Determinants of the continuum of maternal healthcare service utilization in Nigeria: Evidence from the 2024 Nigeria Demographic and Health Survey

Abstract

Background Maternal mortality remains a major public health challenge, particularly in low- and middle-income countries, with Sub-Saharan Africa bearing a disproportionate burden. Nigeria accounts for over one-quarter of all maternal deaths worldwide. This reflects gaps in access to and continuity of maternal healthcare. The continuum of maternal healthcare, which includes antenatal care (ANC), skilled delivery, and postnatal care (PNC) is critical for improving maternal and neonatal outcomes. This study examines the determinants of continuum of maternal healthcare service utilization in Nigeria. Methods This study utilized data from 13,596 women (weighted n = 14,183) from the 2024 Nigeria Demographic and Health Survey. Maternal Health Services Utilization (MHSU) was operationalized as a composite outcome (none, partial, adequate) based on ANC attendance, place of delivery, maternal and child PNC. Multilevel multinomial logistic regression models were fitted to assess individual, household, and contextual predictors. Variables significant at p < 0.20 in bivariate analysis were included in multivariable models. Statistical significance was set at p < 0.05. Results Overall, 44.0% of women did not utilize any services, 44.4% partially utilized services, and only 11.6% achieved adequate utilization. Women with secondary or higher education were significantly more likely to achieve adequate utilization (Relative Risk Ratio (RRR) = 12.10, 95% CI: 8.72, 16.81). Wealth status, media exposure, employment, and health insurance were positively associated with utilization, while higher parity and decision-making barriers reduced utilization. Rural residence was associated with lower utilization (RRR = 0.38, 95% CI: 0.29, 0.49). Distance to health facilities was not significant in the adjusted model. Conclusion Maternal healthcare service utilization in Nigeria remains suboptimal, with significant inequities driven by socioeconomic status, education, and women’s autonomy. Strengthening the continuum of care requires multisectoral interventions addressing structural and social determinants of health.