Determinants of the Utilization of Traditional Birth Attendants and Its Health Implications on Childbearing Women in Yobe State, Nigeria: A Rural-Urban Comparison

Skilled birth attendance in Yobe State, in Nigeria's North East geopolitical zone, remains among the lowest in the country despite two decades of survey-based monitoring and a succession of state-level primary health care investments. This study synthesizes secondary quantitative data from the 2018 Nigeria Demographic and Health Survey (NDHS), the 2021 Multiple Indicator Cluster Survey (MICS), and the 2023-24 NDHS Key Indicators Report, together with state health system documentation and a body of Yobe-specific and northeast Nigerian published literature, to examine the determinants of Traditional Birth Attendant (TBA) utilization among childbearing women in Yobe State and the extent to which these determinants differ between rural and urban populations. Using Andersen's Behavioral Model of Health Services Use as its organizing framework, the study finds that the proportion of Yobe births assisted by a skilled provider rose from 17.8 percent in 2018 to 35.4 percent in 2023-24, while TBA-assisted delivery fell from 20.3 percent to an estimated 6.0 percent in the intervening 2021 MICS round, though state-level sample sizes are small enough that year-to-year figures should be read as indicative rather than precise. National-level Nigeria Demographic and Health Survey and Multiple Indicator Cluster Survey data show a persistent and substantial rural-urban gap in skilled attendance (67.6 percent urban and 28.0 percent rural in 2018; 77.3 percent and 35.5 percent urban and rural in 2021, respectively), and Yobe-specific literature and state health system records indicate that this gap is compounded, rather than offset, by an uneven distribution of primary health care investment, a severe shortfall in health workforce planning, and periodic insurgency-related disruption concentrated in the state's rural and border local government areas. The findings support the study's rural residence and socioeconomic hypotheses in direction, and points to a need for state-level microdata access and routine rural-urban disaggregation in future Yobe focused surveys.