Trends and Geographic Inequalities in Place of Delivery in Nigeria: Evidence from the 2013–2024 Nigeria Demographic and Health Surveys

Every year, millions of women around the world give birth. For many, the safest place for this event is a clinic or hospital, where trained doctors, nurses, or midwives are ready to handle complications. When a baby is born at home without these skilled helpers, the risks of illness or death for both mother and child rise sharply. This reality has driven health officials to encourage more women to deliver in medical facilities. Yet, in Nigeria, a country with a population of over 200 million, the path to safe delivery remains uneven. While the nation has made some progress, a deep divide persists between those who can easily reach a hospital and those who cannot, creating a landscape where a woman's chance of a safe birth depends heavily on where she lives and how much money her family has.

A recent study by researchers from several Nigerian universities examined this exact situation by looking at data from three major national surveys conducted in 2013, 2018, and 2024. The team wanted to understand not just whether more women were going to hospitals, but how this trend changed over time and why some regions remained far behind others. They analyzed information from tens of thousands of women who had recently given birth, looking closely at their education, wealth, where they lived, and whether they had visited a doctor for prenatal checkups before the baby arrived. By comparing these groups across more than a decade, the researchers could see the true shape of the problem: a slow national improvement that has recently stalled, and a stark geographic split that leaves the poorest and most remote communities at the greatest risk.

The story the data tells is one of cautious progress followed by a frustrating plateau. In 2013, only about 38 percent of women in Nigeria gave birth in a health facility, while the vast majority delivered at home. By 2018, that number had climbed to roughly 43 percent, a sign that efforts to improve access were working. However, when the researchers looked at the 2024 data, they found that the number had barely moved, staying at 42.7 percent. The gains made in the first five years of the study had not continued into the second. This means that while the country did take a step forward, it has since stopped moving. The majority of births in 2024 still took place outside of medical facilities, leaving a large portion of the population vulnerable to complications that could have been treated in a hospital.

The most striking finding, however, was not about the national average, but about the massive differences between regions. If you were to draw a line across the map of Nigeria, the contrast would be immediate and severe. In the southeastern part of the country, more than 82 percent of women delivered in a health facility. In the neighboring southwest, the number was similarly high at over 80 percent. But as you move north, the numbers drop precipitously. In the north-central region, only about 35 percent of women used a facility. In the northeast, it fell to 27 percent, and in the northwest, the situation was most dire: only about 19 percent of women gave birth in a hospital, meaning that more than four out of five births in that region happened at home.

This geographic divide is not just a matter of distance; it is a reflection of deep-seated inequalities. The study showed that a woman's likelihood of delivering in a hospital is tightly linked to her education and her family's wealth. Women with higher levels of education were nearly eight times more likely to give birth in a facility than those with no formal schooling. Similarly, women from the wealthiest households were almost six times more likely to use a hospital than those from the poorest families. These factors acted like a filter, allowing the privileged to access care while leaving the disadvantaged behind. Even when the researchers accounted for these differences, the location itself remained a powerful predictor. A woman living in the southeast had a much higher chance of a safe delivery than a woman in the northwest, regardless of her personal wealth or education, suggesting that the health infrastructure in the north is simply not there to support her.

The researchers also looked at what happens during pregnancy to see if it influenced the final decision. They found that women who attended at least four prenatal care visits were nearly four times more likely to deliver in a hospital than those who did not. This suggests that the journey to a safe birth often begins long before the labor starts, with regular checkups building trust and awareness. Conversely, women who had already given birth to several children were less likely to go to a hospital for their next baby, perhaps because they felt confident in their ability to manage the birth at home or because they had faced barriers in the past. Interestingly, while having health insurance and living close to a clinic seemed important in simple comparisons, these factors lost their power when the researchers looked at the whole picture. This indicates that money and distance are not the only barriers; cultural beliefs, lack of information, and the overall quality of care play equally critical roles.

The study concludes that Nigeria has reached a point where general improvements are no longer enough. The national average hides a reality where some communities are thriving while others are being left behind. The progress made between 2013 and 2018 has not been sustained, and the gap between the rich and the poor, and between the south and the north, remains wide. To fix this, the authors argue that policies must stop treating the country as a single unit. Instead, interventions need to be targeted specifically at the regions and groups that are struggling the most. This means building better health facilities in the north, ensuring that poor families can afford care, and running community campaigns to change the mindset that favors home births. Without these specific, targeted actions, the goal of safe childbirth for every woman in Nigeria will remain out of reach.