Determinants of health facility delivery among young mothers aged 15 – 24 years in Nigeria: a multilevel analysis of the 2018 Nigeria demographic and health survey

Abstract

Background Young mothers aged 15 to 24 years are particularly at higher risk of adverse health outcomes during childbirth. Delivery in health facilities by skilled birth attendants can help reduce this risk and lower maternal and perinatal morbidity and mortality. This study assessed the determinants of health facility delivery among young Nigerian women. Methods A nationally representative population data extracted from the 2018 Nigeria Demographic and Health Survey of 5,399 young women aged 15–24 years who had had their last birth in the five years before the survey was analysed. Data was described using frequencies and proportions. Bivariate and multivariate analyses were carried out using Chi-Square test and multilevel mixed effect binary logistic regression. All the analysis were carried out using STATA software, version 16.0 SE (Stata Corporation, TX, USA).. Results Of the total sampled women in the 2018 NDHS, 5,399 (12.91%) formed our study population of young women 15 -24 years who had their last birth in the preceding five years of the survey. Only 33.72% of the young mothers utilized health facility for delivery. Women educated beyond the secondary school level had 4.4 times higher odds of delivering at a health facility compared with women with no education (AOR 4.42 95%, CI 1.83 – 10.68). Having fewer children and attending more antenatal visits increased the odds of health facility delivery. With increasing household wealth index, women were more likely to deliver in a health facility. The odds of health facility delivery were higher among women whose partners had higher than secondary level of education. Women who lived in communities with higher levels of female education, skilled prenatal support, and higher levels of transportation support were more likely to deliver their babies in a health facility. Conclusion Strategies to promote institutional delivery among young mothers should include promoting girl child education, reducing financial barriers in access to healthcare, promoting antenatal care, and improving skilled birth attendants and transportation support in disadvantaged communities.

What predicts health facility delivery among women? analysis from the 2021 Madagascar Demographic and Health Survey

“…It was found that women who had at least an ANC visit were more likely to utilize health facilities during delivery. The finding is in line with previous studies conducted in Asia [ 44 , 52 ], Eastern Africa [ 34 , 58 ], and SSA [ 24 , 27 , 59 ]. The reason could be that during ANC visits, women are most likely to be informed about the benefits associated with health facility delivery [ 43 , 60 ].…”

Women's empowerment and health facility utilisation during childbirth in Cameroon

“…Therefore, these alternative models reject the unitary model which assumes that household's preferences are identical, leading to the conclusion that some sort of bargaining process exists within the household. Based on such a conclusion, several authors established the effect of women's decision-making power at home on the utilisation of several maternal health care services including skilled birth attendance (Yaya et al, 2021;Dickson et al, 2021), antenatal and postnatal care (Annan et al, 2021;Sado et al, 2014) and delivery in a health facility (Ahmmed, 2022;Ilesanmi et al, 2023;Fikre and Demissie, 2012;Mokam and Zamo, 2022;Olubodun et al, 2023;Speizer et al, 2014;Sserwanja et al, 2023;Tiruneh et al, 2017).…”

“…To our knowledge, only Mokam and Zamo Akono (2022) have conducted such study in that context. Besides, there is not a consensus in the literature as there are some studies concluding either to a negative effect (Fikre and Demissie, 2012) or an insignificant effect (Olubodun et al, 2023;Sserwanja et al, 2023) of women's empowerment on health facility delivery. All in all, there is certainly a scope for more research on the effect of women's empowerment on health facility utilisation during childbirth.…”

“…An overwhelming majority of women in developing countries lack access to maternal health services and about half of them choose to give birth outside health institutional settings in unsafe and unhygienic conditions (Prata et al 2014). Health facility delivery provides skilled health attendants to better manage the outcome of pregnancy and child birth and has a positive contribution in reducing maternal and new-born mortality and morbidity (Olubodun et al, 2023). Therefore, a key strategy to ensure skilled care during childbirth is to that all births take place in health facilities in which obstetric complications can be treated when they arise (WHO, 2024).…”

“…mortality (Olubodun et al, 2023). In their literature review on the determinants of delivery service use, Gabrysch and Campbell (2009) highlight the numerous barriers to healthcare access for women: geographic (distance, lack of transportation), economic (poor capacity to pay for health services), and social (gender inequality, limited decision-making power).…”