Patterns of utilization and determinants of maternal health services among women residing in low-income communities in Lagos State, Nigeria

Maternal and perinatal morbidity and mortality can be significantly prevented when women utilize health facilities for antenatal care (ANC), delivery and postnatal care; particularly in low-income communities in sub-Saharan Africa, where facility-based maternal care is underutilized. This study assessed the pattern of utilization and determinants of uptake of maternal health services among women residing in low-income communities in Lagos State, Nigeria. This was a mixed methods cross-sectional study, among women of reproductive age 15 - 49 years. Quantitative data was collected from 3,651 women using interviewer-administered questionnaires. Twenty Focus Group Discussions were carried out among 172 women. Univariate, bivariate and multinomial regression was done to identify determinants of place of delivery.The mean age of respondents was 32 ± 6.4 years. Almost all the women (97.7%) had ANC during their last pregnancy regardless of provider. During ANC visits, 56.4% were attended to by a nurse/midwife, 24.2% by a doctor and 19.4% by a traditional birth attendant (TBA). Thirty-nine per cent of respondents had their last child delivered in a public health facility, 30.8% in a private health facility, and 30.2% at a TBA/religious centre/home. Determinants of facility delivery utilization include higher levels of education, higher household incomes, middle and rich wealth index, fewer number of children and higher level of satisfaction with healthcare facilities.. Reasons for choice of place of ANC and delivery from the qualitative inquiry included distance from homes, attitude of health workers and quality of care, affordability, choice of spouse, and belief in herbs/spiritual beliefs.A significant proportion of women delivered with TBA/religious centre/at home. To improve use of health facilities for maternal care, efforts must be steered at improving health worker attitudes, addressing geographical accessibility and affordability, promoting health insurance, and carrying along all relevant stakeholders including spouses, and religious and traditional leaders.