Abstract

Background: Unskilled birth delivery remains a major contributor to maternal and neonatal mortality in Nigeria, driven by socio-demographic, cultural, and systemic inequities. Despite government and global initiatives promoting skilled birth attendance, many women continue to rely on traditional birth attendants (TBAs) and home deliveries. Objective: This study examined the socio-demographic, cultural, and geographic factors influencing the utilization of skilled delivery services among women of reproductive age in Nigeria. Methods: A cross-sectional mixed-methods design was adopted, combining quantitative surveys and qualitative interviews with 1,200 expectant and recently delivered women across urban, semi-urban, and rural areas. Quantitative data were analyzed using descriptive and inferential statistics in SPSS, while thematic analysis was applied to qualitative interviews and focus group discussions. Results: Only 46.8% of women reported delivering with a skilled birth attendant. Low maternal education (AOR = 2.41, p < 0.01), poverty (AOR = 1.96, p < 0.05), and rural residence (AOR = 2.73, p < 0.01) were significant predictors of unskilled delivery. Cultural beliefs that regarded childbirth as a spiritual or domestic event influenced nearly 61% of respondents, while financial constraints (58%) and poor transport (42%) were the most cited access barriers. Availability of community-based midwives or mobile clinics increased skilled birth attendance to over 70% in covered areas. Conclusion: The persistence of unskilled delivery practices in Nigeria reflects a complex interplay of socio-cultural norms, economic constraints, and systemic inequities. Effective maternal health interventions must therefore be locally adapted, equity-driven, and culturally responsive. Strengthening rural infrastructure, integrating TBAs into supervised care systems, and ensuring policy enforcement can advance progress toward Sustainable Development Goal 3 on maternal and neonatal health. 

Keywords

maternal health, skilled birth attendance, healthcare access, traditional birth attendants, socio-cultural barriers, maternal mortality, health policy, Nigeria