Pregnant in poverty choosing hunger over care how economic hardship and conflict undermine maternal health service use in north east nigeria
1
Public Health, Modibbo Adama University, Yola, Yola, Nigeria
2
Public Health, Yobe State University, Damaturu, Nigeria
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
In north east nigeria, prolonged armed conflict, displacement, and economic decline have weakened access to essential maternal health services. Pregnant women increasingly face trade-offs between meeting basic food needs and seeking pregnancy care, resulting in delayed antenatal attendance, reduced continuity of care, and preventable maternal morbidity. While poverty and conflict are established determinants of maternal mortality, empirical evidence on poverty-driven abandonment of maternal health care within fragile primary health systems remains limited. This study examined how economic hardship, food insecurity, and conflict exposure intersect to influence maternal health care utilization.
METHODS:
A mixed-methods study was conducted between january and september 2025 across 24 primary health care facilities serving conflict-affected communities in Adamawa, Borno, and Yobe states. Quantitative data were collected from 1184 pregnant women enrolled in antenatal services. Measures included household income, food insecurity status, antenatal visit completion, and facility delivery intention. Multivariable logistic regression identified predictors of care abandonment. Qualitative data were obtained through in-depth interviews with 42 pregnant women and 31 maternal health providers analysed thematically. Ethical approval and informed consent were obtained.
RESULTS:
Overall, 44.6% of participants missed at least one recommended antenatal visit due to inability to afford transport, food, or indirect care costs. Severe food insecurity affected 52.1% of women and was independently associated with antenatal care abandonment (adjusted odds ratio 2.63). Women from conflict-displaced households were more likely to delay care beyond the first trimester (61.4%) compared to non-displaced women (38.7%). Qualitative findings revealed that pregnancy care was often deprioritized in favour of household feeding, with women describing clinic attendance as an avoidable expense during economic crisis.
CONCLUSIONS:
Economic hardship and conflict jointly drive poverty-induced abandonment of maternal health care in north east nigeria. Maternal health interventions must integrate food security, financial protection, and conflict-sensitive service delivery to ensure equitable and sustainable care.
In north east nigeria, prolonged armed conflict, displacement, and economic decline have weakened access to essential maternal health services. Pregnant women increasingly face trade-offs between meeting basic food needs and seeking pregnancy care, resulting in delayed antenatal attendance, reduced continuity of care, and preventable maternal morbidity. While poverty and conflict are established determinants of maternal mortality, empirical evidence on poverty-driven abandonment of maternal health care within fragile primary health systems remains limited. This study examined how economic hardship, food insecurity, and conflict exposure intersect to influence maternal health care utilization.
METHODS:
A mixed-methods study was conducted between january and september 2025 across 24 primary health care facilities serving conflict-affected communities in Adamawa, Borno, and Yobe states. Quantitative data were collected from 1184 pregnant women enrolled in antenatal services. Measures included household income, food insecurity status, antenatal visit completion, and facility delivery intention. Multivariable logistic regression identified predictors of care abandonment. Qualitative data were obtained through in-depth interviews with 42 pregnant women and 31 maternal health providers analysed thematically. Ethical approval and informed consent were obtained.
RESULTS:
Overall, 44.6% of participants missed at least one recommended antenatal visit due to inability to afford transport, food, or indirect care costs. Severe food insecurity affected 52.1% of women and was independently associated with antenatal care abandonment (adjusted odds ratio 2.63). Women from conflict-displaced households were more likely to delay care beyond the first trimester (61.4%) compared to non-displaced women (38.7%). Qualitative findings revealed that pregnancy care was often deprioritized in favour of household feeding, with women describing clinic attendance as an avoidable expense during economic crisis.
CONCLUSIONS:
Economic hardship and conflict jointly drive poverty-induced abandonment of maternal health care in north east nigeria. Maternal health interventions must integrate food security, financial protection, and conflict-sensitive service delivery to ensure equitable and sustainable care.
| eISSN: | 2654-1459 |
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