CHAPTER ONE
INTRODUCTION
1.1         Background to the Study
Health is central to community well-being, personal welfare and has strong influence on people’s earning capacity. It is fundamental to people’s ability to enjoy and appreciate all other aspects of life. Health care utilization is use of healthcare services by people. The healthcare utilization of a population is related to the availability, geographical access, quality, cost of services, perceived benefits, as well as to social-economic and cultural structure, and personal characteristics of the users.(Chakraborty et al., 2003; Onah et al., 2009).The joys of motherhood is childbearing, it is a source of sorrow to many households as many women lose their lives during child birth. Every single day, Nigeria loses about 2, 300 under five years old and 145 women of childbearing age (Federal Ministry of Health, 2005). Discussions on reproductive and sexual health rights which had hitherto been a ‘taboo’ in traditional African societies are on the increase according to African scholars (Aniekwu, 2006). While the right to health has been an internationally recognized human right, reproductive health rights gained formal acceptance only in 1993 and the need for women to have access to quality reproductive health services such as medical care, planned family, safe pregnancy, delivery care, treatment and prevention of sexually transmitted infections, such as HIV/AIDS is increasingly gaining recognition in Africa at large and Nigeria in particular (World Health Organization, 2004).
Despite this recognition, reproductive health of women is still one of the major health challenges worldwide particularly in resource-poor countries such as Nigeria. Women represent a vulnerable population group as a result of biological and gender-related differences. Reproductive ill-health accounts for 20% of the global burden of ill-health of women compared to 14% for men (World Health Organization, 2008).According to Shiffman (2007), the health status of countries has been assessed using women reproductive health indicators such as maternal mortality rates, antenatal care coverage, and proportion of delivery supervised by skilled birth attendants, unmet need for family planning among others. This clearly underscores the fact that, all efforts must be on deck by both government and non-governmental organization to ensure that women have access to reproductive health service. The International Conference on Population and Development (ICPD) and the Millennium Development Goals (MDGs), both set goals to reduce maternal mortality and improve access to reproductive health services. The MDG target number 5 to reduce maternal mortality by three-quarter and achieve universal access to reproductive health by the year 2015.(World Health Organization, 2004).
The current population ofNigeria is 189,689,126 people based on the latest United Nations estimate. Nigeria population is equivalent to 2.55% of the total world population (world population prospects, 2015).Abouttwo-third of the population live in rural areas, and most rural dwellers are involved in the agriculture sector. Ibrahim, M. K. (2005). In 2008, the adult literacy rate for both sexes was 74.8%. Nigeria has a high total fertility rate estimated at 5.5 births per woman (compared to a world average of 2.5). The fertility preference of Nigerian women is closely related to the number of living children.