ArticleBMC pregnancy and childbirth2026
Decomposition analysis and spatial change of age disparities in antenatal care utilisation among women with high-risk pregnancies in Nigeria.
Article in BMC pregnancy and childbirth, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDespite global efforts to reduce maternal deaths and stillbirths, these remain critical issues in low- and middle-income countries, particularly in sub-Saharan Africa. Nigeria faces a disproportionately high burden, exacerbated by suboptimal receipt of essential antenatal care (ANC) content, especially among high-risk groups like young women (< 18 years) and women of advanced maternal age (> 35 years). Thus, this study examined the age disparities in the receipt of Optimal ANC content among women with high-risk pregnancies in Nigeria.
methodsThis study analysed data from the 2003, 2008, 2013, and 2018 Nigeria Demographic and Health Surveys (NDHS). Using multi-stage sampling, data were collected from women aged 15-49 years, focusing on those with high-risk pregnancies (below 18 or above 35 years). The analysis included descriptive statistics, spatial mapping of optimal ANC utilisation using Bayesian models, and a multivariate non-linear decomposition model to explore age disparities in the receipt of optimal ANC content. Weighted analysis accounted for survey design complexity, with statistical assessments performed using Stata 17.0 and spatial analysis in R.
resultsReceipt of optimal ANC content among women with high-risk pregnancies in Nigeria remained low but showed a gradual increase from 2003 to 2018. In 2003, the rate of receipt was negligible across all states, and by 2008, Sokoto recorded the highest rate at 21%. Women of advanced maternal age consistently reported higher receipt of optimal ANC content, rising from 1% in 2003 to 48.7% in 2018, compared with younger mothers whose rate increased from 0% to 38% over the same period. Decomposition analysis revealed disparities were largely explained by socio-demographic factors, with education (16.5%) and marital status (38%) being the strongest contributors. CONCLUSIONS AND RECOMMENDATIONS: This study shows persistently low receipt of optimal ANC content among women with high-risk pregnancies in Nigeria, with adolescents particularly disadvantaged. Targeted interventions should prioritise youth-friendly ANC services, community-based outreach in rural areas, and conditional cash transfers to reduce financial barriers. Expanding educational programmes for women with limited schooling and strengthening health system equity policies are also essential in improving access. Future studies should investigate age-specific disparities in pregnancy outcomes, regional barriers to ANC quality, and the effectiveness of adolescent-friendly models.
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