Examining demand and supply factors associated with women's preferences for where to deliver their babies in rural and urban communities of Enugu State, Nigeria

Utilization of maternal health services is largely influenced by women's preferences for service providers. This study examined the factors that influence women's preferences for where to deliver their babies. The study was conducted in three urban and three rural communities in Enugu State, Nigeria using a mix of cross-sectional household survey and exploratory focus group discussions. The survey was conducted among 551 women. Six focus group discussions were conducted with a subset of the survey participants. Bivariate analysis was done to determine the relationship between independent variables (marital status, tribe, level of education, employment status, and cost of service) and women's preferences for where to deliver their babies. Thematic analysis was performed for the qualitative data. Findings showed that government hospital (43.0%) and private hospital (37.5%) were most preferred among women in urban areas. While primary health centre was favoured among women in rural areas (38.7%). The variation among women in urban and rural areas was statistically significant (p < 0.05). Women's preference for where to deliver was associated with supply-side factors of affordability of care, provider attitude and skills, availability of equipment and security (p < 0.01), and demand-side factors of educational level, employment status and parity (p < 0.05). Women's preferences for where to deliver vary by geographic locations and are influenced by demand and supply-side factors. These factors should be taken into consideration when designing maternal health programs.