The Role of Health Insurance Coverage in Reducing Neonatal Mortality in Nigeria: An Analytical Study

Neonatal mortality remains a major contributor to under-five deaths in Nigeria despite ongoing health reforms. Financial barriers to maternal healthcare access have been shown to increase neonatal deaths, particularly among uninsured households. This study investigates the role of health insurance coverage in reducing neonatal mortality using nationally representative datasets.Secondary data from the 2018 and 2023 Nigeria Demographic and Health Surveys (NDHS) were analysed. Weighted logistic regression models examined the association between maternal health insurance coverage and neonatal mortality (death within 28 days of life). Control variables included maternal age, education, region, residence, parity, and socioeconomic status. Data were analysed using Stata 17 following DHS complex survey design protocols.The pooled sample included 38,214 live births. Neonatal mortality declined from 39 deaths per 1,000 live births (2018) to 32 deaths per 1,000 (2023). Insurance coverage increased from 3.6% to 8.2% nationally. Adjusted logistic regression showed insured mothers had 41% lower odds of neonatal death compared to uninsured counterparts (AOR = 0.59; 95% CI 0.45–0.78; p < 0.001). Regional disparities remained, with the North-East recording the highest mortality. Expanding health insurance coverage can significantly reduce neonatal mortality by improving access to skilled delivery and postnatal care. Universal Health Coverage (UHC) policies must prioritize maternal enrolment in insurance schemes