Quality of Maternal Health Services and their Utilization in Five States of Nigeria

Using linked data from the 2009 COMPASS health facility and household surveys, this paper examines the association of the quality of maternal health services with their use in the past five years in five states of Nigeria. The results of multilevel logistic regression models revealed a strong positive association between the availability of essential delivery care equipment and supplies and the odds of initiating antenatal care in the first trimester of pregnancy. The odds of institutional delivery were significantly higher in Local Government Areas (LGAs) that scored higher on management practices that were supportive of quality maternal health services than in LGAs that scored lower, after controlling for other factors. More comprehensive provider training on maternal health had a significant negative association with skilled attendance at birth and institutional delivery. The findings suggest that efforts to increase the utilization of maternal health services should improve health facility management practices, ensure the availability of essential equipment and supplies, and conduct further research to better understand how provider training may influence service use.