Barriers to Institutional Delivery and Postnatal Mental Health Support Among Mothers in Rural Sokoto State, North West Nigeria

Institutional delivery is a critical opportunity to identify and address postnatal mental health needs, yet in rural North West Nigeria, home delivery rates remain high and postnatal psychiatric support is virtually absent. This study examines barriers to institutional delivery and their relationship to postnatal mental health support among rural mothers in Sokoto State. A mixed-methods cross-sectional design will recruit 180 mothers with children under six months in four rural local government areas through community sampling. The Edinburgh Postnatal Depression Scale (EPDS) will screen for postnatal depression, and a structured questionnaire will assess delivery location, reasons for non-institutional delivery, and postnatal support received. Eight in-depth interviews will explore cultural and logistical barriers from the perspective of mothers and traditional birth attendants. Binary logistic regression will examine predictors of non-institutional delivery. Literature from Sokoto State identifies long distances, cultural practices, male guardian control over reproductive decisions, and mistrust of facilities as key deterrents. Findings will inform community-level strategies to improve postnatal mental health integration in Sokoto State's rural health system. Keywords: institutional delivery, postnatal mental health, rural mothers, Sokoto State, Edinburgh Postnatal Depression Scale