Contextual determinants of maternal health care services in Nigeria

Antenatal and postnatal care services are among the major recommended interventions to reduce maternal and newborn deaths. Inspite of the benefits of these interventions, most women in Nigeria do not attend antenatal and postnatal care services. About 58 percent of women receive antenatal care while 36 percent receive postnatal care. Considering the ICPD programme of action call to promote increased use of maternal health services, it is necessary to understand the factors influencing the decisions to seek antenatal and postnatal care. Existing studies focus on individual and household predictors and have largely ignored community contextual determinants. This study examines community contextual influences on decisions to seek antenatal and postnatal care in Nigeria. The study utilizes data from the 2008 Nigerian Demographic and Health Survey. Analysis is based on 18028 women aged 15-49 years. The dependent variables are antenatal and postnatal care, while the independent variables include education, religion, household socio-economic status, sex of household head, ethnic diversity, community hospital delivery, community poverty, community media exposure, community women's education, type of place of residence and region of residence. Bivariate and multilevel logistic regression models were employed for data analysis. Results indicate that seeking antenatal and postnatal care from a skilled provider is associated with region of residence (p<0.001), ethnic diversity (AOR=1.3) community media exposure (AOR=1.9) and community hospital delivery (AOR=2.8). Findings suggest the need for health care interventions that operate on relatively large geographical and population based scales; and community programmes aimed at promoting antenatal and postnatal care-seeking behaviour.