Assessing patterns, barriers, and motivations for family planning utilization among currently pregnant women in Nigeria: a cross-sectional study

Introduction Universal access to family planning is critical to reducing maternal mortality, yet progress remains slow, particularly in Sub-Saharan Africa. In Nigeria, modern contraceptive use is 12%, compared to a global average of 77.5%. This study, therefore assessed contraceptive use patterns, barriers, and motivations among pregnant women to inform the design of context-specific interventions aimed at improving family planning uptake. Methods We conducted a cross-sectional study from July to September 2023 in different settings (Jigawa, Oyo, and Lagos States) to capture varying sociocultural contexts in Nigeria. Pregnant women attending antenatal care at 32 healthcare facilities were sampled using a multi-stage approach. Data collection was through structured questionnaires focusing on respondents' health literacy, family planning awareness and utilization. We used logistic regression to assess the relationship between family planning utilization and maternal health literacy and other sociodemographic characteristics, with statistical significance set at the 95% confidence level. Results Overall, 52.7% of women reported ever using any family planning method after picture prompts, with notable regional differences: Lagos (66.4%), Oyo (61.0%) and Jigawa (35.0%). About one-third (31.9%) of pregnancies were unintended. The mean maternal health literacy (MHL) score was 34.4 (SD = 7.3), with Jigawa having the lowest mean score (30.1, SD = 6.4) compared to Lagos (36.8, SD = 6.3) and Oyo (37.5, SD = 6.9). Higher MHL scores (aOR = 1.32, 95% CI: 0.76–2.31), increasing number of living children (2–4 children: aOR = 2.93, 95% CI: 1.53–5.62), and residence in Lagos (aOR = 2.98, 95% CI: 1.27–7.01) were significantly associated with increased odds of family planning use. Conclusion High maternal health literacy is associated with increased contraceptive utilization, but substantial obstacles, including social disapproval in Jigawa and accessibility challenges in Lagos, continue to impede family planning and adoption. These regional variations in contraceptive use call for targeted interventions to address specific local barriers and improve overall family planning outcomes.