Determinants of antenatal care utilization among women in Nigeria using data from the 2023/2024 demographic and health survey

Abstract Introduction Despite global efforts, inadequate antenatal care (ANC) utilization remains a significant public health challenge in Nigeria. This study examined the determinants of ANC utilization using the 2023/2024 Nigeria Demographic and Health Survey (NDHS). Methods A secondary analysis of 13,026 pregnancies from the NDHS Pregnancy Recode file was conducted. ANC utilization was categorized as no ANC, some ANC (1–7 visits), and appropriate ANC (≥ 8 contacts in line with WHO recommendations). Independent variables included maternal age, residence, region, religion, education, partner’s education and occupation, wealth index, and perceived distance to health facilities. Multinomial logistic regression was used to estimate Relative Risk Ratios (RRR) with 95% confidence intervals (CI), accounting for survey weights, stratification, and clustering. Results Overall, 27.8% of women received no ANC, 54.9% received partial ANC, and 17.3% received appropriate ANC. Adolescents aged 15–19 were significantly less likely to receive appropriate ANC compared to women aged 45–49 (RRR = 0.47; 95% CI: 0.27–0.80). Urban residents were more likely to utilize some ANC (RRR = 3.24; 95% CI: 2.93–3.58) and appropriate ANC (RRR = 11.52; 95% CI: 10.16–13.06) compared to rural residents. Women with no education and those from poorer households were significantly less likely to utilize ANC services, while higher maternal and partner education were strongly associated with increased utilization. Distance to health facilities remained a significant barrier. Conclusion ANC utilization in Nigeria remains suboptimal, with marked socio-economic and geographic inequalities. Targeted interventions focusing on rural populations, adolescents, and socioeconomically disadvantaged women are essential to improve equitable access to maternal healthcare services.