Maternal health
What stops Nigerian women from using maternity care?
Open access · cc by · source: Europe PMC
Whether Nigerian women used maternity care depended not only on their own education and wealth but also on their community and the state they lived in.
Study at a glance
- Design
- Cross-sectional — Secondary analysis of the 2005 Nigerian National HIV/AIDS and Reproductive Health Survey with multilevel logistic models (individual, household, community and state fixed effects plus state random effects).
- N
- N=2148 · 2,148 women aged 15-49 who had a baby in the five years before the survey, drawn from 4,685 surveyed women in all 36 states; each outcome refers to the most recent birth.
- Population
- Women of reproductive age across Nigeria with a recent birth.
- Outcome
- Use of antenatal care, delivery assisted by a doctor, nurse or midwife, and postnatal care.
Structured fields used in claim comparison tables when every cited study has a complete layer.
Key findings
Use was low: 60.3% had antenatal care, 43.4% had skilled help at delivery and 41.2% received postnatal care. Before adding predictors, 36.8% of the variation in antenatal care use lay between states. Education, household wealth and urban residence predicted all three services; women with post-secondary education had about five times the odds of antenatal care, and the richest women almost six times the odds of the poorest. Community media reach and small-family norms mattered for delivery care, more residents per primary care facility meant less antenatal and delivery care, and significant unexplained state differences remained after all adjustments.
Methodology
The authors analysed a 2005 national household survey covering all 36 Nigerian states, focusing on 2,148 women who had given birth in the previous five years. For the most recent birth they looked at three outcomes: any antenatal care, delivery assisted by trained medical staff, and postnatal care. Multilevel models tested individual and household factors (education, age, ethnicity, family-planning attitudes, wealth), community factors (urban residence, local media reach, how common small-family norms were) and a state measure of residents per primary health care facility, while allowing for unmeasured differences between states.
Limitations
The data are cross-sectional, so the authors cannot rule out confounding, reverse causation or selection; they note they did not use methods to correct for endogeneity. Service use was self-reported without checking clinic cards, and key access factors such as distance to the nearest facility were not available, so the state ratio of residents to clinics is only a rough proxy. The survey dates from 2005, and the paper identifies associations to target rather than testing any intervention.
How this study connects
Role on claims
Each row is a claim on a concept or method page where this paper supports, challenges, or qualifies the statement. Roles are hand-checked — not a model guess.
In these settings most women gave birth without skilled help.
Coverage of maternal services was low in national survey data: in Ethiopia only 33.9% of women had skilled antenatal care, 11.7% gave birth in a facility and 9.3% had a postnatal check, while in Nigeria 60.3% had antenatal care and 43.4% had a skilled attendant at delivery.
Evidence for the claim as stated.
Social position strongly predicts who reaches care.
In both cross-sectional surveys, women's education, household wealth and urban residence were associated with more use of care; in Nigeria women with post-secondary education had about five times the odds of antenatal care, and in Ethiopia urban women had about 4.9 times the odds of a skilled birth attendant.
Evidence for the claim as stated.
Where a woman lives shapes access, not only who she is.
Beyond individual factors, place mattered: in Nigeria over a third of the variation in antenatal care use lay between states, and fewer primary care facilities per resident meant less care, with state differences remaining after adjustment.
Evidence for the claim as stated.
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