Abstract:
Disparity in antenatal care visits is a major concern in Nigeria, where maternal mortality rates continue to be among the highest globally, despite decades of policy interventions.
Studies have shown that the utilisation of antenatal care is strongly influenced by the socio-economic and demographic characteristics of the mother. However, in a socio-culturally diverse country like Nigeria, where patriarchal norms often shape health-seeking behaviour, there is a scarcity of studies specifically investigating how husbands’ educational attainment affects the frequency and adequacy of the mother’s antenatal care visits. Understanding this relationship is essential for designing gender-sensitive interventions and policies that promote equitable access to quality maternal healthcare.
This paper presents an empirical assessment of antenatal care utilisation in Nigeria, examining the demand-side determinants that influence utilisation of a component of antenatal care across visits thresholds (1+) visits, ANC (4+) visits and ANC (8+) visits. The disaggregation of antenatal care provides valuable insights to understanding barriers to initial access, evaluating the continuity and effectiveness of recommended minimum visits and shows how well the country is adopting and sustaining the comprehensive antenatal care visits.
Drawing on data from the 2018 Nigeria Demographic and Health Survey (NDHS), the study focuses on women aged 15-49, employing the Quantile Regression technique to identify socio-economic and demographic drivers of antenatal care at each visit threshold.
Findings reveal that while antenatal care utilisation has improved modestly over time, significant inequalities persist across sub-groups. Husband’s education influenced antenatal care with the effects increasing as the quantile thresholds increased. Other demand-side determinants varied across the threshold of visits; education, household wealth, media coverage, health autonomy and health insurance influenced ANC (8+) visits. While education (mother and father), rich households and residence in the South-West and South-East regions influenced ANC (1+) visits. Key demand-side determinants of ANC (4+) visits included education, household wealth, mother’s employment status, health insurance, healthcare autonomy, media exposure, and regional location. In contrast, high birth order, poverty, rural residence and residence in the North-West region were consistently associated with underutilisation.
The findings reveal the need for context-specific, equity-driven, and demand-responsive interventions that prioritise vulnerable regions. Strengthening women’s empowerment, gender dynamics, addressing economic and cultural barriers, and promoting education and media awareness, particularly in the North-West and rural areas are crucial for equitable demand for antenatal care. Policies should enhance regional monitoring to guide data-informed action. A multi-layered approach integrating health insurance coverage, employment support, and socio-economic empowerment will be essential to achieving Sustainable Development Goal 3.1, which aims to reduce the maternal mortality ratio to fewer than 70 deaths per 100,000 live births by 2030.
Biography:
Sa’adatu Bamalli is an Economics research student at Coventry University, currently finalising her thesis titled “Demand for Maternal Healthcare in Nigeria.” Her academic background spans a BSc in Accounting and Finance, an MSc in International Human Resource Management, and an MBA in General Management with a focus on Entrepreneurship and Innovation. Drawing on field experience from immunisation programs in Northern Nigeria, her research explores the socio-cultural determinants of maternal healthcare utilisation. She emphasises the role of husbands as key decision-makers, particularly in Northern Nigeria, where maternal health outcomes are poorest. Her work advocates for gender-inclusive strategies to improve healthcare access.
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