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Healthcare-Seeking Costs and Delayed Access to Maternal Healthcare Services Among Pregnant Women in Abakaliki Metropolis, Nigeria

Nwagidi Martina Dorathy, C. C. Nnamani, K. E. Uma

Abstract

Objective: To examine the independent effect of healthcare-seeking costs on maternal care access delays among women of reproductive age in Abakaliki metropolis, Ebonyi State, Nigeria. Methods: A descriptive cross-sectional survey was conducted among 390 women aged 15–49 years with at least one pregnancy outcome in the preceding five years. Multi-stage sampling was applied across four healthcare catchment areas. Data were collected via structured interviewer- administered questionnaire (Cronbach's α = .866). Bivariate associations were assessed using Pearson chi-square and Cramér's V; binary logistic regression identified independent predictors of care-seeking delay. Model adequacy was evaluated with likelihood-ratio chi-square, pseudo R2, AUC-ROC, and Hosmer-Lemeshow tests. Analyses were performed in Stata and SPSS version 24. Results: Among women reporting unaffordable costs, 75.1% experienced care delays versus 31.1% with affordable costs (χ2 = 75.808, p < 0.001; Cramér's V = 0.441). Healthcare cost perception was the strongest delay predictor (OR = 13.709; 95% CI: 7.039–26.701; p < 0.001), followed by income constraint (OR = 6.078; 95% CI: 3.226–11.453; p < 0.001). Educational attainment was the strongest protective factor, reducing delay odds by 79% per unit increase (OR = 0.214; 95% CI: 0.151–0.304; p < 0.001). Older age was positively associated with delay (OR = 1.467; 95% CI: 1.163–1.850; p = 0.001). The model demonstrated strong predictive performance (LR χ2(4) = 204.74; Pseudo R2 = 0.403; AUC = 0.893). Conclusion: Healthcare-seeking costs are the most powerful barrier to timely maternal care in Abakaliki metropolis, increasing delay odds nearly fourteen-fold. A critical gap exists between free maternal service policies and implementation reality. Targeted interventions addressing transport subsidies, fee waiver enforcement, and health literacy are urgently needed to reduce preventable maternal morbidity and mortality.

Keywords

Maternal Healthcare; healthcare-seeking costs; antenatal care delay; Ebonyi State; Nigeria

References

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