Social Determinants of Maternal Mortality in Rural Northern Nigeria: An Analytical Study of Socio-Structural Factors

Maternal mortality in rural northern Nigeria persists at catastrophic levels compared to both national and sub-Saharan African averages, yet the social and structural determinants underlying this public health crisis remain analytically disaggregated from its biomedical dimensions in most available research. This study analytically examines the social determinants of maternal mortality in rural communities of Jigawa and Katsina States, North West Nigeria. A mixed-methods analytical design was employed, combining secondary analysis of Demographic and Health Survey 2021 data disaggregated at the state level with primary qualitative data collected through twenty-eight in-depth interviews with community members, traditional birth attendants, and health facility staff. The Social Determinants of Health framework of the WHO Commission was applied analytically. Regression analysis of DHS data identified low female educational attainment, early age at first birth, absence of a skilled birth attendant, and distance to the nearest health facility above 10 kilometers as the four strongest independent predictors of maternal death odds within the northern sample. Qualitative findings reveal that gendered social norms requiring male permission for spousal health facility access delayed emergency obstetric care in 78% of documented cases reviewed. Traditional birth attendant reliance was normatively reinforced by cultural familiarity, social trust, and inability to afford facility costs. The study analytically establishes that structural gender inequity, not individual health behavior alone, drives northern Nigeria's maternal mortality crisis, with implications for intervention targeting. Keywords: maternal mortality, social determinants, North West Nigeria, gender inequality, skilled birth attendance.