Nigeria like many other countries in sub-Saharan Africa, has long been overwhelmed with maternal health challenges. Maternal health improvement has attracted global attention and improving women’s health issues pertaining to pregnancy and delivery has become the centerpiece of national development efforts in developing countries. However, despite the relentless effort, there is little evidence to show significant decline in maternal mortality1. The child birth mortality rate has increased in Nigeria and statistics has suggested that 144 women die each day in Nigeria due to pregnancy related reasons, which suggests that the country is one of the worst countries for handling childbirth processes2. Some of the factors that determine maternal mortality include: accessibility to health services, cultural practices, socio-economic status, and the educational background of the child bearing women.
Traditional beliefs and practices, religion and ethnicity influences greatly on cultural practices that influence beliefs, norms and values that determine women place of giving birth3. Most African women consider the right to good health as contingent on fulfilling their purpose of taking care of and meeting the needs of their families especially, the husband, at the expense of their own physical health and well-being1. There is a religious and cultural dimension for this consideration such as the African traditional religion’s patriarchal system and an Islamic culture that undervalues women by putting women’s reproductive health capacities under strict male control and the practice of purdah (wife seclusion) which restrict women’s medical care, marriage at an early age and pregnancy often occurring before maternal pelvic development is complete, polygamy and harmful traditional medical practices among others1.
The study by Sabit et al. showed that Ethiopia recorded many home births which show that home births were still a common practice4. Female autonomy which is the ability of a woman to make decisions in the family relative to the man, plays a vital role in maternal health care, for instance, in Tanzania, the husbands make a choice of where the wives should deliver5,6. The Maasai women of Tanzania shy away from hospital delivery because they perceive vaginal examinations as painful, and also, the Watemi women of Tanzania say that it is dehumanizing for a male healthcare provider to perform a vaginal examination and this makes most of the women to choose home deliveries where all traditional birth attendants are women6.
Cultural beliefs, norms, values, and traditions have a major influence on decision making whether a mother seeks skilled delivery care or not7. In Nigeria, one of the commonest childbirth practices is home births and this is highly influenced by these social and cultural factors8. Home births usually occur in many resource-poor countries. Home births can be planned or unplanned. A planned home birth is not often associated with maternal or prenatal mortality9. The existence of various customs and traditions in Nigeria has also affected the maternal and child health. Nigeria has about 374 ethnic groups, with each ethnic group practicing different cultures which mostly affects childbirth in the country. There is a chance of 1 in every 13 women to die of pregnancy-related causes in Nigeria. These maternal deaths occur during labor, child delivery or within first 24 hours after childbirth10. The deaths that occur after childbirth are often caused by avoidable causes. Situations like infections, sepsis, eclampsia and hemorrhage after childbirth can be easily prevented in a functional healthcare system11.
Furthermore, cultural background has played a major role to other child birth practices. The use of Caesarian section during childbirths is being avoided by some women due to cultural beliefs. Caesarian section is a procedure whereby a child is delivered from an incision made to the womb. This is in contrast with the normal vaginal birth among pregnant women. Caesarian section is often carried out to assist pregnant women who could not push the baby out from the vagina. However, some cultural beliefs have affected the attitude of some pregnant women towards Caesarian section. They refuse caesarian section even when they clearly need it while in labor12.
In African countries like Kenya, maternal age of women is a determining factor to how the women of child bearing age indulge in childbirth practices13. Women are expected to get to a particular age so as to be considered old enough for marriage. In this way, women who are older are more confident and influential in making their own decisions when in marriage as compared to younger women. Hence, they can choose childbirth practices that are favorable to them.
In countries like Benin Republic and Ghana, some cultural beliefs are interlinked with religious beliefs. For instance, people who practice traditional religion do not belief in some medical services. Hence, they use locally made herbs to treat ailments related to pre-natal conditions and maternity. In other cases, some cultural and religious beliefs do not allow child bearing women to receive treatments from male professionals. It is important that these cultural practices in these regions and how they affect women in such environment should be put into consideration when further studies are carried out on maternal mortality14.
In some cultures, women are often given off to marriage before they get to the expected maturity age of eighteen. In Gombe, Adamawa State in Nigeria, these practices are still obtainable. Such cultural practices are known to have encouraged girl child marriage, which in turn increases maternal mortality15. Research has shown that only 61% of child births in Kenya take place in the hospital, under professional medical care. This implies that about 39% of child births take place at homes due to cultural influence on the women of child bearing age in the country16.
Tribalism and ethnicism is a huge factor influencing many practices in sub-Saharan Africa. Many countries in Africa have regions that speak different languages and also practice different cultures17. Because of this, these individuals tend to discriminate among themselves in such a way that women of child bearing age, are selective in the hospitals they are bound to attend. Some of these women may decide not to visit the hospitals for medical care because they do not want to interact with individuals from a different tribe. This shows the extent to which cultural beliefs have massively affected childbirth practices in Sub-Saharan Africa.
Also discrimination based on religious factor affects the maternal health care of women from different backgrounds18.
The child birth mortality rate has increased in Nigeria. Statistics has suggested that 144 women die each day in Nigeria due to pregnancy related reasons, which suggests that the country is one of the worst countries for handling childbirth processes2. Some of the factors that determine maternal mortality include: accessibility to health services, cultural practices, socio-economic status, and the educational background of the child bearing women. In terms of educational background, most educated women prefer hospital child delivery to home delivery8. This is because, they are aware of the fact that hospital delivery takes place in the presence of medical professionals who would ensure and provide basic safe delivery procedures for these women. Evidence has shown that most women of child bearing age give birth at home because of the costs of paying for a hospital birth. Hence, home births have been one of the increasing child birth practices that promote maternal mortality in Nigeria19.
Another popular childbirth practice among women of child bearing age in Nigeria is the attitude towards allowing a male health professional to attend to them during labor. According to Bukar & Jauro the cultural background of most women of child bearing age in Northern Nigeria has made them reject medical care offered by male professionals12. Perhaps, this has led to the reason why most of them end up, choosing home births to hospital births. This is because giving birth at their homes reduces the chance of them getting a medical assistance from a male medical professional. In this case, these women have the cultural belief that no man asides their husbands, are worthy to see their nakedness.
According to the Nigeria Demographic and Health Survey (NDHS), the majority of women of child bearing age, deliver at home, with the Northern part of Nigeria, having the highest number of records of such births20. These home births are not attended by skilled personnel, increasing the chances of these women to face pre-natal and maternal deaths8. Because of this, these child birth practices have become common among many women of child bearing age in Nigeria.
Diversity in childbirth is a global phenomenon. Cultural diversity in Nigeria has led to the numerous differences among people in terms of ideologies, values, principles, morals and standards21. Having a good knowledge of the existing cultures applicable to a particular environment is a key to ensuring low maternal mortality rates and ensuring safe childbirth practices in the country. Nigeria comprises of 774 local government areas and about 250 dialects are spoken across these local governments. Each local government is dominated by different ethnic groups with their various cultural beliefs. In most cases, cultural beliefs are interlinked with religious beliefs and they influence choice of childbirth places in these areas22.
In Northern-eastern Nigeria, Madagali is dominated by the Margi tribe and Islam is highly practiced among the people. The women are forbidden from allowing another man, who is not their husbands to see their nakedness in accordance to the laws of Islam12. Hence, these women fear to get registered for ante-natal care (ANC) because they do not want to be presented with the situation where male health care professionals would examine them during their pregnancy. Hence, the women of child bearing age often resort to home births, most of which are carried out under the supervision of unskilled professionals.
Among the Hausa people of Kaduna State, the findings of the study by Okeshola & Sadiq suggested that the Hausa women of child bearing age were not comfortable with male doctors/nurses attending to them in hospitals8. It was attributed to the cultural beliefs among the Hausa in Kaduna state of women exposing their nakedness to men who are not their husbands. This shows that the extent to which cultural practices have influenced the low turnout of pregnant Hausa women to antenatal care and hospital births in the area. Also, religious leaders often back up childbirth with spiritual reasons. They provide birth rooms and promise good delivery outcomes derived from divine/supernatural involvement. Hence, these women in such communities end up not seeking for skilled health care professionals during pregnancy since they believe more in supernatural health care8.
Some cultural factors can be of negative influence on childbirth in a community. For instance, as seen among the inhabitants of Akinyele local government of Oyo State, some taboos and practices that prevent women from taking appropriate decision on where and when to seek medical attention during pregnancy and childbirth are harmful. There are taboos that emphasize food restriction and also traditional practices, which negatively affect the well being of women during pregnancy and childbirth. These cultural practices, especially food taboos, to a large extent, prevent pregnant women in the community from getting adequate food nutrients to sustain mother and child23. Some culture enforces individuals to adopt the traditional religion which has been practiced by their ancestors. Almost all tribes in Nigeria still have individuals who practice traditional religion and these individuals often reject western education or development and would resort to the use of traditional herbs for handling pregnancy related conditions. Although, there is little documentation to whether the use of these traditional herbs helps pregnant women, it is advisable that women of child bearing age should seek for professional care when they are pregnant. This would reduce maternal mortality.
The women of childbearing age in Oyigbo Local Government need to be conversant with these cultural practices or beliefs existing in the regions where they reside or visit, and be aware of safe and unsafe childbirth places involved which would enable them to make an early and planned decision of place of childbirth. These women should be aware that the availability of healthcare professionals during childbirth is an important factor in preventing maternal mortality and align with the Millennium Development Goal of improving maternal health12. Therefore, this study is aimed to explore the significance of the influence of some cultural factors on choices of childbirth places among women in Oyigbo local government area of Rivers State, Nigeria.