International Journal of Humanities.
Education, and Social Sciences e-ISSN : 3026-0892 p-ISSN : 3026-1422 Index: Harvard.
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58578/IJHESS.
Determinants of Maternal Home Delivery in Nigeria:
Evidence for Targeted Health Policy Interventions Matthew Ayegboyin University of Johannesburg.
South Africa mayegboyin@uj.
Article Info:
Submitted:
Revised:
Accepted: Published:
May 22, 2025 Jun 19, 2025 Jul 1, 2025 Jul 6, 2025 Abstract Maternal mortality remains a critical public health concern globally, with Nigeria bearing the highest burden of avoidable maternal deaths despite a global decline in the maternal mortality ratio.
A significant proportion of these deaths occur during childbirth, often linked to home deliveries.
Although several maternal health policies and programs have been introduced to promote facility-based deliveries, a large number of Nigerian women continue to give birth at home.
This study investigates the determinants of home delivery among Nigerian women to inform health policy aimed at reducing maternal mortality.
Utilizing data from the 2018 Nigeria Demographic and Health Survey (NDHS), a filtered sample of 41,821 women aged 15Ae49 was analyzed using SPSS version 27.
Descriptive and bivariate statistical techniques were employed to identify key influencing factors.
The findings reveal that home delivery is most prevalent among teenage mothers .
1%), uneducated women .
4%), the poorest socioeconomic group .
7%), rural residents .
8%), and women in the northwest region .
4%).
Language barriers also emerged as a significant determinant of home delivery.
The study recommends the development of state-specific policies to train Traditional Birth Attendants (TBA.
at no cost, particularly in rural and underserved communities, to Volume 3.
Issue 3, 2025.
Pages 834-850 https://ejournal.
yasin-alsys.
org/IJHESS IJHESS Journal is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.
0 International License Matthew Ayegboyin improve maternal health outcomes and reduce reliance on unsafe home Keywords: Maternal Mortality.
Place of Delivery.
Home Delivery.
Language Barrier.
Nigeria
INTRODUCTION
Maternal mortality remains a pressing public health challenge globally(WHO, 2.
Despite the global drop in maternal mortality ratio (MMR) by 40 percent between 2000 and 2015, an estimated 287,000 women died from causes related to pregnancy and childbirth in 2020, which is equivalent to 800 deaths daily (WHO, 2024.
WHO & UNICEF, 2.
The global MMR of 223 deaths per 100,000 live births in 2020 poses a great threat to achieving Sustainable Development Goal 3 (SDG) of having below 70 deaths per 100,000 live births in 2030 (WHO, 2023, 2.
, which is the next four years.
The low and middle-income countries experienced more than 90% of the maternal deaths that occurred in the year 2023, while sub-Saharan Africa (SSA) alone accounted for 70% (Dahie et al.
, 2025.
Fentie et al.
, 2025.
WHO, 2.
Among all the regions globally, the Africa Region is the only region which has maintained the highest MMR throughout the last two decades (WHO.
WHO & UNICEF, 2.
Nigeria contributes the highest burden of global estimated MMR, with 28.
3% while about 8,200 maternal deaths and 1,047 deaths per 100,000 live births occurred in the country (Dogbanya, 2025.
UNICEF, 2025.
WHO, 2.
Majority of these deaths occurred at the time of delivery (Adewuyi et al.
, 2019.
Hassan et al.
, 2021.
Tekeba et al.
, 2.
, caused by obstructed labour, sepsis, haemorrhage, and hypertensive disorders (Asirifi et al.
, 2025.
WHO & UNICEF, 2.
However, most of these maternal deaths are avoidable if timely and skilled delivery services are provided to pregnant women (Dahie et al.
, 2025.
Tekeba et al.
, 2.
Besides, the availability of appropriate and accessible care in case of complications, and effective postnatal care within the first twenty-four hours of delivery are strategies in reducing high maternal deaths (Ajayi et al.
, 2023.
Udenigwe et al.
, 2021.
Zegeye et al.
, 2.
Conversely, a significant number of women in developing countries do not have the opportunity to give birth with skilled assistance and at healthcare facilities (Adde et al.
, 2020.
Asirifi et al.
, 2025.
Dickson et al.
Hassan et al.
, 2.
Utilisation of healthcare facilities by women is influenced by Volume 3.
Issue 3, 2025 Matthew Ayegboyin several factors such as availability of healthcare services, cost of services, transportation fare, quality of service provided and received, socioeconomic factors, religious and personal or family health beliefs (Dahie et al.
, 2025.
Dickson et al.
, 2.
Studies have examined significant association between place of delivery and a range of sociodemographic factors such as rural-urban residence, educational levels of women and husbands, maternal religion, region of residence, wealth index, maternal age and birth order, as the determinants of use or non-use of healthcare facility for childbirth in Nigeria (Abubakar et al.
, 2017.
Adewuyi et al.
, 2019.
Asirifi et al.
, 2025.
Dauda, 2023.
Hassan et al.
Izugbara & Wekesah, 2018.
Johnson et al.
, 2020.
Ntoimo et al.
, 2022.
Okeke et al.
Oladele et al.
, 2024.
Oyedele, 2023.
Sabo et al.
, 2024.
Samuel & Okpe, 2024.
UNICEF, 2.
The available studies have focused on factors associated with institutional delivery among reproductive women aged 15Ae49 years and young mothers aged 15Ae24 Thus, no available study in Nigeria explicitly connects home delivery to targeted policy maternal intervention in the country.
Several health policy frameworks and programs like Universal Health Coverage (UHC).
National Health Insurance Scheme (NHIS), and Primary Healthcare Centres (PHC.
have been implemented in Nigeria.
Over the years in the country, some of these policies of improving the delivery of maternal healthcare were implemented through PHCs (Udenigwe et al.
, 2.
since they are the closest to people in the communities.
Between 1975 and 1983, the Basic Health Service Scheme was implemented to increase the quality of healthcare for the entire population with emphasis on improving the delivery of maternal and child health services(Aregbeshola & Khan, 2.
The Alma-Ata Declaration principles were implemented from 1985 to 1992, as a national health delivery system, and the country witnessed the greatest boost to maternal healthcare delivery services (Omuta et , 2.
In 2009.
Nigeria implemented the National Midwifery Service Scheme, which was designed to improve the coverage of skilled birth attendants in rural areas and to reduce maternal, new born and child mortality (Omuta et al.
, 2.
Between 2009 and 2015, free maternal healthcare services were implemented in many Nigerian states (Ajayi et , 2.
Despite these efforts in strengthening the delivery of maternal healthcare services through PHCs in Nigeria, facility-based deliveries remain low, with nearly 60% of births still occurring outside health facilities in Nigeria (Ajayi & Akpan, 2020.
Esan et al.
, 2023.
NPC & ICF, 2.
International Journal of Humanities.
Education, and Social Sciences Matthew Ayegboyin Understanding the complexity of determinants of home delivery in Nigeria is essential for designing effective and context-specific health policy interventions that promote institutional deliveries, reduce inequalities in access to maternal healthcare, and ultimately lower maternal mortality rates.
This study seeks to explore the multifaceted factors influencing women's choice of home delivery in Nigeria, with the goal of informing policy, enhancing health system responsiveness, and ultimately drastically reducing maternal and neonatal morbidity and mortality.
METHODS
Data Source and Design The data for this study were sourced from the Nigeria Demographic and Health Survey (NDHS) dataset, which was conducted in Nigeria from 14th August to 29th December 2018.
The survey was sponsored by the United States Agency for International Development (USAID) through The Demographic and Health Survey (DHS) programme with its successful implementation through the support of the Global Fund, the Bill and Melinda Gates Foundation (BMGF), the United Nations Population Fund (UNFPA), and the World Health Organization (WHO) (NPC & ICF, 2.
The sampling frame was based on the 2006 Population and Housing Census of the Federal Republic of Nigeria (NPHC) conducted in 2006 by the National Population Commission.
Nigeria has 1 Federal Capital Territory (FCT), 36 states and 774 local government areas (LGA.
, and each LGA is divided into political wards.
The survey utilised a cross-sectional design, providing nationally representative data on a wide range of demographic, health, and socioeconomic indicators through household interviews of It employed a two-stage cluster sampling method to select respondents and data collection was carried out using a standardised structured questionnaire.
The main objective of the survey was to provide up-to-date estimates of basic demographic and health indicators in the country.
The information contained in the survey is intended to assist policymakers and programme managers in evaluating and designing programmes and strategies to improve the health status of Nigerians.
The survey also provides indicators relevant to the Sustainable Development Goals (SDG.
for the country.
More information about the survey design is available at the National Population Commission (NPC) [Nigeri.
and ICF.
2019 (NPC & ICF, 2.
Volume 3.
Issue 3, 2025 Matthew Ayegboyin The survey protocol was reviewed and approved by the National Health Research Ethics Committee of Nigeria (NHREC) and the ICF Institutional Review Board.
After all questionnaires were finalised in English, they were translated into Hausa.
Yoruba, and Igbo.
The 2018 NDHS used computer-assisted personal interviewing (CAPI) for data The statistical software used for this study is International Business Machine (IBM) Statistical Package for the Social Sciences (SPSS) version 27.
Descriptive and bivariate analytical techniques were used for the analysis.
The analysis included a total of 106,586 respondents, spread across households .
, women aged 15-49years .
, subsample households .
and men aged 15-59 .
To filter the data relevant to this study from the total sample in the NDHS dataset, only information about women .
9 year.
was extracted.
The dataset used for this study is accessible at https://dhsprogram.
com/data/dataset/Nigeria_Standard-DHS_2018.
cfm?flag=0.
Dependent variable The primary outcome variable of interest was women's place of delivery, defined as respondentsAo home, other home, government hospitals, government health centres, government health posts, other public sector, private hospitals/clinics, other private sector and other.
Explanatory variables The explanatory variables used to analyse the findings were sociodemographic information: age, education, marital status, employment status, wealth index, and place of residence .
rban/rura.
The number of antenatal care (ANC) visits was also part of the explanatory variables.
Handling of data The ANC visits variable was recoded.
The No visit and DonAot know variables were maintained while other variables were recoded as four or fewer visits, five to eight visits, and above eight visits.
International Journal of Humanities.
Education, and Social Sciences Matthew Ayegboyin
RESULTS
Demographic Information of Respondents Table 1 presents some sociodemographic information of the selected respondents used for the survey.
One-fifth .
%) of all the respondents were between 15-19 years.
2% were within 25-29 years, while the least .
3%) belonged to 45-49 years.
The majority .
4%) of the respondents could not attain any formal education.
completed primary school education.
6% completed secondary school, while only 10.
could go beyond secondary school.
One quarter .
2%) of the respondents were from the Northwest region, 18.
3% of respondents were from the Northeast, while the least 12.
were from the South-south region.
The category of wealth index showed that 18.
6% of respondents were the poorest, 20.
0% were middle income, while 21.
7% the richest.
Table 1: Demographic information of Respondents (N=41,.
Demographic Information Age group No education Educational attainment Incomplete primary Complete primary Incomplete secondary Complete secondary Higher Region North Central North East North West South East South South South West Residence Urban Rural Wealth Index Poorest Poorer Middle Richer Richest Volume 3.
Issue 3, 2025 Frequency Percent Matthew Ayegboyin ANC Visits and Place of Delivery The antenatal (ANC) visits by the respondents showed that 24.
6% did not go for any ANC visit, 30.
2% of respondents had five to eight visits, 13.
8% had more than eight ANC visits, while 1.
5% did not know.
For the place of delivery, half .
7%) of the respondents delivered their babies at home, and 13.
6% delivered at government hospitals.
Also, 15.
3% delivered at government health centres/posts, 12.
1% used private hospitals.
Number of ANC visit and Place of Delivery 6% chose other locations as the place of delivery.
No visit Four or less visit Five to eight visits More than eight visits DonAot know Respondent's home Other home Government hospital Government health center Government health post Other public sector Private hospital/clinic Other private sector Other Figure 1.
Number of ANC Visits and Place of Delivery (N = 21,.
Age.
Number of antenatal visits and Place of delivery There is a significant relationship between the place of delivery and age groups.
However, the largest percentage .
1%) of women who gave birth at home were between 15 and 19 years, followed by 58.
3% who were between 45 and 49 years, while the least .
0%) were between 30 and 34 years.
The age group of 15-19 years led women who gave birth at other home, next by 20-24 years with 5.
9% and the lowest .
7%) was among 45-49 The leading percentage .
5%) of women who delivered their babies at government hospitals belonged to the 30-34 years age group, followed by 14.
4% of women aged 35-39 years, while the least .
5%) were women between 15-19 years.
Women aged 35-39 years were the highest .
8%) of those who gave birth at private hospitals/clinics, followed by 4% women aged 30-34.
0% of women from 40-44 years, while the least .
6%) were International Journal of Humanities.
Education, and Social Sciences Matthew Ayegboyin 15-19 years.
Almost all .
1%) of the respondents who delivered at home showed that they never used ANC, while the lowest .
7%) had more than eight ANC visits.
The majority .
%) of respondents who delivered at government hospitals could not recall the number of visits to ANC, while the least .
4%) were those who did not attend ANC.
The highest percentage .
4%) of respondents who gave at private hospitals/clinics were those who had more than eight ANC visits, while the least .
8%) did not visit ANC.
Table 2: Age.
Number of antenatal visits and Place of delivery Place of delivery 15-19 years (%) 20-24 years (%) 25-29 years (%) 30-34 years (%) 35-39 years (%) 40-44 years (%) 45-49 years (%) No visit
(%)
Four or fewer visits (%) Five to eight
visits (%) More than eight visits (%) DonAot know
(%)
Govt Respondent's Other Govt home hospital Govt Private /clinic Other Total Pearson Chi-Square Educational attainment.
Wealth index for urban/rural and Place of delivery The Pearson chi-square shows a significant relationship between educational attainment and place of delivery.
Besides, the highest .
4%) percentage of women who gave birth at home had no formal education, followed by 59.
2% of respondents who could Volume 3.
Issue 3, 2025 Matthew Ayegboyin not complete primary education, while the least .
9%) had more than secondary education.
Among women who gave birth at other home, the highest .
2%) was incomplete secondary education, 8.
7% who had completed secondary school, while 2.
0% did not have an education.
Government hospitals as the place of delivery showed that respondents with higher secondary education were the highest .
6%), 20.
2% completed secondary school, while the lowest .
1%) were without education.
Among the respondents who gave birth at the government health centre, 19.
6% had incomplete secondary, while 12.
7% could not complete primary school.
Those who gave birth at the private hospital/clinics showed 9% had higher educational status, 11.
5% of the respondents completed primary school, 8% had no formal educational attainment.
The majority .
7%) of respondents who gave birth at home were the poorest, while 20.
0% of the richest gave birth at home.
One-tenth .
0%) of the poorer and 17.
5% of the richer category gave birth at government hospitals.
About one-tenth .
9%) of the middle class, 7.
9% of the poorer and 6% of the richer categories gave birth at private hospitals/clinics.
Table 3: Educational attainment.
Wealth index for urban/rural and Place of delivery No education (%) Incomplete primary (%) Complete primary (%) Incomplete secondary (%) Complete secondary (%) Higher
(%)
Poorest
(%)
Poorer
(%)
Middle (%) Richer
(%)
Richest
(%)
Respondent's Other Place of Delivery Govt Govt Govt Private /clinic Other Total International Journal of Humanities.
Education, and Social Sciences Matthew Ayegboyin Region.
Residence Location and Place of Delivery There is a significant relationship between region and place of delivery.
However, almost all .
4%) of the respondents from the Northwest, 44.
8% from the Northcentral and one-quarter .
7%) from the Southsouth gave birth at home.
One-fifth .
8%) and 5% of the respondents from the Northcentral and the Northwest, respectively, gave birth at the government hospitals.
About one-third .
4%), 11.
2% and 4.
3% of respondents from the Southeast.
Northeast and Northwest, respectively, gave birth at the government health centres.
The majority .
9%) of respondents from the Southeast region, 13.
from the Southsouth and 1.
7% from the Northeast used private hospitals/clinics as a place of delivery.
The majority .
8%) of rural dwellers and one-third .
7%) of urban dwellers gave birth at home.
Table 4: Region.
Residence Location and Place of delivery Place of delivery Region
Respondent Other Govt
Govt
North
Central (%) North East
(%)
North West
(%)
South East
(%)
South
South
(%)
South West
(%)
Urban
(%)
Rural
(%)
Pearson Chi-Square Private Govt
health post
/clinic Other Total
DISCUSSION
This study reveals key sociodemographic variables that significantly influence the place of delivery among women in Nigeria.
It shows that women who gave birth in their teens .
Ae19 year.
have a higher percentage of home delivery.
Studies have shown that Volume 3.
Issue 3, 2025 Matthew Ayegboyin many teenagers who gave birth were unintentional due to unplanned pregnancy, school dropout, poverty and lack of sexual education (Onyema & Isokon, 2024.
Salami et al.
The stigma society attributed to teenage pregnancy, the wrong attitude of healthcare professionals and poverty detached many pregnant adolescents from choosing hospitals to give birth (Onyema & Isokon, 2024.
Salami & Ayegboyin, 2.
Thus, these adolescents often lack autonomy, economic power, and awareness of the risks associated with home delivery(Adewuyi et al.
, 2019.
Oladele et al.
, 2024.
Solanke et al.
, 2.
In contrast, women aged 30Ae34 years had the lowest proportion .
0%) of home births, suggesting that women in this age group may have greater decision-making capacity and possibly more exposure to health education.
Additionally, older women .
Ae39 year.
showed the highest usage of private hospitals/clinics likely reflecting greater financial stability and experience with previous births that may influence their preferences.
The significantly lower use of health facilities among adolescents reinforces the need for targeted youth-friendly reproductive health services and educational interventions to promote safe delivery A critical determinant evident in the data is education, which showed a strong and significant association with the place of delivery.
A majority .
4%) of women who gave birth at home had no formal education.
This shows evidence of language barriers since women with no formal education will find it difficult to express themselves clearly with healthcare professionals.
This may propel such women to patronise traditional birth attendants (TBA.
and give birth at home.
These findings are consistent with other studies that highlight the positive impact of female education on health-seeking behaviour (Abubakar et al.
, 2017.
Esan et al.
, 2023.
Ntoimo et al.
, 2.
Educated women are more likely to understand the benefits of skilled birth attendance, navigate healthcare systems, and challenge cultural or familial norms that favour home delivery.
Furthermore, they are more likely to be economically empowered, enhancing their ability to afford facility-based services(Babalola & Fatusi, 2009.
Jiwani et al.
, 2.
The Antenatal Care (ANC) utilisation strongly correlated with the place of delivery.
Almost all 87.
1% of women who delivered at home did not attend ANC.
This pattern demonstrates the synergistic relationship between ANC attendance and institutional delivery, where frequent contact with health professionals during pregnancy may reinforce the importance of delivering in a health facility (Babalola & Fatusi, 2009.
Onyema & Isokon, 2.
The absence of ANC visits among a large proportion of women who International Journal of Humanities.
Education, and Social Sciences Matthew Ayegboyin delivered at home signals missed opportunities for risk screening, birth preparedness, and health education.
It also suggests that barriers to facility-based ANC, such as distance, cost, and sociocultural resistance may continue into the delivery period.
The association between economic status and place of delivery was also significant.
About 75.
7% of women in the poorest wealth quintile gave birth at home, compared to 0% of the richest.
Conversely, private hospitals were primarily used by those in the richer categories.
These patterns are consistent with national and international findings (Ajayi & Akpan, 2020.
Tekeba et al.
, 2025.
WHO, 2.
, which assert that economic empowerment enhances access to health facilities by enabling transportation, affording facility charges, or overcoming indirect costs such as lost labour.
The persistent reliance on home delivery by the poor underscores the need for pro-poor health financing strategies like conditional cash transfers or community-based health insurance schemes.
The significant regional variation in the place of delivery was observed.
For example, 83.
4% of respondents in the Northwest delivered at home, compared to 24.
7% in the Southeast, where private hospital utilisation was also higher .
9%).
These disparities reflect Nigeria's regional imbalances in health infrastructure, education, cultural practices, and poverty levels (Eze & Chukwuma, 2024.
Olowolafe et al.
, 2.
The northern regions, particularly the Northwest and Northeast, are traditionally associated with low levels of female education, early marriage, and gender norms that limit women's autonomy in health decisions (Ntoimo et al.
, 2019.
Yaya et al.
, 2.
On the other hand, the South benefits from better infrastructure, literacy levels, and higher exposure to maternal health Addressing these disparities requires context-specific policy interventions that consider cultural, religious, and socioeconomic realities in each region.
Place of residence remains a potent determinant of delivery location.
A large majority .
8%) of rural dwellers delivered at home, compared to 29.
7% in urban areas, where access to private hospitals .
5%) was significantly higher.
This urbanAerural divide is not surprising given the disparities in healthcare infrastructure, availability of skilled personnel, and transportation networks (NPC & ICF, 2019.
Tekeba et al.
, 2.
Rural women often live far from facilities, face challenges in emergency transport, and may be influenced by traditional norms that favour home births or the use of traditional birth Expanding rural access to quality maternal care through mobile clinics, community health extension workers, and facility upgrades is crucial to bridging this gap.
Volume 3.
Issue 3, 2025 Matthew Ayegboyin Based on these findings, the following policy actions and interventions are recommended to address the structural barriers to institutional deliveries through targeted health policies.
There should be public health campaigns, sensitisation and policies that are tailored to specific regions, languages, and cultural contexts, especially the northern parts of the country where the teenage pregnancy rate is very high.
Policies and programmes such as total free antenatal care and delivery services with or without assisted and caesarean sections mainly channel pregnant adolescents, attracting them to choose health centres over home delivery.
Involving traditional and religious leaders in promoting institutional delivery can help shift long-standing norms that favour home births.
Evidence of a language barrier emerged as a strong determinant of home delivery.
There should be an effective state-by-state policy of training the majority of the TBAs freely, especially at the community level and in rural areas on maternal health delivery.
This is imperative since the majority of women with no formal education patronise them.
Integrate birth preparedness counselling into ANC visits and enforce minimum ANC visit targets as the WHO recommends eight contacts.
Community health workers should be trained to follow up with pregnant women, especially in rural areas, to ensure consistent ANC attendance and timely referrals.
Governments and development partners should increase the number and capacity of maternal health facilities in rural and underserved National and state-level maternal health task forces should be empowered to integrate these sectors into holistic reproductive health strategies.
This study is limited by using descriptive, crosstabulation and chi-square statistical tools.
However, the statistical tools only examined the relationship between the selected variables without looking at the causation of such variables and the direction of their relationship.
CONCLUSION
The study affirms that age, education, wealth.
ANC attendance, region, and place of residence are significant determinants of where Nigerian women give birth.
The high rates of home delivery, particularly among adolescent mothers, the uneducated, the poor, and rural women, highlight the persistence of inequities in accessing maternal healthcare Effective policy must go beyond infrastructure to address the social determinants of health and tailor health interventions to region-specific cultural contexts.
Strengthening ANC uptake, improving health literacy, expanding insurance coverage, and engaging International Journal of Humanities.
Education, and Social Sciences Matthew Ayegboyin community leaders are crucial strategies to increase the rate of facility-based deliveries and reduce maternal and neonatal mortality in Nigeria.
Addressing these inequalities with an inclusive approach to maternal healthcare is essential to meet Sustainable Development Goal 3 on reducing maternal mortality and ensuring access to trained TBAs and skilled birth care.
Qualitative studies on the exploration of cultural norms and barriers, and longitudinal studies in a deeper understanding of choosing home delivery over health facilities, should be conducted in the country especially at the Northwest region.
REFERENCES