Nigeria’s home birth rate hits 58 percent, highest in North-West —Study

Home birth remains highly prevalent in Nigeria, with 58.1% of mothers gave birth at home, and often without skilled attendance or timely access to emergency obstetric care.

In a comparative study, researchers reported that the prevalence of home birth is twice as high in rural areas compared to urban areas; and the North-West region recorded the highest prevalence of home birth nationally (83.6%), in rural areas (89.4%), and in urban areas (66.6%).

The study included Emmanuel O. Adewuyi, Asa Auta, Olumuyiwa Omonaiye, and others in the journal, PLoS One.

Across all regions, except the South-East, rural areas consistently reported higher home birth prevalence than urban areas. Notably, in the South-East region, home birth was slightly higher in urban settings than in rural areas.

In all settings, the Hausa-Fulani ethnic group had the highest home birth prevalence (82.7% in the overall, 88.5% in rural and 66.1% in urban areas) compared to other ethnic groups.

The researchers’ analysis of the data from the cross-sectional Nigerian Demographic and Health Survey (NDHS) 2018 indicated that the lowest prevalence in rural areas was observed in the South-East (16.2%), while the South-West had the lowest in urban areas (16.7%).

According to the study, at the national level and across all settings, factors such as low maternal and husband’s education, poor household wealth, fewer than eight antenatal contacts, higher birth order, Hausa-Fulani ethnicity, and limited exposure to media (radio and television) and the internet were associated with higher odds of home birth.

In rural areas, additional predictors included difficulty obtaining permission, distance to health facilities, limited decision-making autonomy, and significant regional disparities, especially in the North and South-South regions.

In urban areas, young maternal age, Islamic religion, financial barriers, and poor or middle household wealth were uniquely associated with higher odds of home birth.

The researchers said that although current figures represent a modest decline from the 2013 estimates, the prevalence remains one of the highest globally.

The national estimate exceeds that of many African countries and is more than twice the global average of 28%, reflecting only marginal improvements despite interventions implemented over the past decades.

According to the researchers, “reducing home births requires a comprehensive approach that addresses the interplay of factors identified in this study. From a social justice and health determinants perspective, these factors are interconnected and can influence both access to and use of services.

“In rural areas, policies should enhance women’s decision-making autonomy, reduce distance barriers, and address region-specific challenges (e.g., insecurity in northern regions). In urban areas, it is essential to address financial barriers, support young mothers, and provide culturally and religiously sensitive care.

“Nationally, efforts should focus on improving education, expanding and strengthening antenatal care, and increasing access to media and the internet.

“From an equity perspective, interventions must be tailored to specific contexts to reduce unsafe home births and ensure that all mothers, regardless of location, have equitable access to skilled, respectful, and high-quality childbirth care,” they said.

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