Regional inequalities in antenatal care utilization in Nigeria: insights from the Multiple Indicator Cluster Survey (MICS), 2021

Background With a high maternal mortality rate of 1047 deaths per 100,000 live births as of 2020 in Nigeria, it is important to understand the underlying factors contributing to the disparities in maternal healthcare access. This study used the latest Multiple Indicator Cluster Survey (MICS) 2021 to examine regional disparities in Antenatal Care utilization in Nigeria. Methods Data for this study was obtained from the Nigeria MICS 2021, a nationally representative household survey that employed a multistage, stratified cluster sampling design. Information on 6998 women of reproductive age between the ages of 15 - 49 was used. The outcome variable was adequate ANC visits defined by at least four visits while the independent variables were the socioeconomic and demographic factors of the mother. Data was analyzed using Statistical Package for the Social Sciences (SPSS) version 27. Descriptive analyses were done and a multivariable binary logistic model determined the adjusted effect of independent variables on adequate ANC visits at a significance level of 0.05. Results The majority of the respondents were between 15-34 years of age. Inadequate utilization of antenatal care was highest in the North West (35.5%) and generally higher in the Northern region when compared to the Southern region. Women from the North West, North East and North Central regions had an inadequate ANC coverage rate of 35.5%, 31.6%, and 27.3% respectively, while for women from the South-South, South East, and South West it was 14.9%, 10.3% and 10.0% respectively. The regional disparities varied by education, income, parity, and access to internet and health insurance. Women with primary, secondary, and tertiary education from the South-South were 2.2, 1.6, and 6.7 times respectively, more likely to adequately use ANC than those with no formal education. Conclusions We found persisting regional disparities in antenatal care utilization in Nigeria. Hence, a need for evidence-based interventions tailored to address the unique challenges faced by each region to ensure equitable access to maternal healthcare services.