CHAPTER FIVE
DISCUSSION, CONCLUSION, AND RECOMMENDATIONS
5.0 Introduction
This chapter presents a comprehensive discussion of the research findings, comparing them with
existing literature to establish a deeper understanding of the subject matter. It also explores the
implications of these findings for the nursing profession, acknowledges the limitations of the
study, and provides a summary, conclusion, and practical recommendations for stakeholders.
5.1 Discussion of Findings
The discussion is structured around the three main objectives of the study: perceptions,
contributing factors, and reduction measures.
Perception of Home Delivery among Women the study revealed that a significant majority of
women in Hashidu community perceive home delivery as a culturally respectful and comfortable
practice. This finding aligns with the Health Belief Model, where the "perceived benefit" of
cultural adherence and privacy outweighs the "perceived susceptibility" to medical risks. Similar
to the study by Patel et al. (2021), women in this community view home birth as a normal and
safe tradition. The high level of trust in Traditional Birth Attendants (TBAs) observed here
mirrors findings by Egharevba et al. (2022), where TBAs were seen as competent and culturally
aligned with the family’s needs.
Factors Responsible for Home Delivery Economic constraints and physical barriers emerged
as critical drivers. The high cost of hospital services and the long distance to health facilities
were cited as primary obstacles. This is consistent with Tsegay et al. (2023), who identified
geographical distance as a primary contributor to home births in low-income settings.
Furthermore, the study found that negative attitudes of healthcare workers discourage facility
utilization. This supports the research by Scott et al. (2018), which noted that poor treatment by
staff often pushes women toward home delivery. The influence of "previous successful home
births" also acts as a powerful motivator, leading women to believe medical intervention is
unnecessary.
Measures to Reduce the Rate of Home Delivery Respondents indicated that health education
and financial incentives are the most effective interventions. This aligns with Moyer and
Mustafa (2020), who emphasized that supply-side improvements (facility quality) must be
matched with demand-side interventions (community education). The suggestion to involve
community and religious leaders echoes the recommendations of Adebayo et al. (2021), who
argued that shifting social norms requires the engagement of local influencers.
5.2 Implications of Findings to Nursing
The findings hold significant weight for the nursing and midwifery profession:
i. Cultural Competence: Nurses must be trained in cultural sensitivity to ensure that
hospital environments are perceived as respectful and inclusive, rather than alienating.
ii. Community Outreach: There is a clear need for nurses to move beyond clinical walls
and engage in community-based health promotion to address misconceptions about
facility delivery.
iii. Quality of Care: The reported negative attitudes of providers highlight a need for
training in interpersonal communication and "respectful maternity care" to rebuild trust
within the community.
5.3 Limitations of the Study
i. Geographical Scope: The study was limited to Hashidu Community, Dukku LGA, and
may not represent the diverse views of women across the entire Gombe State or Nigeria.
ii. Language Barrier: Despite using assistants fluent in Hausa, some nuances in the
perception of "risk" and "safety" may be lost in translation during the administration of
the self-structured questionnaire.
iii. Self-Report Bias: Respondents may have provided socially desirable answers,
particularly regarding religious or cultural practices.
5.4 Summary of the Study
This study investigated the perceptions of home delivery among women of childbearing age (15
to 49) in Hashidu Community. Using a descriptive cross-sectional design and a sample of 110
women, the research explored why home delivery remains prevalent despite global efforts to
reduce maternal mortality. The findings indicate that while cultural preference and trust in TBAs
drive the practice, economic barriers and poor facility experiences remain significant hurdles.
5.5 Conclusion
In conclusion, home delivery in Hashidu is deeply rooted in cultural values and economic
necessity. While women recognize the potential for complications like Post-Partum Hemorrhage
(PPH), the perceived barriers to hospital care cost, distance, and provider attitude often outweigh
the perceived benefits of institutional delivery. Achieving the goal of safe motherhood requires a
shift from viewing home delivery solely as a "lack of knowledge" to addressing it as a complex
socioeconomic and systemic issue.
5.6 Recommendations
1. Subsidized Care: The Gombe State Government should strengthen the implementation
of free or highly subsidized maternal health services to remove the financial barrier to
facility delivery.
2. TBA Integration: Rather than exclusion, TBAs should be trained as "referral agents"
who are incentivized to bring pregnant women to facilities.
3. Transport Schemes: Establish community-based emergency transport systems (e.g.,
tricycle ambulances) to address the challenge of sudden labor at night and long distances.
4. Health Worker Training: Conduct regular workshops for nurses and midwives on the
importance of empathy and respectful care.
5.7 Suggestions for Further Studies
i. A comparative study between urban and rural communities in Gombe State to determine
if the perceptions of home delivery differ significantly.
ii. A qualitative study involving in-depth interviews with Traditional Birth Attendants
(TBAs) to understand their willingness to collaborate with formal health sectors.
iii. A study on the impact of male partner involvement in the choice of delivery location in
North-East Nigeria.