Factors Associated with the Decline in Health Facility Utilization for Childbirth in Ekiti State, Nigeria: Empirical Evidence from a Mixed-Methods Survey
Peter Oshaji, Chike Nwangwu, Oluwaseyi A. Mohammed, Oyebanji Filani, Charles Doherty, Fatima Zonna, Onyeka Ojogwu, & Bashir Mahmud
NOIPolls Limited, Ekiti State Ministry of Health, GIZ
Introduction: Despite targeted investments in maternal health services, Ekiti State, Nigeria, has experienced a decline in health facility-based deliveries. This study explores the contextual factors influencing the non-utilization of health facilities for deliveries as well as evaluates the vulnerability factors that influence general health-seeking behaviour by women of childbearing age in Ekiti State. Methods: A comprehensive mixed-methods evaluation involving desk reviews, quantitative household surveys, and stakeholder interviews was adopted for the study. Local government areas with the highest trends in drop-off for facility deliveries informed the selection of the six study sites. The quantitative household survey involved 529 respondents and collected data on sociodemographic characteristics, past delivery experiences, perceptions of maternal healthcare services, and the drivers of women's choice of place of delivery. The qualitative component provided deeper insights into stakeholders' perspectives and the contextual factors influencing delivery decisions. Findings: Key findings indicate that the most significant determinant for delivery decisions is spousal influence, whilst the provision of respectful maternal care (RMC) is an additional factor. A follow-up study engaging male partners through Computer-Assisted Telephone Interviewing (CATI) revealed that 50% of men whose wives delivered outside health facilities cited “cost of care” as the main barrier. Other factors included parental pressure, religious beliefs, and the appeal of traditional birth attendants (TBAs). Conclusion: Addressing the identified factors through policy interventions, community engagement, and health system improvements is essential to reversing the decline in facility deliveries and improving maternal and neonatal outcomes in Ekiti State. Actionable recommendations are provided to enhance service quality, build community trust, and strengthen referral pathways.
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