Barriers to the Utilization of Basic Emergency Obstetric and Newborn Services among Health Care Workers in Southwest, Nigeria: A Qualitative Study.

Abstract

Background: Maternal and neonatal mortality remain major public health challenges, particularly in low- and middle-income countries such as Nigeria. Although Basic Emergency Obstetric and Newborn Care (BEmONC) services are designed to prevent most maternal and neonatal deaths, their utilization remains suboptimal due to several contextual barriers. This study explored barriers to the utilization of BEmONC services in selected primary healthcare centres in Oyo State, Nigeria. Methodology: An exploratory qualitative study using Key Informant Interviews (KIIs) was conducted among healthcare workers involved in maternal and newborn care services in selected primary healthcare centres in Oyo State. A total of 28 participants were recruited using purposive sampling. Data were collected using a semi-structured interview guide and were analyzed thematically with the aid of NVivo software. Ethical approval and informed consent were obtained before data collection. Results: Four major themes emerged from the analysis: health system constraints, patient-related barriers, healthcare worker-related barriers, and communication and coordination gaps. Key barriers identified included inadequate equipment and supplies, shortage of skilled personnel, lack of emergency transportation, financial constraints, cultural beliefs, preference for traditional birth attendants, low awareness of BEmONC services, staff stress and burnout, poor healthcare worker attitudes, and weak referral systems. These barriers contributed to delays in seeking, reaching, and receiving appropriate maternal and newborn care. Conclusion: Utilization of BEmONC services is influenced by interconnected health system, socio-cultural, and workforce-related barriers. Strengthening healthcare infrastructure, improving staffing and continuous training, enhancing community awareness, and establishing effective referral and communication systems are essential for improving maternal and neonatal health outcomes in Oyo State, Nigeria.