Multistakeholder perspectives on geographical accessibility to emergency obstetric care in Benin City, Nigeria.

Introduction: In many Nigerian cities, travel to emergency obstetric care (EmOC) remains challenging, and the so-called urban advantage is shrinking. Benin City, Nigeria, has four major referral hospitals providing EmOC, yet maternal mortality remains very high. While facility-based deliveries are common, many women still face significant delays in reaching timely, appropriate care. This study explored women's and stakeholders' perspectives on EmOC geographical accessibility in this rapidly urbanising city. Methods: This descriptive qualitative study was conducted in four referral hospitals in Benin City, Nigeria. In-depth interviews were conducted with 44 purposively recruited women who had experienced obstetric emergencies, alongside 11 key stakeholders, including health service planners and policymakers. Women were recruited from hospital settings and communities in three local government areas identified as having the poorest geographical access to EmOC. Thematic analysis followed Braun and Clarke's six-step approach. Results: Four themes emerged from our study: 1) travel challenges force some women to use unsafe transport and seek informal care in emergencies, 2) bypassing non-preferred facilities prolonged travel to obstetric care, 3) systemic inefficiencies further complicates EmOC geographical access, and 4) multi-sectoral action needed to improve EmOC geographical access. Women described unsafe roads, lack of transport, and security concerns, particularly at night, leading to delays or resorting to traditional birth attendants. Referral inefficiencies, workforce shortages, and inadequate facility readiness compounded these delays. Participants proposed infrastructure upgrades, birth preparedness, improved insurance coverage, and stronger referral coordination to reduce in-transit delays and ensure equitable access. Discussion: Timely access to EmOC in urban settings is undermined by the intersection of spatial inequities, system dysfunction, and unreliable service availability. Addressing these challenges requires integrated infrastructure planning, strengthened referral coordination, and investment in health workforce retention. Without effective implementation of existing policies and targeted support for high-burden areas, maternal health inequities will persist even in urban contexts.