Health Equity in Access to Emergency Obstetric Care Among Marginalised Women in Bayelsa State, South South Nigeria

Emergency obstetric care accessibility is unequal across socioeconomic and geographical strata in South South Nigeria, and Bayelsa State's largely riverine geography compounds physical and financial barriers for marginalised women. This study examines health equity in access to emergency obstetric care among rural, low-income, and physically isolated women in Bayelsa State. A mixed-methods cross-sectional design is applied, involving 265 women who experienced obstetric complications in the past two years, recruited from communities across Sagbama, Southern Ijaw, and Yenagoa local government areas. Structured questionnaires measure travel time to the nearest comprehensive emergency obstetric care facility, out-of-pocket expenditure, perceived quality of care, and treatment outcomes. Six focused group discussions explore perceived barriers and coping strategies. SPSS is used for quantitative analysis, while framework analysis is applied to qualitative data. The 2021 Bayelsa State Maternal Death Review report indicates that over 65 percent of maternal deaths occurred in communities more than two hours from a comprehensive emergency obstetric facility. The Health Equity framework of Whitehead and Dahlgren is applied to identify social determinants driving access disparities. Findings will guide Bayelsa State's Ministry of Health in designing equity-sensitive referral transport systems and expanding emergency obstetric care facility coverage. Keywords: health equity, emergency obstetric care, marginalised women, access barriers, Bayelsa State.