Risk communication as a strategy to combat maternal mortality in Nigeria: a case study in Rivers State

This study was initiated following the high maternal mortality ratio in Rivers State, Nigeria, which stands at 889 maternal deaths per 100,000 live births. Approximately two thirds of Nigerian women deliver their babies outside of health facilities and without medically skilled attendants, thereby, indicating the need for a risk communication, thus increasing the chances of potentially avoidable maternal deaths. A mental models approach to developing risk communication was applied to this study to elicit the knowledge of maternal health experts and lay people, in order to achieve a better understanding of factors that lead to maternal death. The intent is to discover better ways of engaging the stakeholders to achieve a better understanding of the risk in order to enable an improved risk communication in the maternal health sector.
An expert mental model about maternal mortality has been developed based on literature review, and expert interviews. This model provides a framework of components that influence the high rates of maternal mortality seen in the State. The concepts within the model were used as a guide in developing questions for use in semi-structured interviews with the lay participants (Rivers State women of childbearing age). This led to the derivation of 6 emergent themes (religion, negative perception of government’s health provision/responsibility, compassion and skill of workers, influence of native midwives, lack of maternal health information, folklore, customs and tradition), and a diagram illustrating participant’s mental models. Comparison of the expert’s and women’s mental models revealed vital beliefs, knowledge gaps and misconceptions in the women’s understanding. The prevalence of the emerging information was further tested with a wider sample of women participants through means of a questionnaire survey. Finally, analysis of findings led to the derivation of key risk communication messages for the women. The original one-way mental model approach was adapted to become a two-way model, which includes critical findings from the lay participants for expert attention, potentially encouraging a holistic communication solution.
While the mental model approach is established in risk communication research, this is the first known application to the maternal health field. The mental models of experts and participants that emerged identify the diverse ways stakeholders perceive the issue, and components that influence risk attitudes and health care behaviour. On the basis of the findings, key messages have been suggested that may instil behavioural change.