Background: Antenatal care (ANC) is a proven strategy for reducing maternal and neonatal morbidity and mortality. Yet in many low- and middle-income countries (LMICs), including Nigeria, systemic and gendered barriers continue to undermine equitable utilization, particularly in rural settings. This study investigates structural and gender-based inequities influencing ANC utilization among women in rural Kebbi State, Nigeria. Methods: A cross-sectional study was conducted with 420 women in Kebbi State. Data were collected using structured questionnaires and analysed using descriptive statistics, chi-square tests, means, and standard deviations via SPSS v20. Results: Although 95.2% of respondents reported the presence of primary health centres (PHCs), service consistency was limited. Only 59% and 52.9% reported access to iron supplementation and deworming medications, respectively. Major barriers included long distances (48.8%), transport costs (41.0%), and absence of female providers (28.3%). Higher educational attainment and decision-making autonomy were significantly associated with increased ANC attendance (p<0.05). The mean number of ANC visits was 3.7 (SD±1.6), falling short of WHO recommendations, particularly among women with no formal education (mean=2.9, SD±1.4). Conclusions: The availability of ANC services does not equate to equitable access and utilization. Deep-rooted structural and gendered inequities constrain maternal healthcare utilization in rural Nigeria. Interventions must prioritize equity, gender responsiveness, and community empowerment to ensure inclusive maternal health outcomes.
Cyril Afamefuna Egbo (Thu,) studied this question.