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Purpose Health insurance reduces the cost of using modern maternal and child cares and encourages women to use modern care services. This is because health insurance scheme spread the burden of maternal care usage across people and overtime. In Nigeria, there is a dearth of research evidence on the effect of health insurance enrolment on maternal and childcare use. This study examined the effect of health insurance coverage on maternal and childcare use in Nigeria, drawing upon data from the most recent National Demographic and Health Survey (2018). Methods Three outcome indicators were used: a minimum of four antenatal care (ANC) visits, place of delivery, and complete child immunization. Descriptive and predictive analytical methods were utilized. A representative sample of 33,715 women who reported recent birth within the last five years preceding the Survey was used for the analyses. Analyses were undertaken using STATA version 13.0 for windows. Results The results showed that 57% of the women made a minimum of four ANC visits, 41% delivered in health institutions, and 27% undertook complete child immunization. Enrolment in health insurance was low as only 2.3% of the women were under any form of health insurance coverage. However, enrolment in health insurance significantly improves the odds for a minimum of four ANC visits [aOR: 1.52, р = 0.00] and health facility delivery [aOR: 1.42, р = 0.00]. However, there is no significant difference in complete child immunization between women who were under health insurance and those who were not [aOR: 1.36, р = 0.28]. Also, residing in an urban area, Southern geopolitical zones, and being drawn from wealthy homes confer an advantage on women to use modern maternal and child healthcare. Conclusion Pragmatic interventions should be initiated to encourage women’s enrolment in health insurance in Nigeria. Community-based health insurance scheme should be encouraged among rural women and those of them in the informal sector
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