Role of Cultural Beliefs and Practices in Shaping Maternal and Infant Healthcare-seeking Behaviour in Abia Central Senatorial District

Role of Cultural Beliefs and Practices in Shaping Maternal and Infant Healthcare-seeking Behaviour in Abia Central Senatorial District | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Role of Cultural Beliefs and Practices in Shaping Maternal and Infant Healthcare-seeking Behaviour in Abia Central Senatorial District Goodluck Ifeanyi Nwaogwugwu, Ogbonna Jerry Okereke This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6598346/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The research project examines how traditional customs affect maternal and infant medical care utilization patterns within Abia Central Senatorial District of Nigeria. The research used qualitative methods to interview thirty women at urban and rural sites through semi-structured interviews. Traditional Birth Attendant services and home deliveries continue to dominate healthcare delivery despite cultural beliefs which place their trust in local healthcare providers throughout rural areas of Abia Central Senatorial District in Nigeria. Normal births by TBAs and home deliveries continue to play a big role despite which urban areas show an increasing shift toward modern healthcare facilities for prenatal care and institutional births. People face limitations in getting formal healthcare because of their financial problems and geographical difficulties as well as inadequate transportation system and healthcare provider negativity. Family relationships between husbands and mothers-in-law have a direct impact on medical choices made by their female family members. The research team proposes cultural competency in healthcare services together with improved infrastructure and financial support and community-based healthcare education to improve maternal healthcare behavior and results in the target area. Cultural Beliefs Maternal Healthcare Infant Traditional Introduction Nigeria alongside sub-Saharan Africa faces an ongoing public health issue regarding maternal and infant health since multiple healthcare reforms and policies have failed to decrease unacceptably high mortality rates (World Health Organization [WHO], 2023). The sustained health service gaps for maternal and infant populations trace back to cultural beliefs and traditional practices that direct health needs behavior among residents in rural and semi-urban areas. Decisions related to pregnancy and childbirth and postnatal care receive influence from both traditional healthcare and cultural values and norms more than biomedical recommendations in the Abia Central Senatorial District of Nigeria (Okeke & Okafor, 2020 ). Healthcare-seeking behaviour refers to the ways which people decide to handle their perceived health problems through their pursuit of medical support at specific locations during decided time periods (MacKian, 2003 ). Human behavior in healthcare depends on multiple factors beyond service accessibility and medical information because it evolves from a network of social influences. Traditional beliefs related to pregnancy and childbirth run deep throughout African societies as people interpret maternal illness spiritually while following beliefs about ancestral spirits and social status of women and observe cultural taboos (Ajeigbe et al., 2019 ). People hold onto their established beliefs that cause them to pick traditional birth attendants instead of trained medical personnel for childbirth care situations (Ezeama & Uche, 2021 ). Abia Central holds special importance because it contains rural as well as peri-urban communities thus making cultural influences on healthcare-seeking decisions very important. Local indigenous systems together with elders from the community serve as maternal care conduct guides for most households but some women stay away from biomedical services because of worries about mistreatment and costs and health condition stigma (Ntoimo & Okonofua, 2014 ). Women face barriers in their health decision-making due to patriarchal society and male control of decisions (Odetola, 2015 ). The combination of these factors produces mother and baby health risks because mothers delay or avoid visiting formal healthcare facilities. Identifying cultural aspects of maternal and infant healthcare behavior represents a fundamental requirement for developing effective culturally appropriate intervention strategies. Health initiatives that ignore cultural characteristics of their target audience usually achieve minimal success with low public participation. The objective of this research is to explore the particular cultural perspectives which guide maternal and newborn medical care decisions within Abia Central Senatorial District for the development of health policies that fit local beliefs. Influence of Cultural Beliefs on Perceptions of Pregnancy and Childbirth Cultural beliefs actively create how people view pregnancy and childbirth in Abia Central Senatorial District and such beliefs determine when women will receive care during and after pregnancy and where they receive this care. Within numerous communities residing in this particular geographic area pregnancy exists as both a biological occurrence and spiritual and social event. The cultural belief system of this area guides many women to protect their pregnancies from supposed spiritual harm by using charms and rituals instead of medical services at the beginning of their pregnancy (Ajeigbe, Odusanya, & Adebajo, 2019 ). Typically in Abia Central many women think that early pregnancy announcements would attract both spiritual mischief and rivalry from adversaries. The belief system of some women delays their antenatal care registration until the second or third trimester even though public health recommends visiting antenatal care early (Okeke & Okafor, 2020 ). Some women explain their pregnancy symptoms as coming from spiritual causes instead of medical issues and cultural taboos instead of healthcare needs. Medical interpretations which guide women to seek healing from traditional healers and spiritual leaders occur before they consider health facility visits (Ezeama & Uche, 2021 ). Society commonly states that childbirth functions as an assessment of both a woman’s physical capabilities and spiritual sanctity. Communities across the world traditionally recognize women who give birth without medical help as superior to women who need cesarean sections for delivery. Such beliefs guide negative public perception of facility-based deliveries particularly when surgical procedures are expected (Odetola, 2015 ). Labor complications fail to persuade certain women to visit the hospital immediately because they choose to start with traditional remedies or consult traditional birth attendants TBAs instead. The intergenerational transfer of knowledge allows older female members from mother and mother-in-law relationships to hold authority over traditional maternal healthcare practices. Older female figures influence younger women's decisions between medical advice and modern healthcare using considerable force (Ntoimo & Okonofua, 2014 ). The challenging relationship between custom and contemporary healthcare demands that healthcare professionals both teach and intertwine with cultural practices and folk traditions to enhance maternal risk reduction. The way local people frame pregnancy and childbirth in Abia Central Senatorial District heavily influences how mothers seek healthcare for themselves during pregnancy and childbirth. Women allow their spiritual, strength-related and social expectations beliefs to direct their choices which occasionally leads to delayed medical care. To counter these problems requires health education that respects culture together with traditional institutions to modify hazardous beliefs while keeping local populations onboard. Preference for Traditional Birth Attendants and Home Deliveries Traditional Birth Attendants (TBAs) along with home deliveries continue as common birth choice among women in Abia Central Senatorial District because of various cultural economic and structural influences. The district's pregnant women select Traditional Birth Attendants instead of medically trained providers because they prefer familiar faces and trust in their services as well as easy access and the link of traditional practices with cultural beliefs. As health providers Traditional Birth Attendants use local wisdom and both religious customs and traditional birth rituals that their communities handed down through generations. The communities view TBAs as healthcare providers who are better than healthcare workers in public facilities due to their deep community roots and higher levels of care they provide (Adewuyi & Akinade 2020 ). The support and care delivered by Traditional Birth Attendants stands apart from the unfavorable healthcare experiences which some patients encounter in medical institutions because it meets cultural needs. TBAs use prayer as well as herbal remedies and perform massages and apply traditional birthing positions which create comfort for women based on their cultural familiarity (Ezeama & Uche, 2021 ). The financial requirements shape many women's choice to select TBAs as their birth assistance provider. Rural families along with those in low-income areas find hospital-based delivery expenses excessive for many birthing mothers since both private and referral facilities charge high fees. The services provided by TBAs are more reasonably priced and give clients freedom to pay in ways that suit them best which makes their services available to women with less financial means (Odetola, 2015 ). TBAs reduce the transportation difficulties for pregnant women because they serve women within their homes instead of requiring them to travel to health facilities. TBAs deliver their medical services to clients with both sensitivity to cultural traditions and a non-condemning approach. Research shows hospital patients experience negative treatment during pregnancy for unmarried women or for multiple births or requirements for cesarean intervention (Okafor 2014 ). Beneficial outcomes from professional attendance at births stem from being seen as providers who value cultural identity and social standing of clients. The healthcare system that depends on TBAs together with home births comes with significant dangers. Many studies confirm that TBAs do not possess sufficient skills and necessary equipment for dealing with complications including hemorrhage alongside eclampsia and obstructed labor which represent main causes of maternal and newborn death in Nigeria (World Health Organization [WHO], 2023). The shortage of proper referral paths and emergency crisis management networks leads to delayed medical treatment when problems happen thus producing fatal results. Patient choices persist in favor of having child birth under TBA supervision at home due to cultural preferences combined with economical factors and geographic convenience together with problems with formal medical treatment. The emergence of this cultural pattern indicates maternal healthcare needs an integrated system which both advocates TBA regulation and cultural proficiency in health interventions. To improve care quality TBAs should learn danger sign identifications and must promptly refer complicated cases while receiving training in home-based health education activities. Abia Central residents select Traditional Birth Attendants for deliveries because they trust their remedies and cultural practices along with the affordable cost and the sense that hospitals offer substandard care. An inclusive maternal health policy needs to establish communication between traditional and biomedical models to give women from every socio-cultural background access to safe healthcare services that respect their culture. Role of Family, Gender Norms, and Social Influences Social norms and family relationships along with societal factors strongly influence maternal and infant medical care-seeking practices in Abia Central Senatorial District. Decisions concerning pregnancy as well as childbirth usually extend beyond individual women in the district's communities because such choices follow societal and familial expectations which restrict women from accessing suitable prenatal care. Selected geographic communities in the area follow patriarchal household dynamics which make men especially husbands the main decision-making authority for health decisions and financial matters and movement control. According to Ntoimo and Okonofua ( 2014 ), women must either get their husbands' consent or financial assistance to receive healthcare when pregnant at medical facilities. The decision usually passes to other eligible males or senior family members if the husband is out of reach. The dependency between women and their husbands leads to extended delays particularly during emergencies which subsequently decreases the possibility of beneficial maternal and neonatal results (Ogu et al., 2020 ). Numerous decision-making authorities affecting maternal well-being include mothers-in-law together with different older female relatives. Many older female relatives serve as cultural experts in customary practices and they will advise women to birth their children outside of hospitals because they prefer traditional birth at home. The older female relatives hold authority through traditional family values and by honoring births without medical medical interventions because they see Western healthcare systems as both unnecessary and unknown (Ajeigbe, Odusanya, & Adebajo, 2019 ). The behavioral choices of mothers in maintaining their health are influenced by negative public perceptions and social norms. Maternal patients who frequently consult medical professionals during their pregnancy face community stigma because they are considered weak and distant from traditional birth customs. People delivering their babies at home independently receive appreciation for demonstrating cultural tradition as well as showing strength in following local beliefs (Ezeama & Uche, 2021 ). Women face social judgment pressure in such environments which stimulates their selection of traditional care choices over modern medical options. Gender norms create barriers that prevent women from obtaining appropriate education and economic resources as well as contributing to their restricted freedom in seeking medical care by themselves. Studies show continuous evidence that limited educational attainment creates barriers to maternal health care utilization because educated women tend to overcome traditional barriers and obtain health information needed to make better choices (Odetola, 2015 ). Female dependence on their male partners frequently reduces their access to choices especially during healthcare situations which require payments or transportation to far-away facilities. Social and religious institutions of certain communities operate to strengthen traditional male-female roles. Community figures who possess respect and people of religious or traditional leadership make healthcare choices for mothers and influence their behavior. These traditional leaders represent dual potential when they work with formal health services because they can function as barriers or become beneficial partners for advancing health-seeking conduct (Okeke & Okafor, 2020 ). Family relationships together with social and gender-based cultural norms create strong determinants of maternal and infant healthcare service utilization in Abia Central. The achievement of better maternal health results demands proper intervention into these social institutions. Medical interventions need to surpass patient-centered approaches to adopt community-level educational programs along with male engagement in maternal care and programs that provide women with education and economic independence. Local community dynamics require respect from joint health initiatives which incorporate fair healthcare access policies for establishing sustainable improvements in maternal wellness behaviors Barriers to Formal Healthcare Despite Cultural Integration Integrating cultural beliefs as well as practices still does not remove numerous obstacles blocking the access of women in Abia Central Senatorial District to formal healthcare during pregnancy and childbirth. Many socio-cultural economic and systematic obstacles to modern health services jointly sustain long-standing cultural medical frameworks among women who understand the benefits of hospital births. The high financial expenses associated with healthcare represent an outstanding major obstacle in access to medical services. Rural women of Abia Central must cope with financial struggles which prevent them from getting formal medical care during their pregnancy. Proceedings related to antenatal care (ANC) and hospital birth and the expense of transportation to healthcare facilities and postnatal support cost far too much for families with limited income (Ntoimo & Okonofua, 2014 ). The cost of hospital-based healthcare services proves too expensive for women who then turn to traditional birth attendants because their services provide both monetary affordability and flexibility (Ajeigbe, Odusanya, & Adebajo, 2019 ). The absence of adequate infrastructure together with geographical barriers create barriers for formal healthcare accessibility. Pregnant women struggle to access health facilities because numerous Abia Central communities exist in remote locations which have restricted road access especially during emergency medical situations. The absence of effective transportation methods in rural areas pushes pregnant women to delay care by increasing their time to access skilled birth attendants (Odetola, 2015 ). Women who need to travel long distances for delivery will encounter complications since they access health centers that are located too far from their homes. The poor treatment from medical professionals functions as a substantial challenge for women attempting to access healthcare services. Female patients experience discrimination at the hands of healthcare providers who work in public hospitals while accessing medical services. Health professionals display unprofessional behavior by treating women harshly when they practice traditional medicine the professionals view as backward (Ezeama & Uche, 2021 ). The negative experiences of women-directed care discourage numerous pregnant women from choosing formal care services because they see traditional birth attendants and home-based delivery services as offering more comfort. Care at the hands of healthcare workers in rural areas suffers due to excessive workload as well as limited training and inadequate resources which both decrease maternal service quality and strain the trust in national healthcare structures (Okeke & Okafor, 2020 ). Social stigma functions as a main factor that prevents women from using professional medical healthcare facilities. Social disapproval often follows women when they get hospital deliveries or when they frequently visit medical facilities for care. The belief that delivery is a natural private occurrence still prevails in certain cultural groups which discourages them from embracing medical assistance during childbirth. Society views women who need cesarean sections poorly because they do not demonstrate cultural expectations of enduring birth (Adewuyi & Akinade, 2020 ). Society's attitude of stigma makes women hesitant to access suitable pregnancy treatment on time thus delaying necessary medical help during the childbirth process. The healthcare systems operate independently without proper collaboration between traditional and modern practices. Many areas display separate operations between traditional birth attendants and formal healthcare providers since these two groups work independently from each other. The lack of communication between TBA services and the formal medical system prevents women from receiving early medical help since they begin their childbirth experience with these traditional practitioners until problems emerge and it becomes too late to prevent maternal and infant mortality or complications (WHO, 2023). The implementation of training programs to integrate TBAs into the formal health system faces challenges because health workers together with traditional practitioners commonly resist such advancements (Ogu et al., 2020 ). Strategies to improve healthcare utilisation must focus on lowering the financial burden, improving relationships between healthcare providers and patients, addressing stigma, and strengthening collaboration between traditional and modern healthcare systems to ensure that women can access the care they need when they need it. This is because, although maternal healthcare practices in Abia Central Senatorial District have been culturally integrated, there are still many obstacles to formal healthcare that must be overcome. These obstacles include both economic and infrastructural improvements as well as a cultural shift towards respect for both traditional and modern healthcare practices. Theoretical Framework This study draws its foundation from the combined theoretical perspective of Health Belief Model (HBM) and Socio-Cultural Theory which offer appropriate frameworks to analyze the intricate relationship between maternal and infant healthcare-seeking behaviors and cultural and personal beliefs in Abia Central Senatorial District. The Health Belief Model (HBM) developed by Rosenstock in 1950s evolved through additional work by Becker and others provides a prevalent theory which explains and foretells health behaviors through assessment of individual beliefs and attitudes (Rosenstock, 1974 ; Becker, 1974 ). Patients exhibit greater health-promoting behavior when they recognize own risk susceptibility to an illness (perceived susceptibility), understand its serious characteristics (perceived severity), identify protective benefits from health actions (perceived benefits), and believe they can surmount potential barriers (perceived barriers). Cues to action combined with self-efficacy help determine human conduct along with additional model components. Health Belief Model serves to understand why certain women in Abia Central Area refrain from using formal healthcare services during pregnancy and childbirth. A person who considers pregnancy an ordinary and safe process would not visit antenatal facilities or give birth at a medical institution. The woman will choose traditional care options over hospital birth whenever the obstacles including high expenses and distant locations as well as adverse healthcare encounters with workers exceed hospital benefits. Janz & Becker ( 1984 ) together with Glanz, Rimer & Viswanath ( 2008 ) found that cultural norms along with familial advice function as influential action cues which strengthen conventional beliefs and behaviors. The Health Belief Model receives additional support from Vygotsky’s Socio-Cultural Theory when studying how culture and social environments and historical backgrounds affect human behavior and cognitive processes (Vygotsky, 1978 ). Tables show that people lack independence when making choices because they remain part of an interactive social environment which uses cultural artifacts and social customs to shape learning results. Socio-cultural theory explains maternal healthcare decision-making processes because pregnant women in this context often defer to the guidance of mothers-in-law along with elders and traditional birth attendants and community leaders. Residents of Abia Central continue cultural traditions regarding childbirth which they inherit from elders through collective community understanding. Medical advice carries less weight than cultural beliefs especially in rural areas because residents distrust modern health services or these services are scarce. Women in Abia Central face limitations in selecting formal healthcare because traditional gender norms control their power to make decisions independently from male family members or heads (Okafor et al., 2014). This study uses the combination of Health Belief Model alongside Socio-Cultural Theory to examine psychological factors and cultural and social influences on maternal healthcare-seeking actions. The joint theoretical framework between Health Belief Model and Socio-Cultural Theory emerges as an effective method to understand total female behavioral patterns toward getting healthcare services in Abia Central’s multicultural environment. Methodology Through descriptive phenomenological research methods the study investigated cultural beliefs and practices which influence maternal and infant healthcare-seeking actions in Abia Central Senatorial District of Nigeria. The main purpose of this research involved examining how cultural practices together with traditional family systems shape maternal healthcare options between prenatal and postnatal periods. This paper uses the following sections to present the research methodology which includes the design structure alongside the chosen study location and desired participants with detailed information regarding data collection and analytics along with ethical protocols. Research Design This study used a descriptive phenomenological research design to evaluate genuine experiences and perceptions of women toward maternal healthcare choice behaviors. This method enables researchers to examine subject perceived thoughts and discover cultural variables that shape healthcare choices throughout pregnancy and childbirth. The study utilizes phenomenology due to its capacity for understanding how individuals interpret experiences resulting from social and cultural contexts according to Creswell (2013). Study Setting The research took place within the boundary of Abia Central Senatorial District situated in southeastern Nigeria. Abia Central Senatorial District served as the research location because it contains numerous traditional healthcare practices which dominate rural areas. The area contains both urban and rural habitats whose health care service accessibility differs greatly from one location to another. Abia Central residents maintain different healthcare preferences among them since some districts depend on Traditional Birth Attendants for home deliveries but other districts access formal healthcare centers. The study benefited from conducting research in the district because of its diverse healthcare practices. Participant Selection For this study the researchers employed Purposive sampling to identify their research participants. The recruited participants included women aged 18 to 49 years old who gave birth during the last five years. The research selected women across rural and urban sectors from Abia Central to deliver information based on a wide range of experiences. The researcher involved thirty women in the study by actively seeking participating women across different economic levels and educational achievement and cultural backgrounds. The researchers judged this number of participants appropriate for qualitative research because it produced ample deep details alongside feasible data assessment capabilities (Guest, Bunce, & Johnson, 2006). The research team received participant recruits through staff members at health centers as well as attendees at community meetings and through networking with original participants in snowball sampling. The following were the requirements for participation: Women between the ages of 18 and 49 Women who had at least one pregnancy and delivery experience Women who were open to talking about their healthcare-seeking behaviours and cultural customs related to pregnancy and childbirth; Exclusion criteria Women who had not given birth in the previous five years Women who were unable or unwilling to give their consent to participate in the study. Information Gathering Semi-structured interviews were used to gather data for this study because they gave participants the opportunity to talk about their experiences in their own words while still offering some structure to help direct the discussion. The following major themes were intended to be explored in the interview guide: Pregnancy and childbirth practices and cultural beliefs. Pregnancy and childbirth health-seeking behaviours, such as preferences for healthcare providers (e.g., hospital deliveries vs. traditional birth attendants). How social and familial factors affect the choices made about maternal healthcare. Obstacles to obtaining official medical care. Each interview lasted 45 minutes to an hour, and was conducted in either English or the local Igbo dialect, depending on the participant's preference. All interviews were audio-recorded with the participants' consent, and thorough field notes were taken during the interviews to supplement the recorded data. The interviews were conducted in private settings to ensure that participants felt at ease and could speak freely. Data Analysis The following steps were involved in the analysis process, which was conducted using the thematic analysis approach as described by Braun and Clarke (2006). This approach is suitable for qualitative studies because it enables the identification and analysis of patterns or themes within the data: 1. Data familiarisation: The researcher read and transcribed the interview transcripts several times to gain a thorough understanding of the data. 2. Initial coding: The transcripts were coded line-by-line to identify key phrases or concepts related to the research questions. 3. Theme development: The codes were grouped into themes that represented broader patterns in the data regarding the role of cultural beliefs, healthcare-seeking behaviours, and barriers to accessing formal healthcare. 4. Themes were reviewed and refined to ensure they accurately reflected the data and addressed the research questions. 5. Reporting: The final themes were detailed, backed up by direct quotes from participants to highlight important findings. The data was arranged using the NVivo software, which also made the analysis process easier. Ethical Considerations The study complied with ethical standards for participant rights protection, confidentiality, and informed consent. Participants were fully informed prior to the interviews about the study's objectives, the fact that participation was voluntary, and their freedom to discontinue participation at any moment without incurring any fees. All participants provided written informed consent. Additionally, participants received assurances that their answers would be kept private and anonymous, and that pseudonyms would be used to protect their identities when the results were reported. Furthermore, the study made sure that participants would not suffer any physical or psychological harm while taking part. The researcher was cognisant of the cultural and emotional nuances of talking about pregnancy and childbirth, and participants had the choice to skip any questions they felt uncomfortable answering. Findings This section summarises the study's findings, which examined how cultural beliefs and practices shape maternal and infant healthcare-seeking behaviour in Nigeria's Abia Central Senatorial District. The data gathered from 30 women in both urban and rural areas identified a number of important themes that emphasise the impact of gender norms, cultural factors, family dynamics, and financial constraints on maternal health decisions. These themes are categorised under the following headings: Healthcare-Seeking Behaviours, Cultural Beliefs and Practices, Barriers to Formal Healthcare Access, and Role of Family and Social Influences. Cultural Beliefs and Practices One of the most important findings of this study was the strong influence of traditional beliefs and practices on maternal healthcare-seeking behaviour. According to participants, childbirth is viewed as a spiritual and cultural milestone in addition to a biological event, and many women expressed the belief that medical intervention was unnecessary unless complications arose and that childbirth should take place in the community, supported by traditional practices. The notion that pregnancy and childbirth are natural processes that should not be "medicalised" was a common cultural belief mentioned by many participants. One participant said, In our community, giving birth is a woman's responsibility. We trust in the power of nature and our traditional midwives. Only when things go wrong do we go to the hospital. Without a hospital, our moms gave birth at home, and everything went well. Why should we make that change right now? Going to the hospital is not necessary unless there is a serious issue. Giving birth is not a disease. Several women also identified Traditional Birth Attendants (TBAs) as crucial figures during pregnancy and delivery, and participants saw TBAs as highly trusted individuals who not only provided physical care but also offered emotional and spiritual support during childbirth. According to a participant: The TBA is like a mother to me; she prays with me, knows me well, gives me herbs, massages my back, she cares and stays with me until the baby is born because it's more reassuring than visiting a hospital. Many women's maternal health routines were also said to revolve around traditional practices, such as the use of herbal remedies and special postpartum care. One participant said, for example, herbs are given to us after childbirth to strengthen our body and cleanse our system. My mother-in-law made special herbs for me to drink and bathe with after giving birth, which speeds up the healing process. We use local herbs and hot water massage to cleanse the womb and get rid of bad blood. We have a tradition of doing this, and it speeds up our recovery. Healthcare-Seeking Behaviours Despite the prominence of traditional practices, a significant number of women indicated a willingness to seek formal healthcare during pregnancy, particularly for antenatal care (ANC) and during emergencies. However, the degree of access to healthcare services, knowledge of contemporary healthcare, and family guidance all affected the way people sought medical attention. Compared to their rural counterparts, participants in urban areas typically reported using formal healthcare services more frequently. Urban women were more likely to attend ANC clinics, where they received regular screenings and medical advice, and they also had better access to healthcare facilities. I go to the health centre for antenatal care because it's close, and they check everything to ensure my baby is healthy, they perform all the necessary tests, and the nurses always check my blood pressure and give me advice. The clinic is only a few minutes from my house. (One urban participant affirmed). In contrast, rural women, particularly those from remote villages, faced challenges accessing healthcare services due to geographical barriers and the cost of healthcare. Long travel distances and the related transportation expenses prevented many rural participants from seeking hospital-based care, even though they would have preferred to do so. The hospital is a long way away, and I can't afford to pay for a motorbike and occasionally even stay overnight. I wanted to go for prenatal care, but there is no transport available unless someone is travelling that way due to the poor road conditions. Many women sought help from formal healthcare when there were perceived risks or complications. Nonetheless, home deliveries continued to be popular, particularly when there were no issues. TBAs were frequently chosen for routine deliveries due to their perceived familiarity with local customs, their low cost, and the comfort they provided during the birthing process Obstacles to Official Access to Healthcare In order to understand why many women in Abia Central continue to favour traditional healthcare options in spite of the availability of modern medical facilities, the study identified a number of barriers to formal healthcare access. Financial Constraints : One of the most common barriers was the high cost of formal healthcare. Many women stated that they could not afford the cost of healthcare services, especially transportation to medical centres and hospital deliveries. One rural participant stated, "I choose to deliver at home with a TBA because I can't afford to deliver in the hospital; it's too expensive." Inadequate Infrastructure and Accessibility : Access to official healthcare was significantly hampered by geographic constraints. Many women lived in communities without direct access to healthcare facilities, especially those in rural areas. Women found it challenging to get to health centres, particularly during emergencies, due to lengthy travel times and bad road conditions. "The closest hospital is more than 30 kilometres away," one participant shared. I was unable to get there in time when I went into labour. Unfavourable Views of Healthcare Professionals : A few women stated that they were reluctant to seek official medical attention because of unfavourable prior encounters with healthcare professionals. Many women, especially those seeking prenatal care, reported feeling mistreated or disrespected by hospital staff. One participant said, "I felt uneasy around the hospital nurses. They were impolite and gave me the impression that I was too archaic to be there. These unfavourable encounters strengthened dependence on TBAs and increased mistrust of official healthcare systems. Cultural Stigma : According to one woman, “Some people think I am weak because I don’t give birth at home. They say I’m too modern and don’t know how to take care of myself the traditional way.” The study also reported that cultural views regarding childbirth significantly influenced healthcare choices, and women who sought hospital deliveries were frequently stigmatised in their communities because they were seen as not trusting traditional practices. Role of Family and Social Influences Another important factor in determining maternal healthcare-seeking behaviour was the role of family and social networks. Women frequently cited needing the consent of male family members before seeking formal healthcare, especially for hospital deliveries. A participant indicated : My husband has to agree before I go to the hospital. He says it's better to stay home and give birth. Also, without my husband's consent and financial support for transportation, I am unable to visit the hospital. I had to wait for my husband to get back before we could go to the clinic, even though I was in pain. In rural areas, older female relatives had a particularly strong influence. On the basis of conventional beliefs, mothers-in-law and other elderly women in the community frequently served as gatekeepers, directing younger women's healthcare choices. A participant noted, My mother-in-law insists that I give birth at home. She advises me against squandering money on a hospital. Because women in our family always give birth at home, my mother-in-law advised me against going to the hospital. After delivery, I simply follow her instructions after she has prepared the herbs. Nonetheless, in certain instances, women were encouraged to seek formal healthcare when necessary, especially in cases of complications or emergencies, by supportive male partners and extended family members. This was especially noticeable in urban areas where people were more conscious of healthcare. The results of this study highlight the intricate interactions that shape maternal and infant healthcare-seeking behaviour in the Abia Central Senatorial District, including interplays between cultural beliefs, family dynamics, economic factors, and access to healthcare services. Even though traditional methods still predominate, particularly in rural areas, there is a growing trend towards formal healthcare utilisation, especially when complications occur or women have easier access to medical facilities. Improving maternal and infant health outcomes in the area will require overcoming obstacles like cost, geographic constraints, and unfavourable perceptions of healthcare providers. Discussion he study's results show the intricate relationship between socioeconomic factors, cultural beliefs, and healthcare-seeking behaviours in the Abia Central Senatorial District, Nigeria. Based on the lived experiences of the participants, the study emphasises the importance of traditional practices in influencing maternal healthcare choices, while also demonstrating the growing influence of modern healthcare services. The discussion looks at the results in light of previous research, concentrating on the influence of gender norms and family, the impact of cultural beliefs, and barriers to formal healthcare. Cultural Beliefs and Traditional Practices The study's most startling result include the continued prevalence of traditional conceptions of pregnancy and childbirth. Many Abia Central women still mainly rely on home births and Traditional Birth Attendants (TBAs) in spite of the availability of contemporary medical facilities. The idea that childbirth is a normal and culturally significant event that ought to be handled in the community, frequently with the help of family members and TBAs, is the basis for this preference. These results align with earlier research conducted in Nigeria and other African settings, where cultural beliefs significantly influence healthcare practices during pregnancy and childbirth (Abubakar et al., 2014; Ajeigbe et al., 2019 ). Trust in traditional practices and the perceived accessibility and affordability of these services are two of the main reasons for the heavy reliance on TBAs. When interacting with TBAs, many participants reported feeling at ease and supported emotionally, something that was thought to be lacking in hospital settings. This finding is consistent with earlier research that indicates traditional healthcare providers' cultural familiarity and holistic approach to care tend to make women in rural areas feel more connected to them (Adewuyi & Akinade, 2020 ). Herbal remedies and cultural postpartum rituals are two practices that demonstrate the wider influence of cultural beliefs on maternal health practices. Access to Formal Healthcare and Healthcare-Seeking Behaviours The results show a growing trend towards the use of formal healthcare services, particularly in urban areas, even though traditional practices continue to be prevalent. In this study, urban women were more likely to give birth in medical facilities and seek antenatal care (ANC). This trend is indicative of broader changes in health-related behaviours brought about by heightened awareness of the advantages of receiving professional medical care as well as easier access to healthcare in urban areas. According to earlier research, urban women are more likely than their rural counterparts to use hospital services because they have easier access to healthcare facilities (Ntoimo & Okonofua, 2014 ; Ogu et al., 2020 ). However, the study also discovered that because of financial and geographic constraints, rural women who frequently reside in isolated locations with little access to healthcare—continue to rely on TBAs. Many participants stated that the expense of hospital deliveries and prenatal visits discouraged them from seeking formal healthcare, making the cost of healthcare a significant obstacle. This result is in line with other research conducted in Nigeria and sub-Saharan Africa, where access to healthcare is severely impacted by financial constraints (Adebayo & Ogunniyi, 2018). Women frequently prioritised more accessible, affordable traditional options due to the high cost of healthcare and the distance to the closest healthcare facility. The results also show that some women feel disrespected or mistreated by medical staff, especially in public hospitals, which further deters them from seeking formal healthcare. These negative perceptions are a major obstacle to maternal healthcare in many African countries, where poor patient-provider interactions often undermine the effectiveness of health interventions (Adewuyi & Akinade, 2020 ). These findings also point to the need for sensitisation and training of healthcare providers to ensure that women feel respected and supported when seeking care. Obstacles to formal Access to Healthcare Financial constraints were the most frequently reported barrier to accessing formal healthcare, particularly in rural areas where women have limited financial resources. This study identifies a number of barriers to formal healthcare access that persist despite the availability of health facilities. This is consistent with other research that shows that the cost of healthcare, including consultation fees, delivery services, and medication costs, remains a major barrier to accessing formal healthcare services for many women (Ajeigbe et al., 2019 ). The study also found that inadequate healthcare infrastructure, especially in rural areas, is a major obstacle. Women in rural areas find it challenging to access healthcare facilities, particularly during emergencies, due to a lack of dependable transportation and badly maintained roads. According to Odetola ( 2015 ), this result is in line with earlier research that emphasised the geographic inaccessibility of health services in rural Nigeria, which frequently causes delays in seeking prompt care during childbirth. The study also discovered that women's use of formal healthcare services is discouraged by cultural stigma. Communities frequently stigmatised women who sought hospital deliveries, especially those who underwent caesarean sections, for defying accepted childbirth conventions. Women may be deterred from seeking medical attention in hospital settings by such cultural pressure, especially if they are afraid of social rejection. A major contributing factor to the continued use of traditional birth practices is the cultural stigma associated with hospital births, which has been extensively documented in the literature (Adebayo & Ogunniyi, 2018; Ajeigbe et al., 2019 ). Role of social and familial influences It was discovered that social networks and family play a significant role in influencing healthcare choices. Many women stated that husbands and mothers-in-law had a significant impact on their decisions to seek formal healthcare, particularly for hospital deliveries. The use of healthcare services was either strongly encouraged or discouraged by these family members. While patriarchal norms restricted women's ability to seek care without male family members' consent, in other cases, male partners supported hospital deliveries, particularly when complications were expected. This result is consistent with research that has shown how family dynamics and gender norms influence healthcare choices in sub-Saharan Africa (Dada et al., 2020). Women's healthcare-seeking behaviours were also impacted by their interactions with older female relatives, including grandmothers and mothers-in-law. These family members frequently promoted traditional childbirth methods, discouraging hospital deliveries in favour of TBA-attended home births. This trend is consistent with other research conducted in Nigeria, where older women, especially in rural areas, are frequently the keepers of cultural customs (Ntoimo & Okonofua, 2014 ). The results of this study highlight how cultural beliefs, socioeconomic factors, and family dynamics significantly impact the healthcare-seeking behaviours of mothers and infants in the Abia Central Senatorial District. While traditional practices continue to dominate, particularly in rural areas, there is also an increasing recognition of the importance of formal healthcare, especially in urban settings. However, obstacles like lack of funding, inadequate infrastructure, unfavourable opinions of medical professionals, and social stigma still prevent women from receiving official healthcare services. In order to overcome these obstacles and create a more integrated approach to maternal health, multimodal interventions are needed that enhance healthcare access while also encouraging respect for both conventional and contemporary medical procedures. Conclusion In the Abia Central Senatorial District of Nigeria, this study examined how cultural practices and beliefs influence the behaviour of mothers and infants seeking medical attention. The findings underscore the complex interplay between traditional beliefs, socio-economic factors, and healthcare access that influences the decisions women make regarding maternal health. While cultural beliefs still have a significant influence on healthcare-seeking behaviours, particularly in rural areas, there is a shift towards more integrated healthcare practices as people become more aware of the advantages of formal healthcare, especially in urban settings. The study emphasises the persistent use of home births and Traditional Birth Attendants (TBAs), particularly in rural areas where customs surrounding childbirth are deeply ingrained and TBAs are regarded as reliable individuals who offer not only medical but also emotional and spiritual support. Geographical and financial constraints that restrict access to official healthcare services exacerbate this dependence even more. Financial constraints, long distances to healthcare facilities, and the high costs of hospital deliveries were significant barriers for many women, particularly those in rural areas. Notwithstanding these obstacles, the study also discovered that urban women are increasingly using formal healthcare services, especially hospital deliveries and prenatal care, when they can. Nonetheless, broader acceptance of formal healthcare among women in both rural and urban areas is still hampered by unfavourable opinions of healthcare providers, subpar treatment experiences, and the cultural stigma associated with hospital births. Women's decisions about maternal healthcare are greatly influenced by social and familial factors, especially the roles of mothers-in-law, husbands, and other family members. These social factors, which can either promote or impede access to official healthcare services, are frequently based on gender dynamics and cultural norms. These results make it abundantly evident that enhancing maternal healthcare in the Abia Central Senatorial District necessitates a comprehensive strategy that tackles the practical as well as cultural obstacles to healthcare access. In order to respect cultural beliefs and promote the benefits of formal healthcare, policymakers and healthcare providers must interact with communities. Interventions that increase awareness, education, and trust in healthcare providers, alongside improving healthcare infrastructure and affordability, will be essential to improving maternal and infant health outcomes in the region. All things considered, this study offers insightful information about the cultural factors influencing maternal healthcare choices in Abia Central, laying the groundwork for further studies and initiatives targeted at improving the availability, calibre, and acceptability of maternal healthcare services in Nigeria and comparable settings. Recommendations Several suggestions are made to improve the healthcare-seeking behaviours of mothers and infants in Nigeria's Abia Central Senatorial District in light of the study's findings. These recommendations aim to address the identified barriers and encourage a more integrated approach to healthcare that respects cultural practices while promoting the benefits of modern healthcare. Culturally Appropriate Medical Treatments: While promoting the use of official healthcare services, healthcare providers should embrace culturally sensitive strategies that honour regional customs and beliefs. Community-based programs could be developed to bridge the gap between traditional and modern healthcare practices. In order to promote safe birthing practices, these programs should include Traditional Birth Attendants (TBAs), who acknowledge the cultural significance of traditional practices while providing educational sessions on the advantages of medical care. Improving maternal health outcomes and facilitating prompt referrals to medical facilities when needed could be achieved by providing TBAs with training in emergency preparedness and basic maternal healthcare. Enhancement of Medical Facilities: Improvements in healthcare infrastructure, especially in rural areas, are necessary to address the geographic barriers to healthcare access. This includes better roads, transportation options, and the establishment of mobile clinics or health outreach programs to reach women in remote communities. In addition to lowering the cost of transportation to medical facilities, local health facilities should have the staff and resources needed to offer quality maternity care. Funding and Subsidies for Health Services for Mothers: Policies that offer financial support or subsidies for maternal healthcare services are desperately needed, as financial limitations are a major obstacle to receiving formal healthcare, especially for hospital deliveries. Prenatal care and delivery services could be provided by government programs for free or at a reduced cost, especially in underprivileged and rural areas. In order to help pay for maternal care and guarantee that more women have access to essential services without having to worry about paying for them out of pocket, insurance plans could also be investigated. Campaigns for Education and Awareness: Campaigns for education and awareness are required in order to dispel unfavourable opinions about healthcare services and highlight the advantages of formal healthcare, especially hospital deliveries. To create a welcoming atmosphere for seeking medical attention, these campaigns ought to focus on women and their families, particularly men. Attitudes regarding the use of healthcare services may change if people are informed about the dangers of home births, the availability of trained birth attendants, and the safety of hospital births. Initiatives for community health education should also aim to dispel myths about medical professionals and foster confidence in the official healthcare system. Education for Medical Professionals: Enhancing maternal healthcare-seeking behaviours requires improving the standard of care provided in medical facilities. Healthcare providers should undergo regular training on patient-centered care, with a focus on improving interpersonal communication skills and cultural competence. In addition to ensuring that women feel valued and at ease when seeking care, this would help address the unfavourable experiences that women frequently report having with healthcare professionals. Healthcare professionals should also receive training on how to identify and resolve gender-based power dynamics that could affect women's healthcare choices. Increasing Family Support and Involvement: Increasing the participation of family members, especially husbands and mothers-in-law, in maternal health education is crucial because social networks and family have a big impact on the healthcare decisions made by mothers. Involving senior women and men in community health initiatives may enhance support for women's healthcare choices. Couples counselling and family-centered health education initiatives could foster shared accountability for healthcare-seeking behaviours and collaborative decision-making in issues pertaining to the health of mothers and infants. Community Empowerment and Participation: Achieving sustainable health outcomes requires empowering communities to actively participate in enhancing maternal and child health. Initiatives involving local women, TBAs, and other community stakeholders in maternal health programs should be spearheaded by community-based organisations. Local leaders can encourage women to seek care when necessary, promote safe birthing practices, and challenge harmful cultural norms by interacting with the community. Community-driven strategies can also aid in bridging the gap between traditional practices and formal healthcare systems and increasing awareness of the healthcare services that are available. Monitoring and Evaluation: Programs for maternal healthcare must be continuously monitored and evaluated in order to determine how well they are working to improve maternal health outcomes and healthcare-seeking behaviours. In order to improve healthcare services and inform policy decisions, data on maternal health indicators should be gathered, along with input from women and healthcare professionals. Adapting interventions to meet the changing needs of the population will require regular evaluations of cultural practices and their influence on healthcare choices. Declarations Statement of Ethics Approval This study involving human participants was reviewed and approved by the Coal City University Enugu Ethics Committee. The research was found to comply with relevant ethical standards, including informed consent and participant confidentiality. Author Contribution Goodluck Ifeanyi Nwaogwugwu conceived the study, designed the research framework, and led the data collection process.• Ogbonna Jerry Okereke conducted the literature review, participated in the analysis, and contributed to the interpretation of the findings.• Ogbonna Jerry Okereke assisted with data analysis and contributed to writing the methodology and results sections.• Goodluck Ifeanyi Nwaogwugwu drafted the initial manuscript and coordinated the overall writing process.• All authors reviewed and approved the final manuscript and agree to be accountable for all aspects of the work. References Adewuyi, E. O., & Akinade, E. A. (2020). Perceived roles of traditional birth attendants in maternal health care delivery in rural Nigeria. International Journal of Childbirth , 10 (2), 96–107. https://doi.org/10.1891/IJCBIRTH-D-19-00043 Ajeigbe, D. O., Odusanya, O. O., & Adebajo, S. B. (2019). Cultural beliefs and perceptions about maternal health in Southwest Nigeria. African Journal of Reproductive Health , 23 (4), 15–24. https://doi.org/10.29063/ajrh2019/v23i4.2 Becker, M. H. (1974). The Health Belief Model and Personal Health Behavior. Health Education Monographs , 2(4), 324–473. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology , 3 (2), 77–101. https://doi.org/10.1191/1478088706qp063oa Creswell, J. W. (2013). Qualitative inquiry and research design: Choosing among five approaches (3rd ed.). SAGE Publications. Ezeama, N. N., & Uche, I. K. (2021). Traditional beliefs and maternal health practices in Southeastern Nigeria: A qualitative study. Journal of Ethnobiology and Ethnomedicine , 17 , 45. https://doi.org/10.1186/s13002-021-00463-5 Ezeama, N. N., & Uche, I. K. (2021). Traditional beliefs and maternal health practices in Southeastern Nigeria: A qualitative study. Journal of Ethnobiology and Ethnomedicine , 17 , 45. https://doi.org/10.1186/s13002-021-00463-5 Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Health Behavior and Health Education: Theory, Research, and Practice (4th ed.). San Francisco: Jossey-Bass. Guest, G., Bunce, A., & Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods , 18 (1), 59–82. https://doi.org/10.1177/1525822X05279903 Janz, N. K., & Becker, M. H. (1984). The Health Belief Model: A Decade Later. Health Education Quarterly , 11(1), 1–47. MacKian, S. (2003). A review of health seeking behaviour: Problems and prospects . Health Systems Development Programme, University of Manchester. Ntoimo, L. F. C., & Okonofua, F. (2014). Female education and maternal health care utilization in Nigeria: Examining the roles of ethnicity and religion. African Population Studies , 28 (1), 515–527. https://doi.org/10.11564/28-0-526 Odetola, T. D. (2015). Health care utilization among rural women of child-bearing age: A Nigerian experience. The Pan African Medical Journal , 20 , 151. https://doi.org/10.11604/pamj.2015.20.151.5485 Ogu, R. N., Eke, A. C., & Nwachukwu, C. E. (2020). Factors influencing health-seeking behavior among pregnant women in rural Nigeria. International Journal of Women's Health , 12 , 125–134. https://doi.org/10.2147/IJWH.S241817 Okafor, C. B. (2014). Maternal health care utilization in Nigeria: Evidence from demographic and health survey. African Journal of Reproductive Health , 18 (2), 38–45. https://doi.org/10.29063/ajrh2014/v18i2.4 Okeke, T. A., & Okafor, H. U. (2020). Perceptions and determinants of maternal health service use among women in rural Southeastern Nigeria. Nigerian Journal of Clinical Practice , 23 (7), 983–990. https://doi.org/10.4103/njcp.njcp_249_19 Rosenstock, I. M. (1974). Historical Origins of the Health Belief Model. Health Education Monographs , 2(4), 328–335. Vygotsky, L. S. (1978). Mind in Society: The Development of Higher Psychological Processes . Cambridge, MA: Harvard University Press. World Health Organization (WHO). (2023). Trends in maternal mortality 2000 to 2020: Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division . https://www.who.int/publications/i/item/9789240079325 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6598346","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":452425600,"identity":"52ccdc5a-258d-402f-8be3-305d8cfb7cad","order_by":0,"name":"Goodluck Ifeanyi Nwaogwugwu","email":"data:image/png;base64,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","orcid":"","institution":"Department of Sociology Coal City University Enugu","correspondingAuthor":true,"prefix":"","firstName":"Goodluck","middleName":"Ifeanyi","lastName":"Nwaogwugwu","suffix":""},{"id":452425601,"identity":"f708a9e8-b6bf-46f8-9d74-8d08333de6df","order_by":1,"name":"Ogbonna Jerry Okereke","email":"","orcid":"","institution":"Department of Sociology Ebonyi State University Abakaliki","correspondingAuthor":false,"prefix":"","firstName":"Ogbonna","middleName":"Jerry","lastName":"Okereke","suffix":""}],"badges":[],"createdAt":"2025-05-06 02:53:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6598346/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6598346/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83166467,"identity":"31ca9ae6-e8c8-4232-b648-33fdb4087684","added_by":"auto","created_at":"2025-05-20 16:16:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":677087,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6598346/v1/af463006-ca61-4d39-b07b-ba2c1fa160c8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eRole of Cultural Beliefs and Practices in Shaping Maternal and Infant Healthcare-seeking Behaviour in Abia Central Senatorial District\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNigeria alongside sub-Saharan Africa faces an ongoing public health issue regarding maternal and infant health since multiple healthcare reforms and policies have failed to decrease unacceptably high mortality rates (World Health Organization [WHO], 2023). The sustained health service gaps for maternal and infant populations trace back to cultural beliefs and traditional practices that direct health needs behavior among residents in rural and semi-urban areas. Decisions related to pregnancy and childbirth and postnatal care receive influence from both traditional healthcare and cultural values and norms more than biomedical recommendations in the Abia Central Senatorial District of Nigeria (Okeke \u0026amp; Okafor, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHealthcare-seeking behaviour refers to the ways which people decide to handle their perceived health problems through their pursuit of medical support at specific locations during decided time periods (MacKian, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2003\u003c/span\u003e). Human behavior in healthcare depends on multiple factors beyond service accessibility and medical information because it evolves from a network of social influences. Traditional beliefs related to pregnancy and childbirth run deep throughout African societies as people interpret maternal illness spiritually while following beliefs about ancestral spirits and social status of women and observe cultural taboos (Ajeigbe et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). People hold onto their established beliefs that cause them to pick traditional birth attendants instead of trained medical personnel for childbirth care situations (Ezeama \u0026amp; Uche, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAbia Central holds special importance because it contains rural as well as peri-urban communities thus making cultural influences on healthcare-seeking decisions very important. Local indigenous systems together with elders from the community serve as maternal care conduct guides for most households but some women stay away from biomedical services because of worries about mistreatment and costs and health condition stigma (Ntoimo \u0026amp; Okonofua, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Women face barriers in their health decision-making due to patriarchal society and male control of decisions (Odetola, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). The combination of these factors produces mother and baby health risks because mothers delay or avoid visiting formal healthcare facilities.\u003c/p\u003e \u003cp\u003eIdentifying cultural aspects of maternal and infant healthcare behavior represents a fundamental requirement for developing effective culturally appropriate intervention strategies. Health initiatives that ignore cultural characteristics of their target audience usually achieve minimal success with low public participation. The objective of this research is to explore the particular cultural perspectives which guide maternal and newborn medical care decisions within Abia Central Senatorial District for the development of health policies that fit local beliefs.\u003c/p\u003e\n\u003ch3\u003eInfluence of Cultural Beliefs on Perceptions of Pregnancy and Childbirth\u003c/h3\u003e\n\u003cp\u003eCultural beliefs actively create how people view pregnancy and childbirth in Abia Central Senatorial District and such beliefs determine when women will receive care during and after pregnancy and where they receive this care. Within numerous communities residing in this particular geographic area pregnancy exists as both a biological occurrence and spiritual and social event. The cultural belief system of this area guides many women to protect their pregnancies from supposed spiritual harm by using charms and rituals instead of medical services at the beginning of their pregnancy (Ajeigbe, Odusanya, \u0026amp; Adebajo, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTypically in Abia Central many women think that early pregnancy announcements would attract both spiritual mischief and rivalry from adversaries. The belief system of some women delays their antenatal care registration until the second or third trimester even though public health recommends visiting antenatal care early (Okeke \u0026amp; Okafor, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Some women explain their pregnancy symptoms as coming from spiritual causes instead of medical issues and cultural taboos instead of healthcare needs. Medical interpretations which guide women to seek healing from traditional healers and spiritual leaders occur before they consider health facility visits (Ezeama \u0026amp; Uche, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSociety commonly states that childbirth functions as an assessment of both a woman\u0026rsquo;s physical capabilities and spiritual sanctity. Communities across the world traditionally recognize women who give birth without medical help as superior to women who need cesarean sections for delivery. Such beliefs guide negative public perception of facility-based deliveries particularly when surgical procedures are expected (Odetola, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Labor complications fail to persuade certain women to visit the hospital immediately because they choose to start with traditional remedies or consult traditional birth attendants TBAs instead.\u003c/p\u003e \u003cp\u003eThe intergenerational transfer of knowledge allows older female members from mother and mother-in-law relationships to hold authority over traditional maternal healthcare practices. Older female figures influence younger women's decisions between medical advice and modern healthcare using considerable force (Ntoimo \u0026amp; Okonofua, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). The challenging relationship between custom and contemporary healthcare demands that healthcare professionals both teach and intertwine with cultural practices and folk traditions to enhance maternal risk reduction.\u003c/p\u003e \u003cp\u003eThe way local people frame pregnancy and childbirth in Abia Central Senatorial District heavily influences how mothers seek healthcare for themselves during pregnancy and childbirth. Women allow their spiritual, strength-related and social expectations beliefs to direct their choices which occasionally leads to delayed medical care. To counter these problems requires health education that respects culture together with traditional institutions to modify hazardous beliefs while keeping local populations onboard.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePreference for Traditional Birth Attendants and Home Deliveries\u003c/h2\u003e \u003cp\u003eTraditional Birth Attendants (TBAs) along with home deliveries continue as common birth choice among women in Abia Central Senatorial District because of various cultural economic and structural influences. The district's pregnant women select Traditional Birth Attendants instead of medically trained providers because they prefer familiar faces and trust in their services as well as easy access and the link of traditional practices with cultural beliefs.\u003c/p\u003e \u003cp\u003eAs health providers Traditional Birth Attendants use local wisdom and both religious customs and traditional birth rituals that their communities handed down through generations. The communities view TBAs as healthcare providers who are better than healthcare workers in public facilities due to their deep community roots and higher levels of care they provide (Adewuyi \u0026amp; Akinade \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The support and care delivered by Traditional Birth Attendants stands apart from the unfavorable healthcare experiences which some patients encounter in medical institutions because it meets cultural needs. TBAs use prayer as well as herbal remedies and perform massages and apply traditional birthing positions which create comfort for women based on their cultural familiarity (Ezeama \u0026amp; Uche, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe financial requirements shape many women's choice to select TBAs as their birth assistance provider. Rural families along with those in low-income areas find hospital-based delivery expenses excessive for many birthing mothers since both private and referral facilities charge high fees. The services provided by TBAs are more reasonably priced and give clients freedom to pay in ways that suit them best which makes their services available to women with less financial means (Odetola, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). TBAs reduce the transportation difficulties for pregnant women because they serve women within their homes instead of requiring them to travel to health facilities.\u003c/p\u003e \u003cp\u003eTBAs deliver their medical services to clients with both sensitivity to cultural traditions and a non-condemning approach. Research shows hospital patients experience negative treatment during pregnancy for unmarried women or for multiple births or requirements for cesarean intervention (Okafor \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Beneficial outcomes from professional attendance at births stem from being seen as providers who value cultural identity and social standing of clients. The healthcare system that depends on TBAs together with home births comes with significant dangers. Many studies confirm that TBAs do not possess sufficient skills and necessary equipment for dealing with complications including hemorrhage alongside eclampsia and obstructed labor which represent main causes of maternal and newborn death in Nigeria (World Health Organization [WHO], 2023). The shortage of proper referral paths and emergency crisis management networks leads to delayed medical treatment when problems happen thus producing fatal results.\u003c/p\u003e \u003cp\u003ePatient choices persist in favor of having child birth under TBA supervision at home due to cultural preferences combined with economical factors and geographic convenience together with problems with formal medical treatment. The emergence of this cultural pattern indicates maternal healthcare needs an integrated system which both advocates TBA regulation and cultural proficiency in health interventions. To improve care quality TBAs should learn danger sign identifications and must promptly refer complicated cases while receiving training in home-based health education activities.\u003c/p\u003e \u003cp\u003eAbia Central residents select Traditional Birth Attendants for deliveries because they trust their remedies and cultural practices along with the affordable cost and the sense that hospitals offer substandard care. An inclusive maternal health policy needs to establish communication between traditional and biomedical models to give women from every socio-cultural background access to safe healthcare services that respect their culture.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRole of Family, Gender Norms, and Social Influences\u003c/h3\u003e\n\u003cp\u003eSocial norms and family relationships along with societal factors strongly influence maternal and infant medical care-seeking practices in Abia Central Senatorial District. Decisions concerning pregnancy as well as childbirth usually extend beyond individual women in the district's communities because such choices follow societal and familial expectations which restrict women from accessing suitable prenatal care.\u003c/p\u003e \u003cp\u003eSelected geographic communities in the area follow patriarchal household dynamics which make men especially husbands the main decision-making authority for health decisions and financial matters and movement control. According to Ntoimo and Okonofua (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), women must either get their husbands' consent or financial assistance to receive healthcare when pregnant at medical facilities. The decision usually passes to other eligible males or senior family members if the husband is out of reach. The dependency between women and their husbands leads to extended delays particularly during emergencies which subsequently decreases the possibility of beneficial maternal and neonatal results (Ogu et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNumerous decision-making authorities affecting maternal well-being include mothers-in-law together with different older female relatives. Many older female relatives serve as cultural experts in customary practices and they will advise women to birth their children outside of hospitals because they prefer traditional birth at home. The older female relatives hold authority through traditional family values and by honoring births without medical medical interventions because they see Western healthcare systems as both unnecessary and unknown (Ajeigbe, Odusanya, \u0026amp; Adebajo, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe behavioral choices of mothers in maintaining their health are influenced by negative public perceptions and social norms. Maternal patients who frequently consult medical professionals during their pregnancy face community stigma because they are considered weak and distant from traditional birth customs. People delivering their babies at home independently receive appreciation for demonstrating cultural tradition as well as showing strength in following local beliefs (Ezeama \u0026amp; Uche, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Women face social judgment pressure in such environments which stimulates their selection of traditional care choices over modern medical options.\u003c/p\u003e \u003cp\u003eGender norms create barriers that prevent women from obtaining appropriate education and economic resources as well as contributing to their restricted freedom in seeking medical care by themselves. Studies show continuous evidence that limited educational attainment creates barriers to maternal health care utilization because educated women tend to overcome traditional barriers and obtain health information needed to make better choices (Odetola, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Female dependence on their male partners frequently reduces their access to choices especially during healthcare situations which require payments or transportation to far-away facilities.\u003c/p\u003e \u003cp\u003eSocial and religious institutions of certain communities operate to strengthen traditional male-female roles. Community figures who possess respect and people of religious or traditional leadership make healthcare choices for mothers and influence their behavior. These traditional leaders represent dual potential when they work with formal health services because they can function as barriers or become beneficial partners for advancing health-seeking conduct (Okeke \u0026amp; Okafor, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFamily relationships together with social and gender-based cultural norms create strong determinants of maternal and infant healthcare service utilization in Abia Central. The achievement of better maternal health results demands proper intervention into these social institutions. Medical interventions need to surpass patient-centered approaches to adopt community-level educational programs along with male engagement in maternal care and programs that provide women with education and economic independence. Local community dynamics require respect from joint health initiatives which incorporate fair healthcare access policies for establishing sustainable improvements in maternal wellness behaviors\u003c/p\u003e\n\u003ch3\u003eBarriers to Formal Healthcare Despite Cultural Integration\u003c/h3\u003e\n\u003cp\u003eIntegrating cultural beliefs as well as practices still does not remove numerous obstacles blocking the access of women in Abia Central Senatorial District to formal healthcare during pregnancy and childbirth. Many socio-cultural economic and systematic obstacles to modern health services jointly sustain long-standing cultural medical frameworks among women who understand the benefits of hospital births.\u003c/p\u003e \u003cp\u003eThe high financial expenses associated with healthcare represent an outstanding major obstacle in access to medical services. Rural women of Abia Central must cope with financial struggles which prevent them from getting formal medical care during their pregnancy. Proceedings related to antenatal care (ANC) and hospital birth and the expense of transportation to healthcare facilities and postnatal support cost far too much for families with limited income (Ntoimo \u0026amp; Okonofua, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). The cost of hospital-based healthcare services proves too expensive for women who then turn to traditional birth attendants because their services provide both monetary affordability and flexibility (Ajeigbe, Odusanya, \u0026amp; Adebajo, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe absence of adequate infrastructure together with geographical barriers create barriers for formal healthcare accessibility. Pregnant women struggle to access health facilities because numerous Abia Central communities exist in remote locations which have restricted road access especially during emergency medical situations. The absence of effective transportation methods in rural areas pushes pregnant women to delay care by increasing their time to access skilled birth attendants (Odetola, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Women who need to travel long distances for delivery will encounter complications since they access health centers that are located too far from their homes.\u003c/p\u003e \u003cp\u003eThe poor treatment from medical professionals functions as a substantial challenge for women attempting to access healthcare services. Female patients experience discrimination at the hands of healthcare providers who work in public hospitals while accessing medical services. Health professionals display unprofessional behavior by treating women harshly when they practice traditional medicine the professionals view as backward (Ezeama \u0026amp; Uche, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The negative experiences of women-directed care discourage numerous pregnant women from choosing formal care services because they see traditional birth attendants and home-based delivery services as offering more comfort. Care at the hands of healthcare workers in rural areas suffers due to excessive workload as well as limited training and inadequate resources which both decrease maternal service quality and strain the trust in national healthcare structures (Okeke \u0026amp; Okafor, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSocial stigma functions as a main factor that prevents women from using professional medical healthcare facilities. Social disapproval often follows women when they get hospital deliveries or when they frequently visit medical facilities for care. The belief that delivery is a natural private occurrence still prevails in certain cultural groups which discourages them from embracing medical assistance during childbirth. Society views women who need cesarean sections poorly because they do not demonstrate cultural expectations of enduring birth (Adewuyi \u0026amp; Akinade, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Society's attitude of stigma makes women hesitant to access suitable pregnancy treatment on time thus delaying necessary medical help during the childbirth process.\u003c/p\u003e \u003cp\u003eThe healthcare systems operate independently without proper collaboration between traditional and modern practices. Many areas display separate operations between traditional birth attendants and formal healthcare providers since these two groups work independently from each other. The lack of communication between TBA services and the formal medical system prevents women from receiving early medical help since they begin their childbirth experience with these traditional practitioners until problems emerge and it becomes too late to prevent maternal and infant mortality or complications (WHO, 2023). The implementation of training programs to integrate TBAs into the formal health system faces challenges because health workers together with traditional practitioners commonly resist such advancements (Ogu et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStrategies to improve healthcare utilisation must focus on lowering the financial burden, improving relationships between healthcare providers and patients, addressing stigma, and strengthening collaboration between traditional and modern healthcare systems to ensure that women can access the care they need when they need it. This is because, although maternal healthcare practices in Abia Central Senatorial District have been culturally integrated, there are still many obstacles to formal healthcare that must be overcome. These obstacles include both economic and infrastructural improvements as well as a cultural shift towards respect for both traditional and modern healthcare practices.\u003c/p\u003e\n\u003ch3\u003eTheoretical Framework\u003c/h3\u003e\n\u003cp\u003eThis study draws its foundation from the combined theoretical perspective of Health Belief Model (HBM) and Socio-Cultural Theory which offer appropriate frameworks to analyze the intricate relationship between maternal and infant healthcare-seeking behaviors and cultural and personal beliefs in Abia Central Senatorial District.\u003c/p\u003e \u003cp\u003eThe Health Belief Model (HBM) developed by Rosenstock in 1950s evolved through additional work by Becker and others provides a prevalent theory which explains and foretells health behaviors through assessment of individual beliefs and attitudes (Rosenstock, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e1974\u003c/span\u003e; Becker, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e1974\u003c/span\u003e). Patients exhibit greater health-promoting behavior when they recognize own risk susceptibility to an illness (perceived susceptibility), understand its serious characteristics (perceived severity), identify protective benefits from health actions (perceived benefits), and believe they can surmount potential barriers (perceived barriers). Cues to action combined with self-efficacy help determine human conduct along with additional model components.\u003c/p\u003e \u003cp\u003eHealth Belief Model serves to understand why certain women in Abia Central Area refrain from using formal healthcare services during pregnancy and childbirth. A person who considers pregnancy an ordinary and safe process would not visit antenatal facilities or give birth at a medical institution. The woman will choose traditional care options over hospital birth whenever the obstacles including high expenses and distant locations as well as adverse healthcare encounters with workers exceed hospital benefits. Janz \u0026amp; Becker (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e1984\u003c/span\u003e) together with Glanz, Rimer \u0026amp; Viswanath (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2008\u003c/span\u003e) found that cultural norms along with familial advice function as influential action cues which strengthen conventional beliefs and behaviors. The Health Belief Model receives additional support from Vygotsky\u0026rsquo;s Socio-Cultural Theory when studying how culture and social environments and historical backgrounds affect human behavior and cognitive processes (Vygotsky, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e1978\u003c/span\u003e). Tables show that people lack independence when making choices because they remain part of an interactive social environment which uses cultural artifacts and social customs to shape learning results.\u003c/p\u003e \u003cp\u003eSocio-cultural theory explains maternal healthcare decision-making processes because pregnant women in this context often defer to the guidance of mothers-in-law along with elders and traditional birth attendants and community leaders. Residents of Abia Central continue cultural traditions regarding childbirth which they inherit from elders through collective community understanding. Medical advice carries less weight than cultural beliefs especially in rural areas because residents distrust modern health services or these services are scarce. Women in Abia Central face limitations in selecting formal healthcare because traditional gender norms control their power to make decisions independently from male family members or heads (Okafor et al., 2014).\u003c/p\u003e \u003cp\u003eThis study uses the combination of Health Belief Model alongside Socio-Cultural Theory to examine psychological factors and cultural and social influences on maternal healthcare-seeking actions. The joint theoretical framework between Health Belief Model and Socio-Cultural Theory emerges as an effective method to understand total female behavioral patterns toward getting healthcare services in Abia Central\u0026rsquo;s multicultural environment.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eThrough descriptive phenomenological research methods the study investigated cultural beliefs and practices which influence maternal and infant healthcare-seeking actions in Abia Central Senatorial District of Nigeria. The main purpose of this research involved examining how cultural practices together with traditional family systems shape maternal healthcare options between prenatal and postnatal periods. This paper uses the following sections to present the research methodology which includes the design structure alongside the chosen study location and desired participants with detailed information regarding data collection and analytics along with ethical protocols.\u003c/p\u003e\n\u003cp\u003eResearch Design\u003c/p\u003e\n\u003cp\u003eThis study used a descriptive phenomenological research design to evaluate genuine experiences and perceptions of women toward maternal healthcare choice behaviors. This method enables researchers to examine subject perceived thoughts and discover cultural variables that shape healthcare choices throughout pregnancy and childbirth. The study utilizes phenomenology due to its capacity for understanding how individuals interpret experiences resulting from social and cultural contexts according to Creswell (2013).\u003c/p\u003e\n\u003cp\u003eStudy Setting\u003c/p\u003e\n\u003cp\u003eThe research took place within the boundary of Abia Central Senatorial District situated in southeastern Nigeria. Abia Central Senatorial District served as the research location because it contains numerous traditional healthcare practices which dominate rural areas. The area contains both urban and rural habitats whose health care service accessibility differs greatly from one location to another. Abia Central residents maintain different healthcare preferences among them since some districts depend on Traditional Birth Attendants for home deliveries but other districts access formal healthcare centers. The study benefited from conducting research in the district because of its diverse healthcare practices.\u003c/p\u003e\n\u003cp\u003eParticipant Selection\u003c/p\u003e\n\u003cp\u003eFor this study the researchers employed Purposive sampling to identify their research participants. The recruited participants included women aged 18 to 49 years old who gave birth during the last five years. The research selected women across rural and urban sectors from Abia Central to deliver information based on a wide range of experiences.\u003c/p\u003e\n\u003cp\u003eThe researcher involved thirty women in the study by actively seeking participating women across different economic levels and educational achievement and cultural backgrounds. The researchers judged this number of participants appropriate for qualitative research because it produced ample deep details alongside feasible data assessment capabilities (Guest, Bunce, \u0026amp; Johnson, 2006). The research team received participant recruits through staff members at health centers as well as attendees at community meetings and through networking with original participants in snowball sampling. The following were the requirements for participation:\u0026nbsp;\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eWomen between the ages of 18 and 49\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWomen who had at least one pregnancy and delivery experience\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWomen who were open to talking about their healthcare-seeking behaviours and cultural customs related to pregnancy and childbirth;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eExclusion criteria\u0026nbsp;\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eWomen who had not given birth in the previous five years\u003c/li\u003e\n \u003cli\u003eWomen who were unable or unwilling to give their consent to participate in the study.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eInformation Gathering\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSemi-structured interviews were used to gather data for this study because they gave participants the opportunity to talk about their experiences in their own words while still offering some structure to help direct the discussion. The following major themes were intended to be explored in the interview guide:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003ePregnancy and childbirth practices and cultural beliefs.\u003c/li\u003e\n \u003cli\u003ePregnancy and childbirth health-seeking behaviours, such as preferences for healthcare providers (e.g., hospital deliveries vs. traditional birth attendants).\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHow social and familial factors affect the choices made about maternal healthcare.\u003c/li\u003e\n \u003cli\u003eObstacles to obtaining official medical care.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eEach interview lasted 45 minutes to an hour, and was conducted in either English or the local Igbo dialect, depending on the participant's preference. All interviews were audio-recorded with the participants' consent, and thorough field notes were taken during the interviews to supplement the recorded data. The interviews were conducted in private settings to ensure that participants felt at ease and could speak freely.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe following steps were involved in the analysis process, which was conducted using the thematic analysis approach as described by Braun and Clarke (2006). This approach is suitable for qualitative studies because it enables the identification and analysis of patterns or themes within the data:\u003c/p\u003e\n\u003cp\u003e1. Data familiarisation: The researcher read and transcribed the interview transcripts several times to gain a thorough understanding of the data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. Initial coding: The transcripts were coded line-by-line to identify key phrases or concepts related to the research questions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3. Theme development: The codes were grouped into themes that represented broader patterns in the data regarding the role of cultural beliefs, healthcare-seeking behaviours, and barriers to accessing formal healthcare.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4. Themes were reviewed and refined to ensure they accurately reflected the data and addressed the research questions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e5. Reporting: The final themes were detailed, backed up by direct quotes from participants to highlight important findings.\u003c/p\u003e\n\u003cp\u003eThe data was arranged using the NVivo software, which also made the analysis process easier.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study complied with ethical standards for participant rights protection, confidentiality, and informed consent. Participants were fully informed prior to the interviews about the study's objectives, the fact that participation was voluntary, and their freedom to discontinue participation at any moment without incurring any fees. All participants provided written informed consent. Additionally, participants received assurances that their answers would be kept private and anonymous, and that pseudonyms would be used to protect their identities when the results were reported.\u003c/p\u003e\n\u003cp\u003eFurthermore, the study made sure that participants would not suffer any physical or psychological harm while taking part. The researcher was cognisant of the cultural and emotional nuances of talking about pregnancy and childbirth, and participants had the choice to skip any questions they felt uncomfortable answering.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFindings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis section summarises the study's findings, which examined how cultural beliefs and practices shape maternal and infant healthcare-seeking behaviour in Nigeria's Abia Central Senatorial District. The data gathered from 30 women in both urban and rural areas identified a number of important themes that emphasise the impact of gender norms, cultural factors, family dynamics, and financial constraints on maternal health decisions. These themes are categorised under the following headings: Healthcare-Seeking Behaviours, Cultural Beliefs and Practices, Barriers to Formal Healthcare Access, and Role of Family and Social Influences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCultural Beliefs and Practices\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne of the most important findings of this study was the strong influence of traditional beliefs and practices on maternal healthcare-seeking behaviour. According to participants, childbirth is viewed as a spiritual and cultural milestone in addition to a biological event, and many women expressed the belief that medical intervention was unnecessary unless complications arose and that childbirth should take place in the community, supported by traditional practices.\u003c/p\u003e\n\u003cp\u003eThe notion that pregnancy and childbirth are natural processes that should not be \"medicalised\" was a common cultural belief mentioned by many participants. One participant said,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn our community, giving birth is a woman's responsibility. We trust in the power of nature and our traditional midwives. Only when things go wrong do we go to the hospital. Without a hospital, our moms gave birth at home, and everything went well. Why should we make that change right now? Going to the hospital is not necessary unless there is a serious issue. Giving birth is not a disease.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Several women also identified Traditional Birth Attendants (TBAs) as crucial figures during pregnancy and delivery, and participants saw TBAs as highly trusted individuals who not only provided physical care but also offered emotional and spiritual support during childbirth. According to a participant:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe TBA is like a mother to me; she prays with me, knows me well, gives me herbs, massages my back, she cares and stays with me until the baby is born because it's more reassuring than visiting a hospital.\u003c/p\u003e\n\u003cp\u003eMany women's maternal health routines were also said to revolve around traditional practices, such as the use of herbal remedies and special postpartum care. One participant said, for example,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eherbs are given to us after childbirth to strengthen our body and cleanse our system. My mother-in-law made special herbs for me to drink and bathe with after giving birth, which speeds up the healing process. We use local herbs and hot water massage to cleanse the womb and get rid of bad blood. We have a tradition of doing this, and it speeds up our recovery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHealthcare-Seeking Behaviours\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDespite the prominence of traditional practices, a significant number of women indicated a willingness to seek formal healthcare during pregnancy, particularly for antenatal care (ANC) and during emergencies. However, the degree of access to healthcare services, knowledge of contemporary healthcare, and family guidance all affected the way people sought medical attention.\u003c/p\u003e\n\u003cp\u003eCompared to their rural counterparts, participants in urban areas typically reported using formal healthcare services more frequently. Urban women were more likely to attend ANC clinics, where they received regular screenings and medical advice, and they also had better access to healthcare facilities.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eI go to the health centre for antenatal care because it's close, and they check everything to ensure my baby is healthy, \u0026nbsp;they perform all the necessary tests, and the nurses always check my blood pressure and give me advice. The clinic is only a few minutes from my house. (One urban participant affirmed).\u003c/p\u003e\n\u003cp\u003eIn contrast, rural women, particularly those from remote villages, faced challenges accessing healthcare services due to geographical barriers and the cost of healthcare. Long travel distances and the related transportation expenses prevented many rural participants from seeking hospital-based care, even though they would have preferred to do so.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe hospital is a long way away, and I can't afford to pay for a motorbike and occasionally even stay overnight. I wanted to go for prenatal care, but there is no transport available unless someone is travelling that way due to the poor road conditions.\u003c/p\u003e\n\u003cp\u003eMany women sought help from formal healthcare when there were perceived risks or complications. Nonetheless, home deliveries continued to be popular, particularly when there were no issues. TBAs were frequently chosen for routine deliveries due to their perceived familiarity with local customs, their low cost, and the comfort they provided during the birthing process\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObstacles to Official Access to Healthcare\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn order to understand why many women in Abia Central continue to favour traditional healthcare options in spite of the availability of modern medical facilities, the study identified a number of barriers to formal healthcare access.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFinancial Constraints\u003c/em\u003e: One of the most common barriers was the high cost of formal healthcare. Many women stated that they could not afford the cost of healthcare services, especially transportation to medical centres and hospital deliveries. One rural participant stated, \"I choose to deliver at home with a TBA because I can't afford to deliver in the hospital; it's too expensive.\"\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInadequate Infrastructure and Accessibility\u003c/em\u003e: Access to official healthcare was significantly hampered by geographic constraints. Many women lived in communities without direct access to healthcare facilities, especially those in rural areas. Women found it challenging to get to health centres, particularly during emergencies, due to lengthy travel times and bad road conditions. \"The closest hospital is more than 30 kilometres away,\" one participant shared. I was unable to get there in time when I went into labour.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eUnfavourable Views of Healthcare Professionals\u003c/em\u003e: A few women stated that they were reluctant to seek official medical attention because of unfavourable prior encounters with healthcare professionals. Many women, especially those seeking prenatal care, reported feeling mistreated or disrespected by hospital staff. One participant said, \"I felt uneasy around the hospital nurses. They were impolite and gave me the impression that I was too archaic to be there. These unfavourable encounters strengthened dependence on TBAs and increased mistrust of official healthcare systems.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCultural Stigma\u003c/em\u003e: According to one woman, “Some people think I am weak because I don’t give birth at home. They say I’m too modern and don’t know how to take care of myself the traditional way.” The study also reported that cultural views regarding childbirth significantly influenced healthcare choices, and women who sought hospital deliveries were frequently stigmatised in their communities because they were seen as not trusting traditional practices.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRole of Family and Social Influences\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother important factor in determining maternal healthcare-seeking behaviour was the role of family and social networks. Women frequently cited needing the consent of male family members before seeking formal healthcare, especially for hospital deliveries. A participant indicated :\u003c/p\u003e\n\u003cp\u003eMy husband has to agree before I go to the hospital. He says it's better to stay home and give birth. Also, without my husband's consent and financial support for transportation, I am unable to visit the hospital. I had to wait for my husband to get back before we could go to the clinic, even though I was in pain. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn rural areas, older female relatives had a particularly strong influence. On the basis of conventional beliefs, mothers-in-law and other elderly women in the community frequently served as gatekeepers, directing younger women's healthcare choices. A participant noted,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMy mother-in-law insists that I give birth at home. She advises me against squandering money on a hospital. Because women in our family always give birth at home, my mother-in-law advised me against going to the hospital. After delivery, I simply follow her instructions after she has prepared the herbs.\u003c/p\u003e\n\u003cp\u003eNonetheless, in certain instances, women were encouraged to seek formal healthcare when necessary, especially in cases of complications or emergencies, by supportive male partners and extended family members. This was especially noticeable in urban areas where people were more conscious of healthcare.\u003c/p\u003e\n\u003cp\u003eThe results of this study highlight the intricate interactions that shape maternal and infant healthcare-seeking behaviour in the Abia Central Senatorial District, including interplays between cultural beliefs, family dynamics, economic factors, and access to healthcare services. Even though traditional methods still predominate, particularly in rural areas, there is a growing trend towards formal healthcare utilisation, especially when complications occur or women have easier access to medical facilities. Improving maternal and infant health outcomes in the area will require overcoming obstacles like cost, geographic constraints, and unfavourable perceptions of healthcare providers.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ehe study's results show the intricate relationship between socioeconomic factors, cultural beliefs, and healthcare-seeking behaviours in the Abia Central Senatorial District, Nigeria. Based on the lived experiences of the participants, the study emphasises the importance of traditional practices in influencing maternal healthcare choices, while also demonstrating the growing influence of modern healthcare services. The discussion looks at the results in light of previous research, concentrating on the influence of gender norms and family, the impact of cultural beliefs, and barriers to formal healthcare.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eCultural Beliefs and Traditional Practices\u003c/h2\u003e \u003cp\u003eThe study's most startling result include the continued prevalence of traditional conceptions of pregnancy and childbirth. Many Abia Central women still mainly rely on home births and Traditional Birth Attendants (TBAs) in spite of the availability of contemporary medical facilities. The idea that childbirth is a normal and culturally significant event that ought to be handled in the community, frequently with the help of family members and TBAs, is the basis for this preference. These results align with earlier research conducted in Nigeria and other African settings, where cultural beliefs significantly influence healthcare practices during pregnancy and childbirth (Abubakar et al., 2014; Ajeigbe et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTrust in traditional practices and the perceived accessibility and affordability of these services are two of the main reasons for the heavy reliance on TBAs. When interacting with TBAs, many participants reported feeling at ease and supported emotionally, something that was thought to be lacking in hospital settings. This finding is consistent with earlier research that indicates traditional healthcare providers' cultural familiarity and holistic approach to care tend to make women in rural areas feel more connected to them (Adewuyi \u0026amp; Akinade, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Herbal remedies and cultural postpartum rituals are two practices that demonstrate the wider influence of cultural beliefs on maternal health practices.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eAccess to Formal Healthcare and Healthcare-Seeking Behaviours\u003c/h2\u003e \u003cp\u003eThe results show a growing trend towards the use of formal healthcare services, particularly in urban areas, even though traditional practices continue to be prevalent. In this study, urban women were more likely to give birth in medical facilities and seek antenatal care (ANC). This trend is indicative of broader changes in health-related behaviours brought about by heightened awareness of the advantages of receiving professional medical care as well as easier access to healthcare in urban areas. According to earlier research, urban women are more likely than their rural counterparts to use hospital services because they have easier access to healthcare facilities (Ntoimo \u0026amp; Okonofua, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Ogu et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, the study also discovered that because of financial and geographic constraints, rural women who frequently reside in isolated locations with little access to healthcare\u0026mdash;continue to rely on TBAs. Many participants stated that the expense of hospital deliveries and prenatal visits discouraged them from seeking formal healthcare, making the cost of healthcare a significant obstacle. This result is in line with other research conducted in Nigeria and sub-Saharan Africa, where access to healthcare is severely impacted by financial constraints (Adebayo \u0026amp; Ogunniyi, 2018). Women frequently prioritised more accessible, affordable traditional options due to the high cost of healthcare and the distance to the closest healthcare facility.\u003c/p\u003e \u003cp\u003eThe results also show that some women feel disrespected or mistreated by medical staff, especially in public hospitals, which further deters them from seeking formal healthcare. These negative perceptions are a major obstacle to maternal healthcare in many African countries, where poor patient-provider interactions often undermine the effectiveness of health interventions (Adewuyi \u0026amp; Akinade, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). These findings also point to the need for sensitisation and training of healthcare providers to ensure that women feel respected and supported when seeking care.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eObstacles to formal Access to Healthcare\u003c/h2\u003e \u003cp\u003eFinancial constraints were the most frequently reported barrier to accessing formal healthcare, particularly in rural areas where women have limited financial resources. This study identifies a number of barriers to formal healthcare access that persist despite the availability of health facilities. This is consistent with other research that shows that the cost of healthcare, including consultation fees, delivery services, and medication costs, remains a major barrier to accessing formal healthcare services for many women (Ajeigbe et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe study also found that inadequate healthcare infrastructure, especially in rural areas, is a major obstacle. Women in rural areas find it challenging to access healthcare facilities, particularly during emergencies, due to a lack of dependable transportation and badly maintained roads. According to Odetola (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), this result is in line with earlier research that emphasised the geographic inaccessibility of health services in rural Nigeria, which frequently causes delays in seeking prompt care during childbirth.\u003c/p\u003e \u003cp\u003eThe study also discovered that women's use of formal healthcare services is discouraged by cultural stigma. Communities frequently stigmatised women who sought hospital deliveries, especially those who underwent caesarean sections, for defying accepted childbirth conventions. Women may be deterred from seeking medical attention in hospital settings by such cultural pressure, especially if they are afraid of social rejection. A major contributing factor to the continued use of traditional birth practices is the cultural stigma associated with hospital births, which has been extensively documented in the literature (Adebayo \u0026amp; Ogunniyi, 2018; Ajeigbe et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eRole of social and familial influences\u003c/h2\u003e \u003cp\u003eIt was discovered that social networks and family play a significant role in influencing healthcare choices. Many women stated that husbands and mothers-in-law had a significant impact on their decisions to seek formal healthcare, particularly for hospital deliveries. The use of healthcare services was either strongly encouraged or discouraged by these family members. While patriarchal norms restricted women's ability to seek care without male family members' consent, in other cases, male partners supported hospital deliveries, particularly when complications were expected. This result is consistent with research that has shown how family dynamics and gender norms influence healthcare choices in sub-Saharan Africa (Dada et al., 2020).\u003c/p\u003e \u003cp\u003eWomen's healthcare-seeking behaviours were also impacted by their interactions with older female relatives, including grandmothers and mothers-in-law. These family members frequently promoted traditional childbirth methods, discouraging hospital deliveries in favour of TBA-attended home births. This trend is consistent with other research conducted in Nigeria, where older women, especially in rural areas, are frequently the keepers of cultural customs (Ntoimo \u0026amp; Okonofua, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe results of this study highlight how cultural beliefs, socioeconomic factors, and family dynamics significantly impact the healthcare-seeking behaviours of mothers and infants in the Abia Central Senatorial District. While traditional practices continue to dominate, particularly in rural areas, there is also an increasing recognition of the importance of formal healthcare, especially in urban settings. However, obstacles like lack of funding, inadequate infrastructure, unfavourable opinions of medical professionals, and social stigma still prevent women from receiving official healthcare services. In order to overcome these obstacles and create a more integrated approach to maternal health, multimodal interventions are needed that enhance healthcare access while also encouraging respect for both conventional and contemporary medical procedures.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn the Abia Central Senatorial District of Nigeria, this study examined how cultural practices and beliefs influence the behaviour of mothers and infants seeking medical attention. The findings underscore the complex interplay between traditional beliefs, socio-economic factors, and healthcare access that influences the decisions women make regarding maternal health. While cultural beliefs still have a significant influence on healthcare-seeking behaviours, particularly in rural areas, there is a shift towards more integrated healthcare practices as people become more aware of the advantages of formal healthcare, especially in urban settings.\u003c/p\u003e\n\u003cp\u003eThe study emphasises the persistent use of home births and Traditional Birth Attendants (TBAs), particularly in rural areas where customs surrounding childbirth are deeply ingrained and TBAs are regarded as reliable individuals who offer not only medical but also emotional and spiritual support. Geographical and financial constraints that restrict access to official healthcare services exacerbate this dependence even more. Financial constraints, long distances to healthcare facilities, and the high costs of hospital deliveries were significant barriers for many women, particularly those in rural areas.\u003c/p\u003e\n\u003cp\u003eNotwithstanding these obstacles, the study also discovered that urban women are increasingly using formal healthcare services, especially hospital deliveries and prenatal care, when they can. Nonetheless, broader acceptance of formal healthcare among women in both rural and urban areas is still hampered by unfavourable opinions of healthcare providers, subpar treatment experiences, and the cultural stigma associated with hospital births.\u0026nbsp;\u003cbr\u003e\u0026nbsp;Women's decisions about maternal healthcare are greatly influenced by social and familial factors, especially the roles of mothers-in-law, husbands, and other family members. These social factors, which can either promote or impede access to official healthcare services, are frequently based on gender dynamics and cultural norms.\u003c/p\u003e\n\u003cp\u003eThese results make it abundantly evident that enhancing maternal healthcare in the Abia Central Senatorial District necessitates a comprehensive strategy that tackles the practical as well as cultural obstacles to healthcare access. In order to respect cultural beliefs and promote the benefits of formal healthcare, policymakers and healthcare providers must interact with communities. Interventions that increase awareness, education, and trust in healthcare providers, alongside improving healthcare infrastructure and affordability, will be essential to improving maternal and infant health outcomes in the region. \u0026nbsp;All things considered, this study offers insightful information about the cultural factors influencing maternal healthcare choices in Abia Central, laying the groundwork for further studies and initiatives targeted at improving the availability, calibre, and acceptability of maternal healthcare services in Nigeria and comparable settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendations \u0026nbsp;\u003cbr\u003e\u003c/strong\u003eSeveral suggestions are made to improve the healthcare-seeking behaviours of mothers and infants in Nigeria's Abia Central Senatorial District in light of the study's findings. These recommendations aim to address the identified barriers and encourage a more integrated approach to healthcare that respects cultural practices while promoting the benefits of modern healthcare.\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eCulturally Appropriate Medical Treatments: While promoting the use of official healthcare services, healthcare providers should embrace culturally sensitive strategies that honour regional customs and beliefs. Community-based programs could be developed to bridge the gap between traditional and modern healthcare practices. In order to promote safe birthing practices, these programs should include Traditional Birth Attendants (TBAs), who acknowledge the cultural significance of traditional practices while providing educational sessions on the advantages of medical care. Improving maternal health outcomes and facilitating prompt referrals to medical facilities when needed could be achieved by providing TBAs with training in emergency preparedness and basic maternal healthcare.\u003c/li\u003e\n \u003cli\u003eEnhancement of Medical Facilities: Improvements in healthcare infrastructure, especially in rural areas, are necessary to address the geographic barriers to healthcare access. This includes better roads, transportation options, and the establishment of mobile clinics or health outreach programs to reach women in remote communities. In addition to lowering the cost of transportation to medical facilities, local health facilities should have the staff and resources needed to offer quality maternity care.\u003c/li\u003e\n \u003cli\u003eFunding and Subsidies for Health Services for Mothers: Policies that offer financial support or subsidies for maternal healthcare services are desperately needed, as financial limitations are a major obstacle to receiving formal healthcare, especially for hospital deliveries. Prenatal care and delivery services could be provided by government programs for free or at a reduced cost, especially in underprivileged and rural areas. In order to help pay for maternal care and guarantee that more women have access to essential services without having to worry about paying for them out of pocket, insurance plans could also be investigated.\u003c/li\u003e\n \u003cli\u003eCampaigns for Education and Awareness: Campaigns for education and awareness are required in order to dispel unfavourable opinions about healthcare services and highlight the advantages of formal healthcare, especially hospital deliveries. To create a welcoming atmosphere for seeking medical attention, these campaigns ought to focus on women and their families, particularly men. Attitudes regarding the use of healthcare services may change if people are informed about the dangers of home births, the availability of trained birth attendants, and the safety of hospital births. Initiatives for community health education should also aim to dispel myths about medical professionals and foster confidence in the official healthcare system.\u003c/li\u003e\n \u003cli\u003eEducation for Medical Professionals: Enhancing maternal healthcare-seeking behaviours requires improving the standard of care provided in medical facilities. Healthcare providers should undergo regular training on patient-centered care, with a focus on improving interpersonal communication skills and cultural competence. In addition to ensuring that women feel valued and at ease when seeking care, this would help address the unfavourable experiences that women frequently report having with healthcare professionals. Healthcare professionals should also receive training on how to identify and resolve gender-based power dynamics that could affect women's healthcare choices.\u003c/li\u003e\n \u003cli\u003eIncreasing Family Support and Involvement: Increasing the participation of family members, especially husbands and mothers-in-law, in maternal health education is crucial because social networks and family have a big impact on the healthcare decisions made by mothers. Involving senior women and men in community health initiatives may enhance support for women's healthcare choices. Couples counselling and family-centered health education initiatives could foster shared accountability for healthcare-seeking behaviours and collaborative decision-making in issues pertaining to the health of mothers and infants.\u003c/li\u003e\n \u003cli\u003eCommunity Empowerment and Participation: Achieving sustainable health outcomes requires empowering communities to actively participate in enhancing maternal and child health. Initiatives involving local women, TBAs, and other community stakeholders in maternal health programs should be spearheaded by community-based organisations. Local leaders can encourage women to seek care when necessary, promote safe birthing practices, and challenge harmful cultural norms by interacting with the community. Community-driven strategies can also aid in bridging the gap between traditional practices and formal healthcare systems and increasing awareness of the healthcare services that are available.\u003c/li\u003e\n \u003cli\u003eMonitoring and Evaluation: Programs for maternal healthcare must be continuously monitored and evaluated in order to determine how well they are working to improve maternal health outcomes and healthcare-seeking behaviours. In order to improve healthcare services and inform policy decisions, data on maternal health indicators should be gathered, along with input from women and healthcare professionals. Adapting interventions to meet the changing needs of the population will require regular evaluations of cultural practices and their influence on healthcare choices.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Declarations","content":"\u003cp\u003eStatement of Ethics Approval This study involving human participants was reviewed and approved by the Coal City University Enugu Ethics Committee. The research was found to comply with relevant ethical standards, including informed consent and participant confidentiality.\u003c/p\u003e\n\u003cp\u003eAuthor Contribution\u003c/p\u003e\n\u003cp\u003eGoodluck Ifeanyi Nwaogwugwu conceived the study, designed the research framework, and led the data collection process.\u0026bull; Ogbonna Jerry Okereke conducted the literature review, participated in the analysis, and contributed to the interpretation of the findings.\u0026bull; Ogbonna Jerry Okereke assisted with data analysis and contributed to writing the methodology and results sections.\u0026bull; Goodluck Ifeanyi Nwaogwugwu drafted the initial manuscript and coordinated the overall writing process.\u0026bull; All authors reviewed and approved the final manuscript and agree to be accountable for all aspects of the work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAdewuyi, E. O., \u0026amp; Akinade, E. A. (2020). 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Historical Origins of the Health Belief Model. \u003cem\u003eHealth Education Monographs\u003c/em\u003e, 2(4), 328–335.\u003c/li\u003e\n\u003cli\u003eVygotsky, L. S. (1978). \u003cem\u003eMind in Society: The Development of Higher Psychological Processes\u003c/em\u003e. Cambridge, MA: Harvard University Press.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization (WHO). (2023). \u003cem\u003eTrends in maternal mortality 2000 to 2020: Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division\u003c/em\u003e. https://www.who.int/publications/i/item/9789240079325\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cultural Beliefs, Maternal, Healthcare, Infant Traditional","lastPublishedDoi":"10.21203/rs.3.rs-6598346/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6598346/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e The research project examines how traditional customs affect maternal and infant medical care utilization patterns within Abia Central Senatorial District of Nigeria. The research used qualitative methods to interview thirty women at urban and rural sites through semi-structured interviews. Traditional Birth Attendant services and home deliveries continue to dominate healthcare delivery despite cultural beliefs which place their trust in local healthcare providers throughout rural areas of Abia Central Senatorial District in Nigeria. Normal births by TBAs and home deliveries continue to play a big role despite which urban areas show an increasing shift toward modern healthcare facilities for prenatal care and institutional births. People face limitations in getting formal healthcare because of their financial problems and geographical difficulties as well as inadequate transportation system and healthcare provider negativity. Family relationships between husbands and mothers-in-law have a direct impact on medical choices made by their female family members. The research team proposes cultural competency in healthcare services together with improved infrastructure and financial support and community-based healthcare education to improve maternal healthcare behavior and results in the target area.\u003c/p\u003e","manuscriptTitle":"Role of Cultural Beliefs and Practices in Shaping Maternal and Infant Healthcare-seeking Behaviour in Abia Central Senatorial District","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-12 11:32:14","doi":"10.21203/rs.3.rs-6598346/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"359b3362-e4a0-4688-81d3-00f99bab3a92","owner":[],"postedDate":"May 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-05-20T16:08:38+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-12 11:32:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6598346","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6598346","identity":"rs-6598346","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}