Association Between Transport Cost Burden, Basic Health Care Provision Fund (BHCPF) Enrolment, And Completion of Four Or More Antenatal Care Visits Among Pregnant Women in Ilorin South Local Government Area, Kwara State, Nigeria: A Mixed-Methods Study.

Abstract

Background: Antenatal care reduces maternal mortality, yet completion of the recommended minimum of four visits remains suboptimal in Nigeria. High transportation cost is a persistent enabling barrier, while the Basic Health Care Provision Fund (BHCPF) is an enabling financial resource; their interaction has not previously been examined.

Methodology: A convergent mixed-methods study was conducted among pregnant and postpartum women in Ilorin South Local Government Area, Kwara State. Quantitative data from a facility-based survey (n=521) were analysed using chi-square tests and binary logistic regression with a transport-cost-burden × BHCPF-enrolment interaction term. Qualitative data from 14 in-depth interviews were analysed using thematic framework analysis.

Results: Overall, 271 respondents (52.0%) completed four or more ANC visits. Transport cost burden was independently and negatively associated with completion (adjusted odds ratio [AOR]=0.84 per ₦100, p<0.001), while BHCPF enrolment was independently and positively associated with completion (AOR=1.98, p<0.001). The interaction term was significant and positive (AOR=1.29, p=0.021), showing that BHCPF enrolment moderated the adverse effect of transport cost on completion. Qualitative themes showed that women practised "transport rationing" as a coping strategy, and that BHCPF operated as an indirect transport subsidy by freeing household income otherwise spent on consultation and drug costs.

Conclusion: BHCPF enrolment partially offsets the adverse effect of transport cost burden on ANC completion. Policymakers should consider linking BHCPF enrolment more explicitly to direct transport support, particularly for peri-urban populations.