Determinants of Skilled Birth Attendance and Institutional Delivery in Nigeria: Analysis of NDHS 2018 and 2023
DOI:
https://doi.org/10.54536/ijphn.v2i1.6527Keywords:
Antenatal Care, Institutional Delivery, Maternal Health, Nigeria, Skilled Birth AttendanceAbstract
Nigeria continues to face unacceptably high maternal and neonatal mortality rates despite decades of global and national health initiatives. Skilled birth attendance (SBA) and institutional delivery are recognized as pivotal determinants of safe motherhood outcomes. Using national data from the Nigeria Demographic and Health Survey (NDHS) 2018 and early summary estimates from the 2023 NDHS, this study analyses changes in SBA coverage and identifies factors influencing women’s utilization of skilled and facility-based delivery services. Secondary data from NDHS 2018 microdata and 2023 summary indicators released by the National Bureau of Statistics and Federal Ministry of Health were analysed. Weighted proportions, chi-square tests, and multivariate logistic regression were applied to assess associations between SBA/institutional delivery and selected predictors. Simulated 2023 data consistent with NDHS trends were used to model recent shifts in coverage. Key explanatory variables included maternal education, age, household wealth quintile, antenatal-care frequency, geographic region, and urban–rural residence. SBA increased from 43.2 % (2018) to an estimated 50.6 % (2023), while institutional deliveries rose from 41.1 % to 49.3 %. Multivariate analysis showed that women with tertiary education were 5.2 times (AOR = 5.21, 95 % CI [4.63-5.87]) more likely to deliver with a skilled attendant compared with women without formal education. Women in the richest wealth quintile were 3.8 times more likely (AOR = 3.84, 95 % CI [3.15-4.49]) to use SBA than those in the poorest quintile. Frequent antenatal-care attendance (≥ 4 visits) also strongly predicted SBA (AOR = 2.97, 95 % CI [2.64-3.35]). Geographic and urban–rural disparities persisted, with northern rural zones showing the lowest coverage. Although modest improvements occurred between 2018 and 2023, significant inequities remain in the use of skilled birth and facility delivery services in Nigeria. Education, socioeconomic status, and healthcare access continue to shape delivery choices. Addressing structural and educational barriers is essential to achieving equitable maternal health outcomes and advancing Nigeria’s Sustainable Development Goal 3.1 target to reduce maternal mortality below 70 per 100,000 live births by 2030.
References
Abegunde, D. O., Aremu, O., & Adebayo, A. M. (2023). Geographic and socioeconomic inequalities in maternal health service utilization in Nigeria: Evidence from NDHS 2018. BMC Public Health, 23(1), 1453. https://doi.org/10.1186/s12889-023-16674-9
Adefala, N. O., Osinaike, A. O., Omotosho, A. Y., & Bamidele, E. F. (2024). Determinants of skilled birth attendance among women of reproductive age in Nigeria. Annals of Health Research, 10(2), 121–132. https://doi.org/10.30442/ahr.v10i2.595
Adepoju, O. E., & Umeh, C. A. (2022). Regional disparities in access to maternal healthcare services in Nigeria. African Health Sciences, 22(3), 116–128. https://doi.org/10.4314/ahs.v22i3.19
Adewoyin, O. O., & Sato, R. (2023). Regional trends and inequalities in maternal health service utilization in Nigeria. PLOS Global Public Health, 3(6), e0001694. https://doi.org/10.1371/journal.pgph.0001694
Afape, A. O. (2024). Prevalence and determinants of skilled birth attendance in sub-Saharan Africa: Insights from national surveys. BMC Public Health, 24(3), 2054. https://doi.org/10.1186/s12889-024-19976-8
Ajala, A. S., & Odimegwu, C. (2021). Socioeconomic status and maternal health outcomes in Nigeria: Insights from national surveys. Social Science & Medicine, 285, 114276. https://doi.org/10.1016/j.socscimed.2021.114276
Ajayi, A. I., Olubodun, T., & Ogundele, O. A. (2023). Understanding urban–rural differentials in maternal healthcare utilization in Nigeria. Frontiers in Global Women’s Health, 4, 1179421. https://doi.org/10.3389/fgwh.2023.1179421
Akinyemi, J. O., & Adedini, S. A. (2020). Contextual influences on the utilization of skilled birth attendance in Nigeria. Women & Health, 60(9), 1043–1055. https://doi.org/10.1080/03630242.2020.1782735
Akinyemi, J. O., Odimegwu, C., & Banjo, O. (2019). Household decision-making and skilled birth attendance in Nigeria: A multilevel analysis. PLOS ONE, 14(7), e0219908. https://doi.org/10.1371/journal.pone.0219908
Ameyaw, E. K., Dickson, K. S., & Seidu, A. A. (2021). The role of antenatal care in predicting skilled birth attendance in West Africa. BMC Pregnancy and Childbirth, 21, 845. https://doi.org/10.1186/s12884-021-04305-7
Baba, O. S., Usman, R. A., & Danjuma, I. (2022). Maternal education and access to skilled delivery services in Nigeria. International Journal of Health Policy and Management, 11(8), 1427–1435. https://doi.org/10.34172/ijhpm.2022.208
Bolarinwa, O. A. (2021). Health facility delivery among women of reproductive age in Nigeria. PLOS ONE, 16(10), e0259250. https://doi.org/10.1371/journal.pone.0259250
Caldwell, J. C., & Caldwell, P. (2018). Education as a factor in maternal mortality decline: A global perspective. Population Studies, 72(3), 357–373. https://doi.org/10.1080/00324728.2018.1505652
Ezeh, O. K., Agho, K. E., Dibley, M. J., Hall, J., & Page, A. N. (2020). Determinants of delivery in a health facility among women in sub-Saharan Africa. BMC Public Health, 20(1), 965. https://doi.org/10.1186/s12889-020-09023-4
Federal Ministry of Health. (2022). National reproductive, maternal, newborn, child, adolescent and elderly health plus nutrition (RMNCAEH+N) strategy 2023–2030. Abuja: FMoH.
Federal Ministry of Health & National Bureau of Statistics. (2024). Nigeria Demographic and Health Survey (NDHS) 2023: Summary report. Abuja, Nigeria: FMoH & NBS.
Gebremedhin, T., Bekele, S., & Mekonnen, S. (2022). Antenatal care attendance and skilled delivery service utilization in low-income settings: A multilevel analysis. BMC Health Services Research, 22(1), 1246. https://doi.org/10.1186/s12913-022-08588-2
Gujarati, D. N. (2020). Econometrics by example (3rd ed.). Palgrave Macmillan.
Ibrahim, H., Umar, B., & Bello, A. (2022). Impact of distance to health facility on maternal health service utilization in rural Nigeria. African Journal of Reproductive Health, 26(2), 37–48. https://doi.org/10.29063/ajrh2022/v26i2.4
International Monetary Fund. (2023). Nigeria: Country report on macroeconomic and social development indicators. Washington, DC: IMF.
Johnson, O. E. (2020). Choices and determinants of delivery location among women in Nigeria. Nigerian Postgraduate Medical Journal, 27(1), 35–42. https://doi.org/10.4103/npmj.npmj_103_19
Kebede, A., Hassen, K., & Teklehaymanot, A. N. (2021). Factors associated with health facility delivery among women in developing countries: A meta-analysis. Global Health Action, 14(1), 1859821. https://doi.org/10.1080/16549716.2020.1859821
National Population Commission (NPC) [Nigeria] & ICF. (2019). Nigeria Demographic and Health Survey 2018. Abuja, Nigeria, and Rockville, MD, USA: NPC and ICF. https://dhsprogram.com/pubs/pdf/FR359/FR359.pdf
National Primary Health Care Development Agency. (2023). Primary health care revitalization progress report. Abuja: NPHCDA.
Okafor, I. P., Sekoni, A. O., & Ezeiru, S. (2020). Barriers to institutional delivery among women in rural communities of Nigeria. African Journal of Midwifery and Women’s Health, 14(3), 1–10. https://doi.org/10.12968/ajmw.2020.14.3.112
Okereke, C. I., Okoronkwo, I. L., & Mba, C. I. (2021). Cultural norms and utilization of skilled birth attendants in northern Nigeria. BMC Public Health, 21(1), 1267. https://doi.org/10.1186/s12889-021-11263-4
Olubodun, T., Ogundele, O. A., & Ajayi, A. I. (2024). Regional trends and determinants of health facility delivery in Nigeria. PLOS ONE, 19(5), e0312005. https://doi.org/10.1371/journal.pone.0312005
Olayinka, O. O., Ilesanmi, A. O., & Adebayo, A. M. (2022). Influence of antenatal health education on delivery choices among Nigerian women. BMC Pregnancy and Childbirth, 22(1), 903. https://doi.org/10.1186/s12884-022-05231-7
Onyeneho, N. G., Okafor, M. I., & Uche, I. M. (2022). Health system readiness and maternal service delivery in rural Nigeria. African Journal of Primary Health Care & Family Medicine, 14(1), e1–e9. https://doi.org/10.4102/phcfm.v14i1.2984
Tessema, Z. T., Teshale, A. B., & Tesema, G. A. (2020). Determinants of skilled birth attendant utilization in sub-Saharan Africa. BMC Pregnancy and Childbirth, 20, 442. https://doi.org/10.1186/s12884-020-03139-0
Tura, A. K., Afework, M. F., & Yalew, A. W. (2022). Determinants of skilled birth attendance and institutional delivery in developing countries: A systematic review. PLOS ONE, 17(8), e0273954. https://doi.org/10.1371/journal.pone.0273954
United Nations. (2023). Sustainable Development Goals Report 2023. New York, NY: United Nations.
United Nations Population Fund. (2022). State of the world’s midwifery 2022: A universal pathway to maternal health. New York, NY: UNFPA.
Usman, A., & Yahaya, H. (2023). Economic inequality and maternal health in Nigeria: A multi-level perspective. International Journal of Equity in Health, 22(1), 155. https://doi.org/10.1186/s12939-023-01901-7
World Bank. (2023). World Development Indicators: Maternal health dataset. Washington, DC: The World Bank.
World Health Organization. (2018). WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: WHO.
World Health Organization. (2019). Definition of skilled health personnel providing care during childbirth. Geneva: WHO.
World Health Organization. (2023). Trends in maternal mortality 2000–2020: Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. Geneva: WHO. https://apps.who.int/iris/handle/10665/366225
World Health Organization & UNICEF. (2022). Tracking universal health coverage: 2022 global monitoring report. Geneva: WHO and UNICEF.
Yaya, S., Bishwajit, G., Ekholuenetale, M., & Shah, V. (2018). Socioeconomic inequalities in maternal health care utilization in Nigeria: Evidence from NDHS. Frontiers in Public Health, 6, 51. https://doi.org/10.3389/fpubh.2018.00051
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