THE CONTRIBUTIONS OF COMMUNITY FACTORS IN EXPLAINING VARIATIONS IN THE USE OF HEALTH FACILITIES FOR DELIVERY IN NIGERIA
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2025-10
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Lapai International Journal of Politics
Abstract
Nigeria faces significant maternal health issues with low utilizations of health facilities for
childbirth despite global initiatives to enhance maternal health.This research assesses the
impact of community-level factors in explaining the use of maternal health services
(antenatal care, skilled delivery, and postnatal care) in Nigeria.We used the 2008 Nigeria
Demographic and Health Survey (NDHS) data on 17,542 women aged 15-49 years who
had a live birth in the five years before the survey.A multilevel logistic regression was used to
examine the effects of individual, household, community and state factors on the use of
maternal health services.The results of the empty models show significant clustering at the
state level with intra-class correlations (ICC) of 0.372 for antenatal care, 0.401 for skilled
delivery and 0.341 for postnatal care, suggesting big state-level differences.The full model
findings reveal that mothers' education, household wealth and parities also affect
Utilization.At the community level, urbanization, media reach and social norms are
significant predictors of the likelihood of institutional delivery, with state-level health system
capacity significantly predicting utilizations.In summary, this study shows that in Nigeria,
community and structural factors are important determinants of maternal health
behaviors.Therefore, policies should empower individuals and invest in other factors such as
health system infrastructure and community-level interventions.
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Maternal health; Facility-based delivery; Antenatal care; postnatal care; Community factors; multilevel analysis