Gwacham-Anisiobi Uchenna, Oladimeji Adetola, Yesufu Victoria, Kurinczuk Jennifer J, Nair Manisha, McLeish Jenny
National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, United Kingdom.
Institute of Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Canada.
BMC Pregnancy Childbirth. 2025 May 20;25(1):593. doi: 10.1186/s12884-025-07646-5.
Each year 182,000 babies are stillborn in Nigeria, representing nearly 10% of the annual global stillbirth burden. Imo state in south-eastern Nigeria has one of the highest levels of maternal health service access in Nigeria, yet this has not translated into good pregnancy outcomes. Many stillbirth prevention initiatives in Nigeria focus on maternal health education but empirical evidence suggests that sociocultural factors impact healthcare choices and outcomes. This study aims to explore women's and health workers' perspectives of the sociocultural barriers to following medical advice during pregnancy and childbirth, and specifically how these barriers may contribute to an increased risk of stillbirth. This study is part of a broader community-based stillbirth prevention mixed-methods research in Imo State, Nigeria.
A qualitative descriptive study was conducted using in-depth interviews and focus group discussions. 38 participants were purposively recruited; 20 women and 18 health workers. Audio recordings were transcribed, translated and analysed using inductive thematic analysis.
Four themes were identified: (1) trust, where scepticism about health worker motives or competence and trust in community informal networks were highlighted (2) power dynamics within families, with husbands and older female relatives influencing health decisions; (3) personal and community beliefs that undermine confidence in medical interventions, including a pervasive stigma associated with caesarean section; and (4) grassroots proposals for solutions, emphasising the importance of a whole-community approach to maternal health education, mobilising peer voices, engaging traditional leaders and training of traditional birth attendants.
This study provides insights into the sociocultural barriers to following medical advice during pregnancy in Nigeria, which include a lack of trust in health professionals, power dynamics within a woman's family, and entrenched cultural and religious beliefs that oppose medical intervention. Women's decisions about pregnancy and childbirth are heavily influenced by family and cultural norms. Culturally sensitive, community-wide interventions which aim to rebuild trust in the health system, involve women as decision-makers in antenatal care, and engage religious and traditional leaders would be beneficial for improving outcomes.
在尼日利亚，每年有18.2万名婴儿胎死腹中，几乎占全球年度死胎负担的10%。尼日利亚东南部的伊莫州是该国孕产妇保健服务可及性最高的地区之一，但这并未转化为良好的妊娠结局。尼日利亚的许多死胎预防举措都侧重于孕产妇健康教育，但实证证据表明，社会文化因素会影响医疗保健选择和结局。本研究旨在探讨女性和卫生工作者对孕期及分娩期间遵循医疗建议的社会文化障碍的看法，特别是这些障碍如何可能导致死胎风险增加。本研究是尼日利亚伊莫州一项更广泛的基于社区的死胎预防混合方法研究的一部分。
采用深入访谈和焦点小组讨论进行定性描述性研究。有目的地招募了38名参与者；20名女性和18名卫生工作者。对录音进行转录、翻译并使用归纳主题分析法进行分析。
确定了四个主题：（1）信任，其中强调了对卫生工作者动机或能力的怀疑以及对社区非正式网络的信任；（2）家庭内部的权力动态，丈夫和年长女性亲属影响健康决策；（3）削弱对医疗干预信心的个人和社区信念，包括与剖宫产相关的普遍耻辱感；（4）基层解决方案建议，强调全社区方法对孕产妇健康教育的重要性，动员同伴发声，让传统领袖参与并培训传统助产士。
本研究深入了解了尼日利亚孕期遵循医疗建议的社会文化障碍，其中包括对卫生专业人员缺乏信任、女性家庭内部的权力动态以及反对医疗干预的根深蒂固的文化和宗教信仰。女性关于怀孕和分娩的决定受到家庭和文化规范的严重影响。旨在重建对卫生系统的信任、让女性成为产前护理决策者并让宗教和传统领袖参与的具有文化敏感性的全社区干预措施将有助于改善结局。
