Determinants of health facility delivery differ between urban and rural pregnant women in Benin City Nigeria

<title>Abstract</title> <p> <bold>Background:</bold> Despite the proven benefits of health facility delivery in reducing maternal and neonatal mortality, Nigeria continues to experience low facility delivery rates with marked urban-rural disparities. Understanding factors influencing facility delivery decisions is crucial for designing effective interventions. <bold>Objective:</bold> To identify and compare determinants of health facility delivery between urban and rural pregnant women in Benin City, Edo State, Nigeria. <bold>Methods:</bold> A comparative longitudinal study involving 220 pregnant women in their third trimester (110 urban, 110 rural) was conducted from July 2023 to August 2024. Data on previous delivery practices, barriers to facility delivery, support systems, and knowledge about facility delivery importance were collected using structured questionnaires. Binary logistic regression analysis identified predictors of facility delivery. Statistical significance was set at p&lt;0.05. <bold>Results:</bold> Health facility delivery prevalence was 79.1% (87) among urban respondents compared to 70.0% (77) among rural respondents (p=0.122). Urban women prioritized availability of skilled healthcare providers (65.5% (57) urban vs 28.6% (22) rural), while rural women emphasized proximity to home (37.7% (29) rural vs 21.8% (19) urban). Financial constraints (76.5% (26) rural, 70.8% (17) urban) and transportation difficulties (38.2% (13) rural, 54.2% (13) urban) were major barriers. Gravidity (aOR=5.279, p=0.003), support systems (aOR=19.150, p&lt;0.001), and excellent knowledge rating (aOR=16.499, p=0.048) were significant predictors in urban areas. In rural areas, number of children (aOR=7.464, p=0.008), support systems (aOR=6.411, p=0.002), primary education (aOR=0.135, p=0.008), and husband's skill level 2 occupation (aOR=0.164, p=0.046) significantly predicted facility delivery. <bold>Conclusion:</bold> Multiple socioeconomic, educational, and support-related factors influence facility delivery decisions differently in urban and rural settings. Context-specific interventions addressing financial barriers, strengthening support systems, improving health education, and ensuring skilled personnel availability are essential for increasing facility delivery rates. </p>