Determinants of Institutional Delivery in Nigeria: Insights from the 2011 Multiple Indicator Cluster Survey

Background: Childbirth in a health facility is key to reducing maternal mortality. However many mothers still deliver at home, thus lack access to emergency obstetric care in the event of a life threatening complication. This study assessed the association of maternal age with institutional delivery in Nigeria.

Methods: Using data from the 2011 UNICEF Multiple Indicator Cluster Survey, we analyzed data for 9,595 women aged 15-49 years, with live birth in the two years preceding the survey. The outcome variable was place of delivery (home, or health facility), and the independent variable was maternal age. Covariates included literacy, residence, household wealth quintile, geographic zone, religion, marital status, and parity. Bivariate and multivariate logistic regression analyses were used to fulfill the study objectives.

Results: About 48% of all deliveries occurred in a health facility. Women aged 15-19 years accounted for only 3% of all institutional deliveries, compared with 75% for 20-34 year old, and 21% for 35-49 year old women. After adjusting for covariates, maternal age lost its significance as a predictor of institutional delivery; however literacy, geographic zone, and household wealth remained significant. Literate women had over twice the odds of institutional delivery as those who could not read (2.49, 95% CI: 2.06-3.00).

Conclusion: Our findings suggest that age-related differences in the utilization of institutional delivery may actually be attributable to other socioeconomic factors including household wealth, literacy and geographic region. To close the education, wealth and geographic gaps in realized access to delivery services, programs and policies should address the broader socioeconomic context.