Date of Conferral





Public Health


Jennifer A. Oliphant


AbstractNigeria is among the 10 countries in the world with the worst maternal mortality. Though most of these deaths can be prevented using antenatal care (ANC) and having institutional deliveries, in Nigeria, ANC attendance and institutional delivery are suboptimal. Research is lacking on the reasons for the disparity between the use of antenatal services compared to deliveries at health centers. The aim of this study was to determine the associations between sociodemographic, obstetric, and health service factors and the place of delivery used by pregnant women in predominantly urban, cosmopolitan Lagos, Nigeria. Because both service delivery and demand factor categories contribute to utilization, the focusing on the barriers theoretical model—with the constructs of availability, accessibility, affordability, and acceptability of health care provision as contributors to utilization—was used along with the health belief model. For this cross-sectional study, secondary data from the 2018 Nigeria Demographic Health Survey were analyzed using logistic regression. The results showed that there are two important predictors for a pregnant woman to have an institutional delivery. First is having four or more ANC visits, OR = 9.2 [95% CI: 3.7, 22], and second is where ANC was obtained with OR = 6.4 [95% CI: 2.3,18] if it was at a public health center, OR = 11.7 [95% CI: 4.1,33] if it was at a private facility, and OR = 15.3 [95% CI: 1.6, 146] if ANC was at any other place. The evidence from this study may inform policies that cover obstetric care across public, private, and informal providers, which can ensure standardized care packages. It may also potentially empower women to modify their behaviors toward having institutional deliveries, thereby reducing maternal mortality.