A Comprehensive Model of Maternal Health Behaviour: The Interplay of Socio-Demographic and Digital Determinants in Nigeria

Abstract This study develops an integrated model to identify significant socio-demographic and digital determinants of maternal health service utilisation among married women in Nigeria. A cross-sectional analysis of data from the 2018 Nigeria Demographic and Health Survey (NDHS) was conducted on 28,888 married women aged 15 to 49. All analyses were conducted using the Complex Samples module in IBM SPSS Statistics, applying design-corrected variance estimation appropriate for the stratified cluster design of the NDHS. The design-weighted prevalence of 6 or more antenatal care (ANC) visits was 25.0%, and the prevalence of facility-based delivery was 28.7%. A comprehensive multivariate binary logistic regression model assessed influences on both outcomes. Higher education (OR = 2.00, 95% CI: 1.64–2.44 for ANC; OR = 2.40, 95% CI: 1.95–2.96 for facility delivery) and household wealth (richest quintile OR = 1.55, 95% CI: 1.26–1.90 for ANC; OR = 2.65, 95% CI: 2.17–3.25 for facility delivery) were the strongest determinants. Mobile phone ownership was consistently and positively associated with both outcomes (OR = 1.29, 95% CI: 1.16–1.43 for ANC; OR = 1.36, 95% CI: 1.24–1.49 for facility delivery). Internet use was independently and positively associated with ANC attendance (OR = 1.64, 95% CI: 1.30–2.07), while frequent internet use was independently and negatively associated with ANC attendance (OR = 0.60, 95% CI: 0.47–0.76). Mobile financial transactions were associated with significantly lower odds of facility delivery (OR = 0.78, 95% CI: 0.69–0.89). A complex interplay of structural inequities and digital influences shapes maternal health behaviour in Nigeria. Policies must be multi-sectoral, addressing foundational determinants such as education and wealth, while recognising that the impact of digital technology on health choices is not uniformly linear.