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Abstract：
BACKGROUND: The 2018 Nigeria Demographic and Health Survey shows poor maternal health in northern Nigeria. Contraceptive use remains low and maternal mortality high. Studies show that cultural norms related to men\'s decision-making role in the family significantly contribute to this phenomenon.
OBJECTIVE: The assessment was designed to identify barriers to service delivery and utilisation of maternal-health and family-planning services in three northern Nigerian states, focusing on aspects of service delivery affected by husband involvement.
METHODS: Qualitative design included 16 focus group discussions and 12 in-depth interviews with facility clients, and 16 in-depth interviews with healthcare providers, in each of the three states.
METHODS: Primary healthcare facilities in three northern Nigeria states: Bauchi, Kebbi and Sokoto.
METHODS: Women who came to the facility for family-planning services (n=233 in 24 focus groups); women who came for antenatal care (n=97 in 12 focus groups); men married to women who either received antenatal care or delivered in a facility (n=96 in 12 focus groups); mothers of newborns who delivered in a facility (n=36) and healthcare providers (n=48).
RESULTS: We found gender barriers to contraceptive use and to obtaining maternal healthcare, with some women requiring their husband\'s permission to use services, even in emergencies. Several supply-side barriers exacerbate the situation. Many healthcare providers would not provide women with a family-planning method without their husbands\' presence or approval; some male providers would not admit a woman to deliver in a facility if her husband objected to her being treated by a man and there was no female provider present and some facilities do not have the infrastructure to accommodate men.
CONCLUSIONS: Despite years of programming, barriers to women\'s family-planning and maternal-health service utilisation persist. State governments in northern Nigeria should invest in additional provider training, improving infrastructure and hiring more female healthcare providers.
OBJECTIVE: The assessment was designed to identify barriers to service delivery and utilisation of maternal-health and family-planning services in three northern Nigerian states, focusing on aspects of service delivery affected by husband involvement.
METHODS: Qualitative design included 16 focus group discussions and 12 in-depth interviews with facility clients, and 16 in-depth interviews with healthcare providers, in each of the three states.
METHODS: Primary healthcare facilities in three northern Nigeria states: Bauchi, Kebbi and Sokoto.
METHODS: Women who came to the facility for family-planning services (n=233 in 24 focus groups); women who came for antenatal care (n=97 in 12 focus groups); men married to women who either received antenatal care or delivered in a facility (n=96 in 12 focus groups); mothers of newborns who delivered in a facility (n=36) and healthcare providers (n=48).
RESULTS: We found gender barriers to contraceptive use and to obtaining maternal healthcare, with some women requiring their husband\'s permission to use services, even in emergencies. Several supply-side barriers exacerbate the situation. Many healthcare providers would not provide women with a family-planning method without their husbands\' presence or approval; some male providers would not admit a woman to deliver in a facility if her husband objected to her being treated by a man and there was no female provider present and some facilities do not have the infrastructure to accommodate men.
CONCLUSIONS: Despite years of programming, barriers to women\'s family-planning and maternal-health service utilisation persist. State governments in northern Nigeria should invest in additional provider training, improving infrastructure and hiring more female healthcare providers.
摘要：
背景：2018年尼日利亚人口与健康调查显示，尼日利亚北部的孕产妇健康状况较差。避孕药具使用率仍然很低，孕产妇死亡率很高。研究表明，与男性在家庭中的决策角色相关的文化规范对这一现象有重要贡献。
目的：评估旨在确定尼日利亚北部三个州提供服务和利用孕产妇保健和计划生育服务的障碍，重点关注受丈夫参与影响的服务提供方面。
方法：定性设计包括16次焦点小组讨论和12次与设施客户的深入访谈，和对医疗保健提供者的16次深入采访，在三个州的每一个。
方法：尼日利亚北部三个州的主要医疗机构：Bauchi，Kebbi和Sokoto.
方法：来到医院接受计划生育服务的妇女（24个焦点小组中的n=233）；来接受产前护理的妇女（12个焦点小组中的n=97）；男性与接受产前护理或在医院分娩的妇女结婚（12个焦点小组中的n=96）；在医院分娩的新生儿母亲（n=36）和医疗保健提供者（n=48）。
结果：我们发现了使用避孕药具和获得孕产妇医疗保健的性别障碍，一些妇女需要丈夫的许可才能使用服务，即使在紧急情况下。几个供应方面的障碍加剧了这种情况。许多医疗保健提供者不会在没有丈夫在场或批准的情况下为妇女提供计划生育方法；一些男性提供者不会允许妇女在一个机构分娩，如果她的丈夫反对她接受男性治疗，而且没有女性提供者在场，一些机构没有容纳男性的基础设施。
结论：尽管经过多年的编程，妇女计划生育和孕产妇保健服务利用的障碍仍然存在。尼日利亚北部的州政府应该投资于额外的提供者培训，改善基础设施并雇用更多女性医疗保健提供者。
目的：评估旨在确定尼日利亚北部三个州提供服务和利用孕产妇保健和计划生育服务的障碍，重点关注受丈夫参与影响的服务提供方面。
方法：定性设计包括16次焦点小组讨论和12次与设施客户的深入访谈，和对医疗保健提供者的16次深入采访，在三个州的每一个。
方法：尼日利亚北部三个州的主要医疗机构：Bauchi，Kebbi和Sokoto.
方法：来到医院接受计划生育服务的妇女（24个焦点小组中的n=233）；来接受产前护理的妇女（12个焦点小组中的n=97）；男性与接受产前护理或在医院分娩的妇女结婚（12个焦点小组中的n=96）；在医院分娩的新生儿母亲（n=36）和医疗保健提供者（n=48）。
结果：我们发现了使用避孕药具和获得孕产妇医疗保健的性别障碍，一些妇女需要丈夫的许可才能使用服务，即使在紧急情况下。几个供应方面的障碍加剧了这种情况。许多医疗保健提供者不会在没有丈夫在场或批准的情况下为妇女提供计划生育方法；一些男性提供者不会允许妇女在一个机构分娩，如果她的丈夫反对她接受男性治疗，而且没有女性提供者在场，一些机构没有容纳男性的基础设施。
结论：尽管经过多年的编程，妇女计划生育和孕产妇保健服务利用的障碍仍然存在。尼日利亚北部的州政府应该投资于额外的提供者培训，改善基础设施并雇用更多女性医疗保健提供者。
