<p>Null model results (Model 0).</p>

Multilevel multinomial logistic regression models were fitted to assess individual, household, and contextual predictors. Variables significant at <i>p</i> < 0.20 in bivariate analysis were included in multivariable models. Statistical significance was set at <i>p</i> < 0.05.</p> <p>Results</p><p>Overall, 44.0% of women did not utilize any services, 44.4% partially utilized services, and only 11.6% achieved adequate utilization.

Women with secondary or higher education were significantly more likely to achieve adequate utilization (Relative Risk Ratio (RRR) = 12.10, 95% CI: 8.72, 16.81). Wealth status, media exposure, employment, and health insurance were positively associated with utilization, while higher parity and decision-making barriers reduced utilization. Rural residence was associated with lower utilization (RRR = 0.38, 95% CI: 0.29, 0.49).

Distance to health facilities was not significant in the adjusted model.</p> <p>Conclusion</p><p>Maternal healthcare service utilization in Nigeria remains suboptimal, with significant inequities driven by socioeconomic status, education, and women’s autonomy. Strengthening the continuum of care requires multisectoral interventions addressing structural and social determinants of health.</p></div>