JMIR Publications

Background:

Unskilled birth delivery significantly contributes to maternal and neonatal mortality in Sub-Saharan Africa, especially Nigeria, due to cultural beliefs, poverty, poor health access, and weak policies. Despite efforts to promote skilled attendance, many women still use traditional birth attendants (TBAs) and home deliveries. This study explores the socio-demographic, cultural, and systemic factors driving this trend, offering evidence for better policies and health interventions.

Objective:

This study examined the socio-demographic and socio-cultural barriers to the utilization of skilled delivery services among women of reproductive age in Nigeria.

Methods:

A cross-sectional design utilizing both quantitative surveys and qualitative interviews was employed. The study involved 1,200 expectant and recently delivered women across urban, semi-urban, and rural regions in Nigeria. Data on socio-demographics, beliefs, access factors, and healthcare usage were collected. Policy documents and intervention records were reviewed, while focus groups provided depth to cultural and systemic themes. Descriptive and inferential statistics were applied using SPSS, and thematic analysis was used for qualitative data. A literature triangulation approach was used to validate findings with existing research.

Results:

The study revealed that low maternal education, poverty, and rural residence strongly predicted unskilled delivery service usage. Cultural norms that regard childbirth as a domestic or spiritual event influenced avoidance of hospitals. Access barriers included poor transport, cost, and distrust in formal healthcare. Geographic inequality was evident, with rural regions lacking health infrastructure. Policy review showed limited reach and weak enforcement of maternal care programs. However, when community-based midwives or mobile clinics were available, skilled birth attendance improved significantly.

Conclusions:

The persistence of unskilled deliveries is a multifaceted issue driven by intersecting socio-cultural, economic, geographic, and institutional factors. Despite policy efforts, gaps remain in cultural sensitivity, resource allocation, and infrastructure coverage. To address maternal health effectively, interventions must be locally adapted, multidimensional, and equity-focused. To address unskilled delivery use, maternal health education should leverage community programs with local languages and cultural context. Rural healthcare infrastructure must expand via mobile clinics and trained midwives to improve access. Skilled delivery costs should be subsidized or covered by insurance to remove financial barriers. Traditional birth attendants could be trained and integrated into the formal health system under supervision. Finally, maternal health policies require regular review, adequate funding, and strict monitoring to ensure impact. These steps are vital to reducing maternal mortality in Nigeria and Sub-Saharan Africa. Unskilled delivery service utilization represents a critical barrier to maternal and neonatal health improvements in Nigeria and Sub-Saharan Africa. Addressing this issue through targeted socio-cultural, structural, and policy interventions is essential to reduce preventable maternal deaths and achieve Sustainable Development Goal 3 on maternal health.