The high
health facility deliveries and skilled attendant
present at birth in this study is in contrast to the
Nigeria National averages from previous surveys
[2,35] which had health facilities deliveries (35%)
and skilled attendant present at birth (39%)
respectively. In addition other studies, in Enugu,
South Eastern Nigeria [27], Southern Ethiopia
[24] and rural Uganda [36] equally showed low
level of birth preparedness among nursing
mothers and pregnant women resulting in low
health facility deliveries. These studies showed
that inadequate preparation was a key factor
influencing the level of birth preparedness as
most of the respondents had poor plans towards
birth preparedness; majority of them had not
identified skilled care providers or health facility
for delivery or emergencies, made no
transportation plan, or made savings nor
identified potential blood donor during
emergency situations.
Majority of pregnant women in this study did not
make plans for potential blood donor, inadequate
plans in relation to identifying potential blood
donors can result in serious morbidity and
mortality during emergency situation such as
from severe vaginal bleeding during pregnancy,
delivery and even post-delivery. Bleeding events
have been reported to contribute significantly to
maternal mortality globally4-5. These
unpredictable emergency events can occur in
locations were laboratory facilities may not be
readily available to assess blood group and
having this information can minimize time delays
in accessing safe and appropriate blood for
transfusion needed under such circumstances to
save life.
The high level of birth preparedness identified in
this study is encouraging and should be
sustained by stepping up health education
interventions. This further reinforces the
importance of adequate planning and making
basic preparations towards delivery and
emergency situation which are usually
unpredictable; this study showed that
respondents who made saving plans, registered
for ANC and identified skilled attendant towards
delivery had higher rates of health facility
deliveries than those who did not. This is the
essence of the birth preparedness and
complication readiness strategy to empower
women with basic information to plan better,
recognize early warning signs and take
necessary steps that will minimize delays in
accessing appropriate care from skilled hands
and thus enhancing health facilities deliveries
and improve maternal and child health outcomes.
5. CONCLUSIONS
This study identified that majority of respondents
studied had positive attitude towards BPACR and
were well prepared with regards to intended and
actual birth plans respectively. Awareness of
birth preparedness and antenatal care
registration were identified as significant
predictors for BPACR plan; furthermore, high
health facility deliveries were reported among
pregnant women studied in Benin City. There is
need to strengthen Antenatal Care (ANC)
registration practices to sustain the improved
utilization of skilled attendants at birth and health
facility deliveries identified among pregnant
women in Benin City, Edo State.
COMPETING INTERESTS
Authors have declared that no competing
interests exist.
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_________________________________________________________________________________
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