Journal of Health Literacy

Journal of Health Literacy

Socioeconomic Determinants and Health Literacy-Related Pathways to Prenatal Care Utilization and Birth Outcomes in Nigeria

Articles in Press

Document Type : Original Article

Authors
Abdullahi Buba 1
Akram Dalili Muhammad 2
Aminu Muhammad Bello 3, 4
1 Department of Economics, Gombe State University, Gombe – Nigeria
2 Student, Department of Economics, Gombe State University, Gombe – Nigeria.
3 Master of Health Economics Student, Department of Economics, Gombe State University, Gombe – Nigeria.
4 Department of Pharmaceutical Services, State Specialist Hospital, Gombe – Nigeria.
10.22038/jhl.2026.93990.1922
Abstract
Background and Objectives: Prenatal care utilization and healthy birth outcomes remain unevenly distributed across socioeconomic groups in many low- and middle-income countries (LMICs), including Nigeria. While socioeconomic status (SES) is a well-established determinant of maternal health, less is known about how SES operates through pathways associated with health literacy to influence prenatal care use and birth outcomes at the population level.
This study examines the extent to which socioeconomic determinants conceptualized as pathways to health literacy shape prenatal care utilization and birth outcomes among women in Nigeria.

Material and Methods: Using nationally representative data from Nigeria’s Multiple Indicator Cluster Survey (MICS) Round 6, we analyzed women aged 15–49 years with a recent live birth. Prenatal care utilization was assessed using both extensive (receipt of any prenatal care) and intensive (frequency of prenatal visits) measures. Birth outcomes were measured using recorded birth weight and maternal assessment of child size at birth and using socioeconomic and health literacy–related proxy indicators including maternal education and media exposure, a composite media exposure index and household wealth index. Multivariable logistic regression models were estimated, reporting adjusted odds ratios, while accounting for survey design and relevant demographic controls.

Results: Higher maternal education, greater household wealth, and increased media exposure were significantly associated with higher odds of receiving prenatal care and, to a lesser extent, more frequent prenatal visits. These associations were stronger for extensive utilization than for intensity of use. For birth outcomes, maternal education and regional location showed consistent associations with both birth weight and child size at birth, while wealth and media exposure demonstrated more pronounced effects when child size was used as a secondary outcome. Substantial regional disparities persisted, highlighting contextual inequities in maternal health access and outcomes.

Conclusion: Socioeconomic determinants influence prenatal care utilization and birth outcomes in Nigeria through health literacy related pathways that enhance informational access, decision-making capacity, and engagement with health services. Policies aimed at improving maternal and neonatal health in LMICs should integrate health literacy strategies alongside socioeconomic interventions to reduce persistent inequities.
Keywords
Health literacy
Prenatal Care Utilization
Birth Outcomes
Socioeconomic Status
Nigeria

Acknowledgements: The authors would like to acknowledge UNICEF and the National Bureau of Statistics (NBS) of Nigeria for granting access to the Nigeria Multiple Indicator Cluster Survey (MICS) Round 6 dataset, which made this study possible. The authors also appreciate the valuable contributions of all survey participants and field personnel involved in the implementation of the MICS survey.


Availability of data and materials: The dataset that supports the findings of this study are publicly available at: https://mics.unicef.org/surveys.


Conflict of interest: The authors indicate no relevant financial or non-financial interests to disclose.


Consent for publication: Not applicable.


Ethics approval and consent to participate: This study relied on secondary, anonymized, publicly available data from MICS Round 6. Ethical approval for data collection was obtained by UNICEF and the National Bureau of Statistics of Nigeria. The present analysis involved no direct contact with participants and therefore did not require additional institutional ethical approval.


Funding: The authors do not receive any funds, grants, or other financial support during the preparation of this manuscript.


Authors' Contribution: AB contributed to the study design, interpretation of findings, critical revision of the manuscript, and overall supervision of the research process. ADM conceived and designed the study, developed the analytical framework, performed the data analysis, interpreted the findings, and drafted the manuscript. AMB contributed to the literature review, data management, and manuscript preparation. All authors read and approved the final version of the manuscript and agreed to be accountable for all aspects of the work.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/

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Journal of Health Literacy

Articles in Press, Accepted Manuscript
Available Online from 15 August 2026