Nigeria’s Bauchi State has one of the highest maternal mortality rates in the world. Home visit programs are making a difference in reducing this rate by bringing vital healthcare knowledge straight to the doorsteps of pregnant women. By meeting women and their families where they are, this initiative helps address maternal health inequities and support vulnerable families.
Anne Cockcroft, professor at McGill’s Department of Family Medicine in the Faculty of Medicine and Health Sciences, recently published a paper in Community Health Equity Research & Policy examining the equity of universal home visits to pregnant women in the Bauchi State.
“All women need care during pregnancy and childbirth,” Cockcroft wrote in an email to The Tribune. “A problem with many interventions that involve outreach to communities or home visits is that they do not reach the most vulnerable households.”
Maternal health services in low- and middle-income countries (LMICs) are often under-resourced and unable to provide sufficient care for pregnant women. This study specifically examined how home visits—which aim to share actionable health information and promote equity—impact disadvantaged groups including women in rural areas, low-income households, and those with limited education.
During these home visits, trained visitors shared crucial information on preventing pregnancy complications, equipping households to take proactive measures, particularly with men’s involvement. This included reducing heavy workloads, avoiding violence, and recognizing danger signs during pregnancy and childbirth.
One key element of the program’s success was its focus on involving men. Men home visitors spoke with husbands, encouraging them to discuss pregnancy-related topics with their spouses and support them with household tasks. One of Cockcroft’s previous studies has shown that this not only improves maternal and child health outcomes but also improves the husband’s behaviour and attitude towards maternal and child care.
Another major strength of the program is its universal approach.
“We did not make initial assumptions about which women and which households most needed help,” Cockcroft wrote. “Only by making the visits universal can one ensure all women get support.”
This approach differs from government-provided health services in that it is available to all households. The most disadvantaged households often face the greatest barriers to accessing facility-based healthcare services.
“The same factors that increase maternal morbidity and mortality reduce the ability of women to attend facilities for antenatal care or childbirth,” Cockroft wrote.
The study found significant improvements in maternal knowledge of potential pregnancy risks in disadvantaged pregnant women. Pregnant women in rural and remote areas, those from impoverished households, and those without formal education experienced the greatest benefits. These included increased knowledge of danger signs during pregnancy, reduced instances of domestic violence, and improved spousal communication.
Similar to earlier reports of the trial, the home visits also produced notable improvements in maternal and child health. These benefits, however, tend to favour less disadvantaged groups, potentially widening the gap with more marginalized populations. What is unique about this study, however, is that it confirmed the pro-equity nature of home visits.
“The home visits did reach everyone equally, and the program was pro-equity,” Cockcroft wrote. “The impact of the visits was greater in poorer, less educated women in rural communities.”
Comprehensive household-level programs are critical in addressing barriers to accessing healthcare services and offer a practical approach to advancing universal health coverage. Additionally, home visit intervention promotes gender equity and can even be gender transformative.
Moving forward, the Bauchi Ministry of Health is planning to integrate home visits—like those in Cockcroft’s study—into its routine services.
This initiative stands as a testament to the transformative power of equity-driven healthcare. Its success reminds us that equitable health solutions are not only possible, but essential.
