Regional Disparities and Sociodemographic Determinants of Institutional Delivery Dropout (IDD) among Women in Nigeria: Analysis of the 2018 Demographic and Health Survey

Background Institutional delivery is a critical component of maternal healthcare that reduces the risk of maternal and neonatal morbidity and mortality. While antenatal care (ANC) coverage has improved in Nigeria, a significant number of women who attend ANC still deliver outside health facilities—a phenomenon referred to as institutional delivery dropout (IDD). This study examined the prevalence, regional disparities, and sociodemographic determinants of IDD among women of reproductive age in Nigeria. Methods This cross-sectional study utilized data from the 2018 Nigeria Demographic and Health Survey (NDHS). The analysis included 16,100 women aged 15–49 years who reported at least one ANC visit and provided information on the place of delivery for their most recent birth. Descriptive statistics, bivariate analysis using crude odds ratios (COR), and multivariable logistic regression were conducted to assess predictors of institutional delivery. All analyses accounted for the complex survey design and applied sampling weights. Results The prevalence of IDD in Nigeria was 48%. Marked regional disparities were observed, with the highest dropout in the North West (75.9%) and the lowest in the South East (17.1%). In bivariate analysis, maternal education, wealth index, religion, residence, and region were significantly associated with institutional delivery. Multivariable analysis confirmed that higher education (AOR = 5.14; 95% CI: 4.12–6.41), higher wealth (AOR = 4.65; 95% CI: 3.80–5.69), Christian religion (AOR = 0.60; 95% CI: 0.53–0.69), urban residence (AOR = 1.14; 95% CI: 1.02–1.25), and southern regional residence were associated with increased likelihood of institutional delivery. Conclusion Nearly half of Nigerian women who attend ANC still deliver outside health facilities, reflecting a serious breakdown in the maternal healthcare continuum. Sociodemographic inequalities and regional disparities play a substantial role in institutional delivery decisions. Addressing IDD requires targeted interventions that improve health facility access, enhance service quality, and challenge sociocultural norms—especially in underserved regions. These findings underscore the need for regionally targeted interventions to improve maternal health outcomes and reduce preventable maternal deaths in Nigeria.