Determinants of Adequate Antenatal Care Utilisation and its Association with Women’s Experiences of Maternal Health Services in Kwara State, Nigeria: A Mixed-Methods Study

Abstract

Background: Adequate antenatal care (ANC) protects maternal and newborn health, yet many Nigerian women do not receive it. Beyond access, women’s experiences may influence completion of recommended visits. No state-wide estimate of adequate ANC or its link with women’s experiences exists for Kwara State. Objective: To estimate adequate ANC prevalence, identify determinants, and assess association with women’s experiences of maternal health services in Kwara State, Nigeria. Methods: A community-based, sequential explanatory mixed-methods study was conducted among women aged 15–49 with a live birth in the preceding two years. A multistage stratified cluster sample was drawn from six local government areas across three senatorial districts. Interviewer-administered questionnaires collected data. Adequate ANC was defined as ≥4 visits with all core components (blood pressure, urine test, blood test, ≥2 tetanus toxoid doses, ≥1 intermittent preventive malaria treatment). Experiences (respect, communication, waiting time, satisfaction) were scored 8–32. Chi-square tests and binary logistic regression were used; 22 in-depth interviews and 10 key informant interviews were analysed thematically. Results: Of 420 questionnaires, 408 (97.1%) were analysed. Adequate ANC was achieved by 43.6% (95% CI 38.7–48.6); only 28.7% began ANC in the first trimester. Prevalence was higher among urban (52.8%) than rural (36.6%) women, and highest in Kwara Central (52.1%), followed by Kwara South (42.6%) and Kwara North (34.6%). Determinants included tertiary education (AOR 8.03; 3.72–17.31), richest wealth quintile (AOR 5.49; 2.52–11.97), health insurance (AOR 2.52; 1.09–5.83), distance >5 km (AOR 0.32; 0.17–0.60), waiting >2 hours (AOR 0.17; 0.08–0.38), drug stock-outs (AOR 0.22; 0.11–0.44) and age 15–19 (AOR 0.41; 0.18–0.95). Good experiences increased odds of adequate ANC 8.06-fold (3.82–17.01); moderate experiences, 3.24-fold (1.58–6.64). Qualitative data cited cost, transport, long waits, disrespectful care, stock-outs and limited spousal support. Conclusions: Fewer than half of women receive adequate ANC, with geographic and socioeconomic gaps. Poor experiences, long waits and stock-outs were strongly associated with inadequate ANC. Interventions should combine access measures with respectful, efficient, well-supplied services. Causal inference is limited by the cross-sectional design.