Birth preparedness and complications readiness among women in a cosmopolitan city in western Nigeria: a mixed-methods cross-sectional study

Abstract Background Low- and middle-income countries bear a significant burden of the global maternal and neonatal mortality. Birth preparedness and complications readiness (BP/CR) reduces the risk of preventable deaths. Objective To assess BP/CR and predictors among recently delivered women in urban Lagos, southwest Nigeria. Methods This was a mixed-methods cross-sectional, community-based study involving urban women who delivered within two years prior to study. Recruitment was by multistage sampling method. Quantitative data were collected from 790 women using a validated questionnaire. Respondents’ level of BP/CR was measured using key components of BP/CR. Summary and inferential statistics were done. Predictors of BP/CR were determined by multivariable regression analysis. Focus group discussions (FGDs) were used to collect exploratory qualitative data using a semi-structured interview guide and were analyzed thematically. Results Mean age of 790 respondents was 31.1 years (SD 1.8). About 78% utilized formal antenatal care services and institutional delivery (74.6%) in their last pregnancy. Reported counselling on BP/CR was inadequate. Only 26.6% (95% CI 23.5 to 29.7) met three out of the four key BP/CR components hence ‘well prepared’ − 94.8% saved money towards the baby’s birth, 33.5% identified mode of transport ahead of labour or emergency, 29% identified health facility (HF) or skilled birth attendant (SBA) for delivery, and 9.4% identified blood donor for emergency. The predictors of being ‘well prepared’ were, older age ≥ 30 years (AOR: 1.80; 95% CI: 1.25, 2.59), Yoruba ethnicity (AOR: 1.49; 95% CI: 1.04, 2.11), monthly income/allowance of less than the minimum wage (AOR: 1.73; 95% CI: 1.23, 2.42), lower parity < 5 (AOR: 2.96; 95% CI: 1.28, 6.86), final decision on BPCR by mother or relatives (AOR: 2.00; 95% CI: 1.00, 4.00), recent delivery in the last six months prior to study (AOR: 1.64; 95% CI: 1.11, 2.43), previous delivery in HF (AOR: 1.58; 95% CI: 1.05, 2.36), and receiving counselling on facility delivery/SBA (AOR: 1.64; 95% CI: 1.15, 2.34). FGDs revealed that traditional obligations, bureaucratic delays, inadequate finance, and poor health worker attitudes, constitute challenges to adequate BP/CR practice. Conclusion The urban women were not prepared for birth and possible complications. There is urgent need for integrated interventions that address individual, family, community, and health system barriers to BP/CR practice to reduce maternal and newborn deaths and achieve sustainable development goals (SDG) 3.