Quality of maternal health services in Lagos, Nigeria: Women’s perspectives across healthcare districts

BACKGROUND: Women's perceptions of care quality during maternal health visits influence service use and maternal and neonatal outcomes. This study assesses perceived quality of maternal health services across healthcare districts in Lagos, Nigeria. METHODS: This cross-sectional study analyzed data from 7,324 women aged 15-49 years in Lagos State from the 2022 LARCHIS Survey. It examined how demographic, reproductive, care-use, and facility factors predicted perceived maternal healthcare quality (poor/fair, good, or excellent) using multinomial logistic and mixed-effects models. RESULTS: Among 7,324 women (mean age: 31.2 ± 5.9 years), perceived service quality varied significantly by district and facility type. Compared with District I, women in District III were less likely to rate services as good (aOR = 0.37; 95% CI: 0.24-0.56) or excellent (aOR = 0.08; 95% CI: 0.05-0.14), whereas women in District V had higher odds. Lack of response to inquiries was associated with lower odds of rating services as good (aOR = 0.12; 95% CI: 0.08-0.18) or excellent (aOR = 0.06; 95% CI: 0.03-0.16). Rude staff behavior similarly reduced the odds of good ratings (aOR = 0.15; 95% CI: 0.11-0.21) and excellent ratings (aOR = 0.06; 95% CI: 0.06-0.13). Missionary and private facilities received higher ratings than public facilities. Facility readiness-24-hour services, doctor availability, and skilled staff-predicted higher ratings, whereas long waits and closures predicted lower ratings. Staff courtesy and responsiveness were the strongest predictors. CONCLUSION: Women's perceptions of maternal healthcare in Lagos are shaped by structural and interpersonal factors. Improving facility readiness, reducing delays, and promoting respectful care may improve experiences, service use, and maternal and neonatal outcomes.