Determinants of Maternal Health Care Utilization in Nigeria: a multilevel approach.

Introduction: Fourteen percent of maternal deaths globally occur in Nigeria. Low utilization of maternal health services for delivery may partially explain the high maternal mortality. The aim of this study was to examine the contribution of community factors in explaining variations in the use of health facilities for delivery in Nigeria.

Methods: Our sample consisted of 17,542 women aged 15-49 years drawn from 2008 Nigeria Demographic and Health Survey, who had had their last birth in the five years before the survey. We employed multilevel analysis to identify community factors related to the use of delivery care.

Results: In addition to several individual factors, region of residence was significantly associated with facility delivery. Women who lived in Northern Nigeria were less likely to deliver in a health facility than those who resided in the Southern part of the country. Residence in communities with a high proportion of women who had secondary and higher education significantly increased the odds of facility delivery whereas ethnic diversity was negatively associated with health facility delivery.

Conclusion: Interventions aimed at promoting the use of health facility for childbirth should not only be implemented at the individual level but also tailored to the community level as interventions conceived without consideration for community context are likely to have limited impact. Increasing women's education in disadvantaged communities and region-specific interventions that increase access to health facilities are likely to have far-reaching impacts in reducing maternal mortality.