Path of Science: International Electronic Scientific Journal

Maternal mortality remains a major public health and socioeconomic challenge, with Nigeria contributing disproportionately to the global maternal death index. Although largely preventable, many women, especially in rural areas, face barriers such as limited access to skilled care, cultural practices, poverty, and inadequate health infrastructure. This study examines the determinants of antenatal care (ANC) utilisation among pregnant women in the Makurdi area of Nigeria, focusing on awareness, socioeconomic and health system factors, and cultural influences. The researchers used a descriptive survey design guided by the Health Belief Model (HBM). The researchers selected a sample of 300 pregnant women aged 18–45 years from a study population of 1,327 women registered for ANC. Data were collected through systematic and simple random sampling from three major facilities — Benue State University Teaching Hospital, Federal Medical Centre Wadata, and Bishop Murray Medical Centre — using a validated, structured questionnaire. Results show high awareness of ANC services, but utilisation is limited by socioeconomic constraints (spousal support, transport, and work schedules), health system challenges (accessibility and quality of facilities), and cultural beliefs (patriarchal control and religious restrictions). The study concludes that while ANC is essential, socioeconomic and cultural barriers in Nigeria, particularly in Makurdi, hinder effective utilisation. It recommends community-based education, financial support for ANC, improved healthcare facilities and staffing, and culturally sensitive programs that engage community leaders to address these barriers.

Maternal Mortality; Antenatal Care; Socioeconomic Factors; Health System Determinants; Cultural Beliefs; Public Health; Healthcare; Health Belief Model; HBM; Makurdi

1. Daily Trust. (2021). Why Nigeria's Maternal Mortality is Amongst the Highest In The World. Retrieved from https://dailytrust.com/why-nigerias-maternal-mortality-amongst-highest-in-the-world/

2. WHO. (2025). Maternal mortality. Retrieved from https://www.who.int/news-room/fact-sheets/detail/maternal-mortality

3. Narain, S., & McEwan, A. (2023). Antenatal assessment of fetal well-being. Obstetrics Gynaecology & Reproductive Medicine, 33(8), 217–224. doi: 10.1016/j.ogrm.2023.05.002

4. UNICEF. (2024). Antenatal care is essential for protecting the health of women and their unborn children. Retrieved from https://data.unicef.org/topic/maternal-health/antenatal-care/

5. Alukagberie, M. E., Elmusharaf, K., Ibrahim, N., & Poix, S. (2023). Factors associated with adolescent pregnancy and public health interventions to address in Nigeria: a scoping review. Reproductive Health, 20(1). doi: 10.1186/s12978-023-01629-5

6. Shibre, G., Zegeye, B., Idriss-Wheeler, D., & Yaya, S. (2020). Factors affecting the utilisation of antenatal care services among women in Guinea: a population-based study. Family Practice, 38(2), 63–69. doi: 10.1093/fampra/cmaa053

7. Oluseye, A. O. (2021). Exploring the lived experiences of unmarried young mothers in South-Western Nigeria. (Thesis; The Open University UK)

8. Bintabara, D., & Mwampagatwa, I. (2023). Socioeconomic inequalities in maternal healthcare utilisation: An analysis of the interaction between wealth status and education using population-based surveys in Tanzania. PLOS Global Public Health, 3(6), e0002006. doi: 10.1371/journal.pgph.0002006

9. Fagbamigbe, A. F., Olaseinde, O., & Fagbamigbe, O. S. (2021). Timing of first antenatal care contact, its associated factors and state-level analysis in Nigeria: a cross-sectional assessment of compliance with the WHO guidelines. BMJ Open, 11(9), e047835. doi: 10.1136/bmjopen-2020-047835

10. Lateef, M. A., Kuupiel, D., Mchunu, G. G., & Pillay, J. D. (2024). Utilisation of antenatal care and skilled birth delivery services in Sub-Saharan Africa: A Systematic Scoping review. International Journal of Environmental Research and Public Health, 21(4), 440. doi: 10.3390/ijerph21040440

11. Samuel, M. M., James, G., & James, A. A. (2024). Utilisation of maternal healthcare services and maternal mortality among women in rural communities in Nasarawa state, Nigeria. Polac Economic and Management Sciences Journal, 4(1),

12. Ajayi, A. I., & Akpan, W. (2020). Maternal health care services utilisation in the context of 'Abiye' (safe motherhood) programme in Ondo State, Nigeria. BMC Public Health, 20(1). doi: 10.1186/s12889-020-08512-z

13. Ikemeh, C., Adeyemi, A. O., Arogundade, K., Frerichs, L. M., Shea, C. M., & Trogdon, J. G. (2025). Assessing the antenatal care-seeking determinants associated with the penetration of the WHO eight-visit antenatal care policy across states in Nigeria. BMC Pregnancy and Childbirth, 25(1). doi: 10.1186/s12884-025-07713-x

14. Adedokun, S. T., Uthman, O. A., & Bisiriyu, L. A. (2023). Determinants of partial and adequate maternal health services utilisation in Nigeria: analysis of a cross-sectional survey. BMC Pregnancy and Childbirth, 23(1). doi: 10.1186/s12884-023-05712-4

15. McCauley, H., Lowe, K., Furtado, N., Mangiaterra, V., & Van Den Broek, N. (2021). What are the essential components of antenatal care? A systematic review of the literature and development of signal functions to guide monitoring and evaluation. BJOG an International Journal of Obstetrics & Gynaecology, 129(6), 855–867. doi: 10.1111/1471-0528.17029

16. Albarqi, M. N. (2025). The Impact of Prenatal care on the Prevention of neonatal Outcomes: A Systematic Review and Meta-Analysis of Global Health Interventions. Healthcare, 13(9), 1076. doi: 10.3390/healthcare13091076

17. Bishnoi, S., Yadav, P., & Malik, P. (2020). Care during pregnancy – A review. In book: Research Trends in Home Science and Extension, 4 (pp.57-74). AkiNik Publications doi: 10.22271/ed.book.960

18. Al-Mutawtah, M., Campbell, E., Kubis, H., & Erjavec, M. (2023). Women's experiences of social support during pregnancy: a qualitative systematic review. BMC Pregnancy and Childbirth, 23(1). doi: 10.1186/s12884-023-06089-0

19. Ekelöf, K., Tangen, G. A., Nyström, C. D., Löf, M., & Thomas, K. (2025). Mental well-being during pregnancy and the transition to motherhood: an explorative study through the lens of healthcare professionals. BMC Pregnancy and Childbirth, 25(1). doi: 10.1186/s12884-025-07894-5

20. Girardi, G., Longo, M., & Bremer, A. A. (2023). Social determinants of health in pregnant individuals from underrepresented, understudied, and underreported populations in the United States. International Journal for Equity in Health, 22(1). doi: 10.1186/s12939-023-01963-x

21. Pascual, Z. N., & Langaker, M. D. (2023). Physiology, pregnancy. StatPearls Publishing.

22. Bhumi, M. A., & Chajhlana, S. P. S. (2018). Knowledge of obstetric danger signs among pregnant women attending the antenatal clinic at the rural health training centre of a medical college in Hyderabad. International Journal of Community Medicine and Public Health, 5(6), 2471. doi: 10.18203/2394-6040.ijcmph20182179

23. Owoseni, J. S. (2016). Factors affecting the utilisation of antenatal care among pregnant women in Moba LGA of Ekiti State, Nigeria. International Journal of Traditional and Complementary Medicine, 1(1), 20–30.

24. Saad–Haddad, G., DeJong, J., Terreri, N., Restrepo–Méndez, M. C., Perin, J., Vaz, L., Newby, H., Amouzou, A., Barros, A. J., & Bryce, J. (2016). Patterns and Determinants of Antenatal Care Utilisation: Analysis of National Survey Data in Seven Countdown Countries. Journal of Global Health, 6(1). doi: 10.7189/jogh.06.010404

25. Mgata, S., & Maluka, S. O. (2019). Factors for late initiation of antenatal care in Dar es Salaam, Tanzania: A qualitative study. BMC Pregnancy and Childbirth, 19(1). doi: 10.1186/s12884-019-2576-0

26. Rwabilimbo, A. G., Ahmed, K. Y., Page, A., & Ogbo, F. A. (2020). Trends and factors associated with the utilisation of antenatal care services during the Millennium Development Goals era in Tanzania. Tropical Medicine and Health, 48(1). doi: 10.1186/s41182-020-00226-7

27. Jiwani, S. S., Amouzou-Aguirre, A., Carvajal, L., Chou, D., Keita, Y., Moran, A. C., Requejo, J., Yaya, S., Vaz, L. M., & Boerma, T. (2020). Timing and number of antenatal care contacts in low and middle-income countries: Analysis in the Countdown to 2030 priority countries. Journal of Global Health, 10(1). doi: 10.7189/jogh.10.010502

28. Adewuyi, E. O., Auta, A., Adewuyi, M. I., Philip, A. A., Olutuase, V., Zhao, Y., & Khanal, V. (2024). Antenatal care utilisation and receipt of its components in Nigeria: Assessing disparities between rural and urban areas—A nationwide population-based study. PLoS ONE, 19(7), e0307316. doi: 10.1371/journal.pone.0307316

29. Ntoimo, L. F. C., Okonofua, F. E., Ekwo, C., Solanke, T. O., Igboin, B., Imongan, W., & Yaya, S. (2021). Why women utilise traditional rather than skilled birth attendants for maternity care in rural Nigeria: Implications for policies and programs. Midwifery, 104, 103158. doi: 10.1016/j.midw.2021.103158

30. Oladele, R., Ojo, E., Okoduwa, G. E., Olajide, O. A., Olufadewa, I., & Adesina, M. (2024). Utilisation of antenatal care by young mothers and adolescents in Nigeria. Deleted Journal, 21(1). doi: 10.1186/s12982-024-00335-2

31. Opara, U. C., Iheanacho, P. N., & Petrucka, P. (2025). Visible and invisible cultural patterns influencing women's use of maternal health services among Igala women in Nigeria: a focused ethnographic study. BMC Public Health, 25(1). doi: 10.1186/s12889-025-21275-9

32. Igbokwe, C. C., Ihongo, J. T., Abugu, L. I., Iweama, C. N., & Ugbelu, J. (2024). Influence of cultural beliefs on the utilisation of integrated maternal, newborn, and child health services in Benue State, Nigeria. Cureus. doi: 10.7759/cureus.52808

33. Abimbola, J. M., Makanjuola, A. T., Ganiyu, S. A., Babatunde, U. M. M., Adekunle, D. K., & Olatayo, A. A. (2017). Pattern of utilisation of ante-natal and delivery services in a semi-urban community of North-Central Nigeria. African Health Sciences, 16(4), 962. doi: 10.4314/ahs.v16i4.12

34. Glanz, K., Rimer, B. K., & Viswanath, K. (2015). Health Behaviour: Theory, Research and Practice. John Wiley & Sons.

35. Zampetakis, L. A., & Melas, C. (2021). The health belief model predicts vaccination intentions against COVID‐19: A survey experiment approach. Applied Psychology Health and Well-Being, 13(2), 469–484. doi: 10.1111/aphw.12262

36. Gautam, N., Dessie, G., Rahman, M. M., & Khanam, R. (2023). Socioeconomic status and health behaviour in children and adolescents: a systematic literature review. Frontiers in Public Health, 11. doi: 10.3389/fpubh.2023.1228632

37. Ruggeri, S. Y., Emerson, A., & Russell, C. L. (2023). A concept analysis of routines for improving health behaviours. International Journal of Nursing Sciences, 10(3), 277–287. doi: 10.1016/j.ijnss.2023.06.004

38. Ngobua, S. J., Omuemu, V. O., Ande, A. B., Olaleye, O. S., Awunor, N. S., & Ieren, I. I. (2024). Adolescent reproductive health care services: knowledge, perspectives, and challenges among service providers in Makurdi, Benue State, Nigeria. African Journal of Reproductive Health, 28(10), 131–140. doi: 10.29063/ajrh2024/v28i10.13

39. Asaju, K., & Tachia, J. (2025). Effect of Insecurity on Economic Development in the Makurdi and Guma LG Areas of Benue State. SSR Journal of Arts, Humanities and Social Sciences

40. Shaibu, O., Omokaro, G. O., Onyamoche, E. P., Tafese, G. T., Nafula, Z. S., Niambe, O. K., & Nnoli, E. C. (2025). Assessment of urbanisation's environmental impact in Makurdi Metropolis, Benue State, Nigeria. International Journal of Environmental Impacts, 8(2), 393–400. doi: 10.18280/ijei.080218

41. Merga, B. T., Raru, T. B., Deressa, A., Regassa, L. D., Gamachu, M., Negash, B., Birhanu, A., Turi, E., & Ayana, G. M. (2023). The effect of health insurance coverage on antenatal care utilisation in Ethiopia: evidence from a national survey. Frontiers in Health Services, 3. doi: 10.3389/frhs.2023.1101164

42. Madu, U. A., & Nworie, C. S. (2022). Influence of Ethnocentric Billboard Advertising Messages on Product Consumption in Nigeria: A Study of Hero Lager. Path of Science, 8(5), 7001–7011. doi: 10.22178/pos.81-13

43. Bashir, S., Ansari, A. H., & Sultana, A. (2023). Knowledge, Attitude, and Practice on Antenatal Care Among Pregnant Women and Its Association With Sociodemographic Factors: A Hospital-Based Study. Journal of Patient Experience, 10. doi: 10.1177/23743735231183578

44. Kruk, M. E., Gage, A. D., Joseph, N. T., Danaei, G., García-Saisó, S., & Salomon, J. A. (2018). Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries. The Lancet, 392(10160), 2203–2212. doi: 10.1016/s0140-6736(18)31668-4

45. Oluoch, F., Ayodo, G., Owino, F., & Okuto, E. (2020). Modelling the impact of travelling time on the utilisation of maternity services using routine health facility data in Siaya County, western Kenya. American Journal of Geographic Information Systems, 9(1), 1–12. doi: 10.5923/j.ajgis.20200901.01

46. Mshelia, S. E., Analo, C. V., & Booth, A. (2020). Factors influencing the utilisation of facility-based delivery in Nigeria: a qualitative evidence synthesis. Journal of Global Health Reports, 4. doi: 10.29392/001c.17961

47. Madu, U. A. (2021). Effectiveness of social media in unifying fragmented Nigerian societies. Path of Science, 7(12), 3001–3010. doi: 10.22178/pos.77-5