: Maternal mortality in northern Nigeria is among the highest in the world. To
understand better the pathways through which the socio-demographic environment affects
awareness of obstetric danger signs (i.e., potential problems associated with pregnancy),
preparations for delivery, and skilled birth attendance, we conducted a survey of 5,083 women
with recent pregnancies in three northern Nigerian states. Only 25% attended antenatal care
(ANC), and 91% of all births took place at home. Less than one-third knew three or more
danger signs of pregnancy or labor and delivery. Higher socioeconomic status was associated
with knowledge of danger signs, but not with knowledge of life-threatening, critical
danger signs. Antenatal care visits did not increase knowledge of critical danger signs, but
they were associated with skilled birth attendance. Knowledge of critical pregnancy danger
signs also was associated with skilled birth attendance. Improving the quality and coverage
of ANC will ensure greater awareness of the critical danger signs. Future research is needed
to identify creative and innovative ways to strengthen strategies for educating pregnant
women about danger signs and in facilitating uptake of delivery services.