“I went to the primary health centre close to my workplace, but their capacity cannot deliver the baby”: Understanding factors influencing choice of providers for maternal health services in Nigeria

Abstract Background Maternal health remains a significant public health concern globally, particularly in low- and middle-income countries such as Nigeria. Despite concerted efforts to improve maternal health services to achieve the Sustainable Development Goal of less than 70 maternal deaths per 100,000 live births by 2030, maternal mortality rates in Nigeria remain unacceptably high. Understanding the factors that shape women's choices in selecting the place of delivery could help tailor services and improve quality of care for mothers and infants. Therefore, our study seeks to understand the experiences, barriers and facilitators influencing where women choose to access maternal health services in three diverse Nigerian states: Lagos, Oyo and Jigawa. Methods We conducted a qualitative study using in-depth interviews with nursing mothers, healthcare workers in Lagos, Oyo and Jigawa states, and traditional birth attendants (TBAs) in Lagos and Oyo. We used maximum variation sampling to purposefully recruit nursing mothers in their puerperium who delivered in different places. Healthcare workers and TBAs were purposively selected from birth health facilities and birth homes. We used reflexive thematic analysis to generate themes across participant types and states. Results We identified five major themes: (1) preference for safe, comfortable and quality health services; (2) Social diffusion and cultural/religious influences; (3) Physical, geographical and financial inaccessibility; (4) Symbolic perception of health facilities and (5) Misunderstanding of health promoting and preventive care in pregnancy. The main reasons for choice of place of delivery were preference for safe, comfortable, and high-quality healthcare as well as the perceived convenience and accessibility of birth homes within close proximity to the women’s homes. Conclusions We found women’s choice of place of delivery is influenced by a complex interplay of factors. Prominent among these are health system inadequacies, socio-economic influences, and the desire for comfortable and quality maternal healthcare. Healthcare providers, TBAs, and nursing mothers emphasised these determinants as critical in shaping their decisions regarding where to give birth. This highlights the need for comprehensive interventions across policy, healthcare delivery, community engagement, and individual levels to overcome barriers, improve maternal health outcomes, and support women in making informed childbirth decisions.