Impact of Naira Scarcity and Cashless Policy on Health-Seeking Behaviour and Antenatal Care Utilisation Among Pregnant Women in Northcental Nigeria

Abstract

Introduction: Cashless policy is a macroeconomic measure aimed at repositioning the nation for economic growth, through reduction of currency notes in circulation, lowering of the inflation, money laundering and other financial related crimes. Unfortunately the implementation of this policy brought about untoward hardship to the citizens. Among the worst hit by the naira scarcity are the pregnant women, whom by the virtue of their physiological state could not endure the long queues at ATM or the banking hall to access cash. Thus, the artificial naira scarcity created could negatively affect the uptake of antenatal care services among pregnant women and contribute to unwarranted increase in maternal mortality and morbidity.

Objectives: This study sought to determine the effects of naira Scarcity on the difficulties encountered in seeking health among pregnant women attending ANC clinic, determine the effects of socioeconomic indices on the difficulties in seeking health amidst the naira scarcity and to estimate the proportion of pregnant women who had difficulties in accessing health care services consequent to naira scarcity at the Federal Medical Centre, Keffi, Nasarawa State, North- Central Nigeria.  

Materials and Methods: This was a cross sectional study conducted among pregnant women attending antenatal care in Federal Medical Centre Keffi, Nasarawa state Nigeria. The study was carried out during the period of naira scarcity between 10th January 2023 and 9th march 2023. During the period, a total of 340 pregnant women were recruited using a convenient sampling method. Consecutive, consenting patients were given questionnaire and information including their sociodemographic, obstetrics, average cumulative family income, modes of transaction before the naira scarcity and during the scarcity, effect of naira scarcity on their willingness to attend ANC, difficulty in transportation and difficulty in accessing care among many others. Data were gotten and analyzed using SPSS 25. Categorical variables were presented as frequencies and percentages. 

Results: A total of 340 pregnant women were recruited for this study. Women aged between 30-39 years (60.3%) ranked highest in the study with 246(72.4%) having tertiary level of education A larger number of the women in the study were unemployed 135(39.7%) while majority of the husbands of the women in the study were civil servants accounting for 195(57.4%).Most of the families in the study earned an average monthly income of >100,000 naira per month. The Point of sale (POS) was the most preferred mode of transaction accounting for 34.7% and 44.4% before and during the naira scarcity. The association between level of education and the mode of transaction during the period of the naira scarcity was significant with mobile bank app with a P = 0.0000. About 189(55.5%) women missed between 1-6 antenatal visits due to the naira scarcity but the association between the average monthly family income of respondents and the number of ante natal care missed was not statistically significant with an overall P= 0.479 .

About 266(78.2%) and 310 (91.2%) of the respondents believed that prolonged effect of the naira scarcity could lead to increased maternal mortality and morbidity

Conclusion: The cashless policy of Central Bank of Nigeria was geared towards economic recovery. The artificial naira scarcity created by the policy brought unimaginable hardship on the health seeking behavior of pregnant women such as difficulty in accessing care, missed antenatal appointments, denial of antenatal care services due to lack of cash and failure of electronic payment platforms. All the aforementioned difficulties could ultimately have a negative effect on pregnancy outcome and maternal health.