Perceived Quality of Perinatal Care in Public and Private Secondary Health Facilities in Ibadan, Nigeria: A Comparative Cross-Sectional Study

In many parts of the world, the journey of childbirth has shifted from the home to the hospital. For decades, public health efforts focused on getting women into facilities, operating on the simple belief that a skilled attendant and a roof over one's head would automatically mean safety. Yet, statistics in countries like Nigeria tell a different story: even as more women give birth in hospitals, the number of mothers and babies dying remains unacceptably high. This gap suggests that simply being in a building is not enough; the quality of what happens inside matters just as much. Researchers have long known that care has two sides. One side is the hard stuff: the number of doctors, the availability of medicine, and the condition of the equipment. The other side is the human experience: whether a woman feels heard, respected, and supported, or if she feels ignored and frightened. While the first side is easy to count, the second is harder to measure, yet it is often the missing piece that determines whether a mother trusts the system enough to return for future care.

A team of researchers in Ibadan, Nigeria, set out to examine this missing piece by looking directly at how women felt about their care. They compared two types of hospitals: public facilities, which are government-run and often handle the most complex emergencies, and private clinics, which are often assumed to offer a more personal and comfortable experience. The study involved 500 women who had just given birth, 500 healthcare workers, and the managers of 28 different facilities. The researchers did not just ask if the women were happy; they used a detailed framework to break down the experience into three parts. First, they looked at the structure: were the staff there when needed, and did they seem motivated? Second, they examined the process: how did the staff talk to the women, did they explain what was happening, and did they offer emotional support during the intense moments of labor? Finally, they measured the outcome: how did the women rate their overall experience, and were they satisfied with the care they received?

The results painted a picture that challenged many common assumptions. When the researchers asked the women about the basics, the two sectors looked surprisingly similar. In both public and private hospitals, about half of the women felt that staff were readily available when they arrived, and roughly three-quarters of the healthcare workers reported feeling motivated to do their jobs. However, when it came to the human connection, the picture was starkly different. Across the board, the interaction between the woman and her caregiver was poor. Only a tiny fraction of women, fewer than one in twenty, reported that they received good communication and emotional support during labor. This lack of respectful interaction was not a problem unique to one type of hospital; it was a widespread issue that affected everyone, regardless of whether they were in a public or private facility.

Perhaps the most surprising finding was that the women in public hospitals reported a significantly better overall experience than those in private hospitals. About 64 percent of women in public facilities said they had a good experience, compared to only 50 percent in private ones. This was true even though the women in private clinics often praised the physical environment and the doctors, while the women in public clinics praised the nurses and the willingness of the staff to involve them in decisions. Yet, when asked if they were satisfied with their care, the numbers were almost identical: nearly 90 percent of women in both sectors said they were satisfied. This suggests that satisfaction is a tricky measure; a woman can be satisfied simply because she received care, even if that care lacked dignity or clear communication. The study indicates that satisfaction alone is not a reliable sign that the quality of care is actually good.

The researchers found that the factors most strongly linked to a good experience were not the type of building or the wealth of the patient, but rather the presence of staff and how competent the women felt those staff members were. When women felt that a provider was available and skilled, they were much more likely to have a positive experience. Interestingly, the study also found that the private sector did not hold the advantage many people expect. While private facilities were better at providing a comfortable physical space, they struggled to match the public sector in terms of staffing depth and the ability to manage complex emergencies. The public hospitals, despite their challenges, seemed to provide a more supportive environment for the actual process of giving birth.

This study does not prove that one system is perfect and the other is broken, but it does highlight a critical flaw in how we measure success. The fact that satisfaction is high while the actual experience of care is often poor means that health systems are missing a vital signal. If managers only look at satisfaction scores, they might think everything is fine, while women are actually suffering through disrespectful or confusing interactions. The findings suggest that improving maternity care requires more than just building new wards or hiring more doctors. It demands a deliberate focus on how staff talk to patients, how they offer emotional support, and how they ensure every woman feels safe and respected. In a system where public and private facilities operate side by side, the lesson is clear: the quality of care is defined not by the ownership of the building, but by the quality of the human connection inside it.