Maternal High-Risk Birth Behaviour in Nigeria: A Multilevel Multinomial Analysis of the 2021 Multiple Indicator Cluster Survey Data

Abstract

Maternal high-risk birth behaviours (MHRBBs) has been linked to adverse maternal and child health outcomes. MHRBBs have been measured using three indicators; the maternal age at first birth (< 18 years and > 34 years), shorter and longer birth intervals (< 24 months and > 59 months), and a higher number of live births (4 birth orders or higher) order. This study examined the prevalence of MHRBBs and examined their contextual determinants among ever married women (15-49 years) in Nigeria. This was with the view to provide valuable insights into how individual and contextual determinants are associated with high-risk birth behaviour in Nigeria. A secondary dataset from a population-based cross-sectional study design was extracted from the 2021 Nigeria UNICEF Multiple Indicator Cluster Survey (MICS) and used for this study. A weighted sample size of 24,241 women who had a recent birth within the 5 years preceding the 2021 MICS was analysed. Charts and percentage distributions were used to describe the data. The associations between contextual determinants and high-risk birth behaviours were determined using Pearson’s chi-square test, and a multilevel multinomial logistic regression analysis was carried out to identify predictors of high-risk birth behaviours in Nigeria. The adjusted odds ratio (AOR) with 95% confidence interval (CI) was presented at a p<0.05 level of significance.  Two-fifths (40%) of births were identified as having no risk, one-third (34%) had a single risk, and more than a quarter (26%) had multiple risk factors. There were more Northern women with multiple risks (29%) than their Southern counterparts (22%). Women aged 35+ are about 14 times experiencing single risk (RRR=13.79, p<0.001, CI [11.22-16.94]) compared to the lesser age group. Also, the chances of experiencing single and multiple risks reduce as the education level increases, Women who are using contraceptives have higher chances of experiencing single risk (RRR=1.26, p<0.001, 95% CI [1.11-1.42]) and multiple risks (RRR=1.56, p<0.001, CI [1.30-1.88]) than their counterparts who are not using contraceptives. The study has established a strong relationship between individual, household and community-level factors and maternal high risk behaviours. Thus, policymakers and stakeholders should design interventions that take into account the factors that predispose women to have high-risk birth behaviours particularly women who reside in areas with a high proportion of high-risk birth behaviours.