Determinants of Skilled Birth Attendance Utilisation Among Women in Hard-to-Reach Communities of Taraba State, North East Nigeria

Skilled birth attendance is a critical intervention for reducing intrapartum maternal and neonatal mortality, yet coverage remains dangerously low in geographically isolated communities of North East Nigeria. This study identifies the determinants of skilled birth attendance utilisation among women who delivered within the preceding 24 months in hard-to-reach communities of Taraba State. A cross-sectional analytical design is applied to 260 women selected through community enumeration and random sampling from twelve hard-to-reach communities across Ardo-Kola, Bali, and Gashaka local government areas. The structured questionnaire assesses previous birth experiences, household decision-making dynamics, distance and transport availability, facility costs, community health worker contact frequency, spousal education level, and awareness of emergency obstetric care. Binary logistic regression in SPSS identifies independent determinants of skilled attendance. The 2022 Taraba State Demographic and Health Survey supplement reports skilled birth attendance rates of under 25 percent in its three most remote local government areas, with road inaccessibility and spousal refusal as the most cited barriers. The Three Delays Model, which analyses delays in deciding, reaching, and receiving care, provides the study's conceptual framework. Findings will support Taraba State's Expanded Programme on Immunisation and maternal health unit in deploying skilled birth attendant outreach and emergency referral transport strategies. Keywords: skilled birth attendance, determinants, hard-to-reach communities, maternal health, Taraba State.