1.1. PROBLEM STATEMENT
The number of women dying annually from pregnancy, childbirth and attendant complications are still a global concern (WHO 2015). Lack of access to quality healthcare services for pregnancy and delivery are among the reasons for high maternal mortality rates worldwide (Alvarez et al. 2009) with the situation particularly marked in many low-resource settings. For example, despite the reported increase in the proportion of skilled delivery care recorded across the world, only just over half of all deliveries in sub-Saharan Africa are attended by skilled health workers (WHS 2015). Available evidence has shown that the highest number of maternal deaths occur during the delivery and post delivery period (Khan et al. 2006), and increasing access to skilled birth attendance at delivery and provision of emergency obstetric services for women with complications are effective interventions in reducing maternal deaths (Paxton et al. 2005; Rosenfield et al. 2007). In addition, half of the maternal deaths and complications that occur during pregnancy are preventable by antenatal care programs that provide essential services to pregnant women (Abou-Zahr & Wardlaw 2003; Lincetto et al. 2006). Therefore, timely access to maternal care services, therefore, remain an important indicator for monitoring the progress of maternal outcomes including maternal mortality.
Access to maternal health services Nigeria is still marked with inequities across geographical and economic gradients (Fagbamigbe & Idemudia 2015a). Financial inaccessibility owing to inability to afford the cost of care have been established as a barrier to use of health facilities,
particularly for the poor and vulnerable women (Ekabua et al. 2011). Studies correlating utilisation of maternal health services with models of healthcare financing in low income countries found that higher proportion of government financing is associated with greater utilization of skilled birth attendants and caesarean section (Kruk et al.2007). However, out of pocket financing of the costs of facility delivery has been shown to have substantial repercussion on households including having to borrow money or sell valuable household items making families more vulnerable to impoverishment (Russell 1996; McIntyre et al. 2006). According to Alvarez et al. (2009), Maternal mortality ratios in sub-Saharan African Countries is inversely correlated with per-capita government expenditure on health and directly related to the out-of-pocket expenditure on health, the more out-of-pocket expenditure in health in a country the higher the maternal mortality rate (MMR). Over the last decade, there has been shift towards the eradication of user fees for maternal health services in low and middle income countries with studies showing marked improvement in service coverage with their removal (Ponsar et al. 2011).||