Maternal Health Care Utilization in Nigeria: Analysis of community contextual determinants

Despite the high maternal mortality ratio in Nigeria, utilization of maternal health care services has remained poor. Attempts to explain this situation have focused on individual and household determinants. The role of community characteristics has been largely ignored. Given that individuals live within households and households are embedded within communities, and the fact that individual decisions can be influenced by community characteristics, it becomes imperative to look beyond familial factors influencing the decisions to seek maternal health care. We examined community-level determinants of antenatal and delivery care in Nigeria. The sample population consists of women aged 15-49 years drawn from 2008 Nigeria Demographic and Health Survey. Multilevel models were fitted to identify community factors associated with the use of antenatal and delivery care. Findings indicated that residence in communities with high proportion of women who delivered in a health facility was significantly associated with higher odds of having four or more antenatal care visits (OR=4.2, p<0.001) and health facility delivery (OR=17.2, p<0.001). Findings suggest the need to tailor interventions to the community context and increase women’s education and health facility delivery in disadvantaged communities.