Urban–Rural Disparities in Access to Epidural Labour Analgesia and Provider Perspectives in Nigeria: A Preliminary Comparative Study

Abstract

Background: Epidural analgesia is the most effective pharmacological method of intrapartum pain relief, yet its availability across Nigerian healthcare facilities remains limited and unevenly distributed. Aims: This preliminary study compared access to, and healthcare providers' perspectives on, epidural labour analgesia between urban and rural Nigerian healthcare facilities. Methods: A descriptive cross-sectional survey using a structured, self-administered electronic questionnaire distributed to maternal healthcare providers (midwives, nurses, obstetricians, medical officers, and anaesthetists). Thirty-five valid responses were analysed using descriptive statistics, Pearson’s chi-square test, and Fisher’s exact test, with significance set at p < 0.05. Results: Twenty-eight respondents (80.0%) practised in urban facilities and seven (20.0%) in rural facilities. Epidural analgesia was available in 39.3% of urban facilities compared with none in rural facilities (p = 0.072). Trained personnel capable of administering epidural analgesia were present in 60.7% of urban facilities versus 0.0% of rural facilities (p = 0.008). Rural respondents cited lack of trained staff as a limiting factor in 85.7% of cases, compared with 32.1% of urban respondents (p = 0.027). Conclusion: Provider attitudes toward the effectiveness and safety of epidural analgesia were favourable in both settings, with no statistically significant urban–rural difference. A substantial urban–rural gap exists in the availability of trained personnel and functional epidural analgesia services in Nigeria, even though provider attitudes toward the intervention are broadly positive in both settings; the principal barriers are structural and human-resource related rather than attitudinal. Given the modest sample size, these findings should be regarded as preliminary and hypothesis-generating rather than nationally representative. Targeted investment in training, equipment, and government funding, particularly for rural and primary healthcare facilities, is recommended to close this gap, alongside larger, probability-sampled replication.