Abstract
BackgroundNigeria is experiencing a high level of urbanization and urban poverty. Within Nigeria maternal and child health and family planning outcomes may differ by residence (capital city, urban/non-capital city and rural) as well as by measures of women’s empowerment and wealth. This paper presents a detailed analysis of maternal and child health and family planning outcomes in Plateau State, Nigeria.MethodsData came from the 2017 Nigerian Urban Reproductive Health Initiative Sustainability Study. Multivariable logistic regression was used to study the associations between the key independent variables of residence, women’s empowerment and wealth with having a skilled birth attendant at childbirth and childhood preventative visits. The women’s empowerment variables included perceptions about household decision-making, financial decision-making, views on wife beating and having a prohibition, defined as a restriction on specific activities imposed by a woman’s husband. Multinomial regression was used to study the association of the same factors with the family planning outcome which had three categories – no use, traditional method use and modern method use. Regressions were also run separately for urban and rural populations.ResultsWomen in the capital city of Jos were significantly more likely to have a skilled birth attendant at childbirth, take a child to a preventative visit and use family planning than women in rural areas of Plateau State. Three of the four measures of empowerment (household decision-making, financial decision-making and having a prohibition) were significantly associated with the family planning outcome, while having a prohibition was negatively associated with having a skilled birth attendant at childbirth. In rural areas, women involved in financial decisions were significantly less likely to use a modern method compared to a traditional method. Wealth was a significant factor for all outcomes.DiscussionState-level analyses can provide valuable information to inform programs and policies at a local level. Efforts to improve use of maternal and child health and family planning services in Plateau state, Nigeria, should consider women’s empowerment, residence and poverty. Community education on the effectiveness of modern versus traditional methods and potential side effects of specific modern methods, may help women make informed decisions about contraception.
Highlights
Nigeria is experiencing a high level of urbanization and urban poverty
In 2018, the total fertility rate (TFR) in Nigeria stood at 5.3 births per woman and the unmet need for family planning among currently married women was 18.9% [4]
Of women with a live birth in the past 5 years, 61% of urban women compared to 26% of rural women delivered their baby in a health facility according to the 2018 Nigeria Demographic and Health Survey [4]
Summary
Within Nigeria maternal and child health and family planning outcomes may differ by residence (capital city, urban/non-capital city and rural) as well as by measures of women’s empowerment and wealth. This paper presents a detailed analysis of maternal and child health and family planning outcomes in Plateau State, Nigeria. Even within urban areas there are distinctions given that there is a high level of urban poverty About 54% of the urban population in Nigeria lives in slum settings according to the United Nations [5]. Half of the Nigerian population lives in urban areas [9] Given these demographic and cultural shifts, differences in health outcomes are more complex than a simple urbanrural distinction, and other factors, including women’s empowerment and poverty level, should be considered
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