Barriers to Skilled Birth Attendance Among Women in Rural Communities of Zamfara State

Skilled birth attendance is a critical strategy for reducing intrapartum and immediate postpartum maternal and neonatal mortality, yet utilisation remains extremely low in rural communities of Zamfara State, North West Nigeria. This study identifies barriers to skilled birth attendance among women in rural Zamfara State. A community-based cross-sectional study enrolled 260 women who delivered within the previous 12 months in Gusau, Talata Mafara, and Bungudu LGAs through household enumeration sampling. A structured questionnaire explored place of delivery, reason for home delivery, access to facilities, and partner and community influences on delivery decisions. Skilled birth attendance was achieved in only 17 percent of deliveries. Traditional birth attendant-assisted home delivery was the most common birth setting (63 percent). Key barriers included perceived distance to facility (71 percent), lack of female health providers at facilities (58 percent), husband authority over delivery decisions (66 percent), and cost of facility delivery (48 percent). Women with secondary education had 4.3 times higher odds of skilled attendance. The study reveals that social and structural barriers, not merely geographic distance, drive home delivery in rural Zamfara. Recommendations include mobile skilled birth attendant teams, community dialogue with male gatekeepers, training of traditional birth attendants as safe birth promoters, and free delivery services at Zamfara State primary facilities. Keywords: skilled birth attendance, home delivery, Zamfara State, rural communities, North West Nigeria