Maternal screening coverage and determinants during facility-based antenatal care in Nigeria: analysis of the 2018 Demographic and Health Survey

TL;DR

Wealth disparities in Nigeria affect how often pregnant women receive facility-based antenatal care and essential health screenings during pregnancy.

Contribution

This study identifies wealth and facility type as key determinants of maternal screening coverage during antenatal care in Nigeria.

Findings

72.8% of women in Nigeria used facility-based antenatal care, with 83.4% receiving all three screening components.

Wealthier women were four times more likely to use facility-based ANC and three times more likely to receive all three tests.

Women using private facilities were 50% less likely to receive all three screening components compared to those using public facilities.

Abstract

Antenatal care (ANC) provides an opportunity for early identification and treatment of pregnancy-related conditions to prevent adverse maternal and foetal outcomes. The influence of socioeconomic and health system factors on maternal screening during ANC remains unclear. We evaluated the coverage and determinants of facility-based ANC use and components related to maternal screening for common pregnancy-related conditions in Nigeria.

Using data from the 2018 Nigeria Demographic and Health Survey, we estimated the percentage of women aged 15–49 years who reported facility-based ANC for their most recent live birth in the 5 years preceding the survey. Among them, we estimated the percentage who received care components related to maternal screening (blood pressure measured, and urine and blood samples taken) at least once. We used logistic regression to examine the association between household wealth and 1) facility-based ANC utilisation and 2) screening components of care received. Facility type (private or public sector) was considered as an effect modifier.

Among the sample of 21,792 women, 72.8% reported facility-based ANC. Most ANC users reported having had their blood pressure measured (95.2%), and their blood (89.3%) and urine samples taken (88.0%). All three screening components were received by 83.4% of facility-based ANC users. Compared to women from the poorest quintile, the richest had significantly higher adjusted odds of having facility-based ANC (aOR 4.25, 95% CI: 3.23 – 5.59) and, among ANC users, of receiving all three screening components (aOR = 3.43, 95% CI: 2.52 – 4.68). The adjusted odds of receiving all three components were 49% lower among women who used private ANC compared to those who used only public providers (aOR = 0.51, 95% CI: 0.43 – 0.61). There was no evidence of interaction by facility type.

Wealth inequality is associated with disparities in the utilisation of facility-based ANC and maternal screening. Socio-economically disadvantaged women, who are most in need of maternal health services, face a ‘double penalty’ of deprived ANC use and maternal screening during ANC. Interventions focused on mitigating these disparities can help improve maternal outcomes. Concerted efforts are required to regulate the private facilities and strengthen the public facilities to provide high-quality maternal healthcare services.

The online version contains supplementary material available at 10.1186/s12978-026-02269-1.

Pregnant women receive care in health facilities to ensure the well-being of themselves and their babies. The factors that affect the use and quality of care received by pregnant women are not well understood. We estimated the percentage of pregnant women who received care in health facilities and had tests to detect common pregnancy conditions, including measuring blood pressure, and taking urine and blood samples. Then, we examined whether the woman’s household wealth influences her ability to receive pregnancy care in health facilities and be tested for common pregnancy conditions. We also examined whether the type of facility where the women received care affects the tests done.

About three-quarters of the women reported receiving care in health facilities during pregnancy. Nearly all these women had their blood pressure measured, and approximately 9 in 10 had their blood and urine samples taken at least once. Women from the richest households were four times more likely to receive care in health facilities during pregnancy and three times more likely to have all three tests done compared to women from the poorest households. Women who had care in private facilities were about 50% less likely to receive all three tests than those in public facilities.

Differences in wealth status influence the ability of women to receive care in health facilities during pregnancy and tests to detect common pregnancy conditions, thereby facing a ‘double penalty’. Efforts are needed to eliminate these differences and improve the quality of care received in public and private facilities.

The online version contains supplementary material available at 10.1186/s12978-026-02269-1.

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