Geographical and Socioeconomic Inequalities in the Utilization of Maternal Healthcare Services in Nigeria

Abstract

Maternal healthcare utilization remains suboptimal in Nigeria, with persistent socioeconomic and geographical disparities undermining progress toward reducing maternal morbidity and mortality. This study aims to assess the geographical and socioeconomic inequalities of maternal healthcare utilization in Nigeria. Maternal healthcare utilization in Nigeria remains suboptimal, with persistent socioeconomic and geographical disparities hindering progress in reducing maternal morbidity and mortality. This study assessed inequalities in the utilization of antenatal care (ANC4+), facility-based delivery (FBD), and postnatal care (PNC) using data from the 2018 Nigeria Demographic and Health Survey. Socioeconomic inequalities were examined using Erreygers Normalized Concentration Indices (ENCI) and concentration curves disaggregated by region and residence, while decomposition analysis identified key drivers. Findings revealed significant pro-rich inequalities across all services. Facility-based delivery showed the widest gaps (urban ENCI = 0.295; rural = 0.121), particularly in the Northwest (0.398) and Northeast (0.254). ANC4+ visits displayed moderate inequality, highest in the Northwest (0.169). PNC showed minimal inequality, with ENCI values near zero. Wealth status was the strongest contributor to inequality, supported by education, parity, and religion, while age, marital status, employment, autonomy, and insurance played minor roles. Although overall utilization was higher in urban areas, inequality was more pronounced there, highlighting deep intra-urban socioeconomic divides. Substantial socioeconomic and geographic inequities persist in maternal healthcare utilization in Nigeria. Targeted interventions addressing financial, educational, and sociocultural barriers, especially in northern and urban-poor populations, are crucial to narrowing gaps and improving maternal outcomes.