Locus of Control and Utilization of Skilled Birth Care in Nigeria: The Mediating Influence of Neuroticism

Despite ongoing efforts to reduce maternal mortality in Nigeria, the uptake of skilled birth attendance remains persistently low, especially in rural areas. While structural and socio–demographic barriers have been widely studied, less attention has been paid to psychological determinants of maternal healthcare-seeking behavior in low-resource settings. This study explores how the locus of control influences the use of skilled birth care among postpartum women in rural Edo State, Nigeria, and whether neuroticism serves as a mediating factor in this relationship. We draw on data from a cross-sectional survey involving 1411 women aged 15–45 who had given birth within the two years preceding the study. Participants were recruited from 20 randomly selected communities across two rural Local Government Areas. Data were collected using structured interviews that included validated measures of locus of control, neuroticism, and self-reported use of skilled birth care. We applied the Baron and Kenny mediation framework using linear and logistic regression models with standardized coefficients, adjusting for education, household wealth, and women’s decision-making autonomy. The findings show that women with a more external locus of control were significantly less likely to utilize skilled birth care (p < 0.01), and that neuroticism partially mediated this effect. Higher levels of neuroticism were associated with a reduced likelihood of engaging with skilled maternity care services. These results highlight the importance of psychological traits in shaping maternal health behaviors. Integrating psychosocial interventions, such as emotional support, cognitive reframing, and community health education, into maternal healthcare programs may improve service uptake in marginalized rural populations.