Neighborhood socioeconomic disadvantage, individual wealth status and patterns of delivery care utilization in Nigeria: a multilevel discrete choice analysis

Olatunde Aremu, Stephen Lawoko, Koustuv Dalal

Research output: Contribution to journalArticlepeer-review

52 Citations (Scopus)


BACKGROUND: High maternal mortality continues to be a major public health problem
in most part of the developing world, including Nigeria. Understanding the
utilization pattern of maternal healthcare services has been accepted as an
important factor for reducing maternal deaths. This study investigates the effect
of neighborhood and individual socioeconomic position on the utilization of
different forms of place of delivery among women of reproductive age in Nigeria.
METHODS: A population-based multilevel discrete choice analysis was performed
using the most recent population-based 2008 Nigerian Demographic and Health
Surveys data of women aged between 15 and 49 years. The analysis was restricted
to 15,162 ever-married women from 888 communities across the 36 states of the
federation including the Federal Capital Territory of Abuja.
RESULTS: The choice of place to deliver varies across the socioeconomic strata.
The results of the multilevel discrete choice models indicate that with every
other factor controlled for, the household wealth status, women's occupation,
women's and partner's high level of education attainment, and possession of
health insurance were associated with use of private and government health
facilities for child birth relative to home delivery. The results also show that
higher birth order and young maternal age were associated with use of home
delivery. Living in a highly socioeconomic disadvantaged neighborhood is
associated with home birth compared with the patronage of government health
facilities. More specifically, the result revealed that choice of facility-based
delivery is clustered around the neighborhoods.
CONCLUSION: Home delivery, which cuts across all socioeconomic strata, is a
common practice among women in Nigeria. Initiatives that would encourage the
appropriate use of healthcare facilities at little or no cost to the most
disadvantaged should be accorded the utmost priority.
Original languageEnglish
Pages (from-to)167-174
Number of pages8
JournalInternational Journal of Women's Health
Publication statusPublished - Jul 2011


  • delivery care
  • maternal health services utilization
  • multilevel discreet choice
  • Nigeria
  • socioeconomic disadvantaged
  • neighborhood
  • health policy


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