1.1 Background of the Study

Nigeria continues to experience an unacceptably high burden of maternal mortality and morbidity. According to the World Health Organization (2023), the country’s maternal mortality ratio stood at approximately 512 deaths per 100?000 live births in 2021, making it one of the highest globally. Despite concerted efforts, utilization of essential maternal health services remains suboptimal: only about 74?% of Nigerian women attend at least one antenatal care (ANC) visit, 41?% give birth in a health facility, and a mere 21?% receive postnatal care (Smith & Adekunle, 2023). These national averages mask stark regional disparities—women in the Northwest zone have the lowest facility?delivery rate (15.8?%), compared to 76.6?% in the Southeast (Uthman et al., 2023).

In Northern Nigeria, socio?cultural norms, limited female autonomy, and economic constraints further depress service uptake. For example, only 19.6?% of Nigerian women achieved the recommended eight ANC contacts during their most recent pregnancy, and just 40.5?% delivered in a health institution (Odusina & Oladele, 2023). At the Federal Medical Centre (FMC), Birnin?Kebbi, routine obstetric records mirror these trends: fewer than half of expected births occur at the facility, and many women present late in labour or with complications that could have been averted through earlier contact and skilled attendance.

1.2 Statement of the Problem

Despite national policies and guidelines aimed at increasing service coverage, maternal health?service utilization remains critically low in FMC Birnin?Kebbi’s catchment area. Inadequate ANC attendance, home deliveries without skilled attendants, and low postnatal care uptake contribute to persistent high rates of obstetric complications and deaths. Without a clear understanding of the individual, household, and facility level factors driving these behaviours—ranging from decision making autonomy to perceived quality of care—interventions risk failing to address the root determinants of under-utilization.

1.3 Aim and Objectives of the Study

The aim of this study is to identify and analyse the determinants of maternal health-service utilization among women attending antenatal and delivery services at FMC Birnin?Kebbi, Kebbi State.

1. 1.3.1 Specific Objectives
2. To quantify the proportion of pregnant women attending at least four ANC visits at FMC Birnin-Kebbi.
3. To determine the rate of skilled birth attendance among the facility’s obstetric clients.
4. To assess women’s decision making autonomy and its association with service uptake.
5. To explore perceived barriers—financial, cultural, and logistical—to facility based care.

1.4 Research Questions

1. What proportion of women attending FMC Birnin-Kebbi complete the World Health Organization’s recommended minimum of four ANC visits?
2. What is the prevalence of skilled birth attendance among women who deliver at FMC Birnin-Kebbi?
3. How does women’s autonomy in household health decisions relate to their utilization of ANC and facility delivery services?
4. Which socio?economic, cultural, and health?system factors most strongly inhibit or facilitate maternal health-service utilization in this setting?

1.5 Scope of the Study

This study will be conducted at FMC Birnin?Kebbi’s Obstetrics and Gynaecology Department, targeting women who register for ANC or deliver at the facility between August 2024 and July 2025. A mixed?methods design will be employed: quantitative data will be collected through structured exit interviews and review of facility registers to measure ANC attendance and delivery patterns, while qualitative insights will be gathered via in?depth interviews and focus group discussions with clients and key informants (midwives, doctors, and community health workers) to probe decision?making autonomy and contextual barriers.

References

Odusina, E. K., & Oladele, O. S. (2023). Is there a link between the autonomy of women and maternal healthcare utilization in Nigeria? A cross-sectional survey. BMC Women’s Health, 23, 167. https://doi.org/10.1186/s12905-023-02317-z

Smith, J. M., & Adekunle, T. (2023). Determinants of partial and adequate maternal health services utilization in Nigeria: Analysis of cross sectional survey. BMC Pregnancy and Childbirth, 23, Article 410. https://doi.org/10.1186/s12884-023-05712-4

Ugochukwu, C. G., Elusoji, C. I., Eze, C. N., et al. (2023). Determinants of maternal healthcare services utilization in selected communities in Edo Central Senatorial District, Nigeria. International Journal of Research in Medical Sciences, 11(10), 3609–3617. https://doi.org/10.18203/2320-6012.ijrms20233009

Uthman, O. A., Oladipo, O. T., & Eze, P. N. (2023). Determinants of health facility delivery among young mothers aged 15–24 years in Nigeria: A multilevel analysis. BMC Pregnancy and Childbirth, 23, Article 912. https://doi.org/10.1186/s12884-023-05492-x

World Health Organization. (2023). Trends in maternal mortality 2000 to 2020: Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva, Switzerland: WHO.

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