Assessment of Maternal Healthcare Utilisation and Barriers to Skilled Birth Attendance in Adamawa State

Skilled attendance at birth is a critical intervention for reducing maternal and neonatal mortality, yet its coverage in north-eastern Nigerian states including Adamawa remains significantly below national targets. This study assessed utilisation of maternal healthcare services and barriers to skilled birth attendance in Adamawa State, North East Nigeria. A descriptive cross-sectional study was conducted in three rural LGAs: Song, Maiha, and Lamurde, enrolling 240 women who had delivered in the preceding 24 months through multistage sampling. A structured questionnaire captured antenatal attendance, delivery location (health facility versus home), delivery attendant type, postnatal care seeking, and perceived barriers to facility delivery. Results showed that 68.3 percent attended antenatal care at least once, but only 44.2 percent completed four or more antenatal visits. Skilled birth attendance was achieved in only 36.7 percent of deliveries. The most common barriers to facility delivery were distance (71.6 percent), husband decision-making authority (64.2 percent), cost (58.8 percent), and fear of caesarean section (42.5 percent). Maternal education (OR 4.2; p < 0.001) and prior facility delivery experience (OR 3.1; p < 0.001) were the strongest predictors of skilled attendance. The study recommends strengthening obstetric care outreach through mobile clinics, male partner engagement programmes, community midwifery deployment, and free maternal care policies in Adamawa State as priority interventions. Keywords: skilled birth attendance, maternal healthcare, antenatal care, Adamawa State, North East Nigeria