Cultural and religious structures influencing the use of maternal health services in Nigeria: a focused ethnographic research.

Background: Cultural and religious structures encompass a set pattern of values, beliefs, systems and practices that define a community's behaviour and identity. These structures influence women's health-seeking behaviour and access to maternal health services, predisposing women to preventable maternal health complications. However, most maternal health policies have focused on biomedical strategies, with limited attention to women's cultural challenges around childbirth. The overall aim of this paper is to provide a thick description and understanding of cultural and religious structures in Nigeria, their meaning and how they influence women's use of maternal health services.

Methods: Roper and Shapira's (2000) focused ethnography comprising 189 h of observation of nine women from the third trimester to deliveries. Using purposive and snowballing techniques, 21 in-depth interviews and two focus group discussions comprising 13 women, were conducted in two Nigerian primary healthcare facilities in rural and urban area of Kogi State. Data was analyzed using the steps described by Roper and Shapira.

Results: Using the PEN-3 cultural model, nine themes were generated. Positive factor, such as the language of communication, existential factor, such as religion, and negative factors, such as the use of prayer houses and lack of women's autonomy, were either positive or negative enablers influencing women's use of maternal health services. Additionally, women's perceptions, such as their dependency on God and reliance on cultural norms were significant factors that influence the use of maternal health services. We also found that the use of herbal medicine was a negative enabler of women's access to facility care. At the same time, family support was also a positive and a negative nurturer that could influence how women use facility care. Finally, factors such as religion, Ibegwu, and male child syndrome were negative nurturers influencing women's contraceptive use.

Conclusion: Cultural and religious structures are significant factors that could promote or limit women's use of maternal health services. Further studies are needed to understand culturally focused approaches to enhance women's use of maternal health services in Nigeria.