Abstract

ABSTRACT
Background
Maternal and child mortality remain major public health challenges in Nigeria, despite being largely preventable through skilled maternity care. Although antenatal care attendance is relatively high, facility-based delivery remains low, particularly in the northern regions where over 90% of births occur at home. Socio-cultural norms, financial barriers, and limited decision-making autonomy contribute to the persistence of home deliveries.
Aim
To assess and compare perspectives on place of delivery and its determinants in rural and urban communities in Kano State.
Methods
A comparative qualitative study was conducted between December 2023 and March 2024 in one urban and one rural LGAs of Kano State. Six focus group discussions (FGDs) were held with men and women who were purposively selected and had experienced childbirth within the previous year. Data was collected using an adapted FGD guide. Transcripts were analyzed using thematic framework analysis, following open, axial, and selective coding.
Results
Rural discussants showed attachment to home delivery, while urban discussants expressed relatively acceptance of hospital delivery, particularly among women. Rural discussants perceived childbirth as a natural process that does not necessarily require institutional care except when there is a complication. Men, from rural communities, preferred home delivery for their wives because of cost, convenience and previously uncomplicated home births motivating them. Conversely, women, especially from the urban communities showed preference for hospital delivery due to perceived quality of care and fear of complications.
In both urban and rural settings, husbands were identified as the major decision makers, while fathers-in-law and mothers-in-law also make some influences especially in rural communities. Many women, especially in rural communities, reported that they require permission before seeking healthcare or deciding where to deliver. But some urban women indicated involvement in decision-making. Socio-demographic factors including age, culture, income, and social status, strongly influenced delivery choices.
Conclusion
Delivery location decisions in Kano are shaped by socio-cultural norms, economic barriers, and gender powered dynamics, which continue to drive a significant share of home deliveries. To increase facility-based delivery interventions should align to address the determinants.

Key words: Determinants; place of delivery; skilled birth attendants; urban and rural; qualitative