Husband Decision-Making Authority and Its Influence on Maternal Healthcare Utilisation in Katsina State

Husband decision-making authority is a recognised socio-cultural determinant of maternal healthcare utilisation in northern Nigeria, with women's autonomous decision-making capacity frequently constrained by patriarchal household norms that delay or prevent facility-based care. This study examines the influence of husband decision-making authority on antenatal attendance, facility delivery, and postnatal care utilisation among women in Katsina State, North West Nigeria. A community-based cross-sectional study enrolled 260 married women of reproductive age who had delivered within the preceding 12 months in Katsina, Funtua, and Daura LGAs. A structured questionnaire assessed decision-making dynamics, healthcare utilisation metrics, and sociodemographic characteristics. Women who reported joint decision-making with husbands were 3.8 times more likely to have delivered in a facility and 3.1 times more likely to have completed four or more antenatal visits compared to those with husband-dominated decisions. Husband refusal to permit facility delivery was cited by 38 percent of women who delivered at home. Only 19 percent of women reported making maternal healthcare decisions independently. The study demonstrates that patriarchal decision-making structures are a major structural driver of poor maternal health utilisation in Katsina State. Recommendations include male engagement community forums, Islamic scholar partnerships to promote facility-based maternity care, and community health worker household visit programmes targeting both women and their husbands. Keywords: husband decision-making, maternal healthcare utilisation, Katsina State, facility delivery, North West Nigeria