Socio-Cultural and Economic Barriers to Facility-Based Delivery: Perspectives of Men and Community Gatekeepers in Nasarawa State
Abstract:
This study examined the
socio-cultural and economic barriers influencing the uptake of facility-based
delivery in Nasarawa State, Nigeria, from the perspectives of men and community
gatekeepers, while proposing policy recommendations for strengthening male
engagement and traditional birth attendant (TBA) collaboration. A mixed-methods
cross-sectional design was employed, combining quantitative data from 443
married men across Akwanga, Keffi, and Lafia LGAs, alongside qualitative
insights from 12 FGDs, 21 KIIs, and 46 IDIs with male decision-makers, TBAs,
elders, and health workers. Quantitative data were analyzed using descriptive
statistics, chi-square tests, and logistic regression (p < 0.05).
Qualitative data were thematically coded to explore cultural norms, economic
barriers, gendered decision-making, and perceptions of health facilities. Economic
constraints, including financial hardship (61.2%), transport limitations
(57.8%), and long distances to facilities (54.9%), were the most frequently
cited barriers. Socio-cultural beliefs that childbirth is a strictly female
domain, community reliance on TBAs (48.5%), and the influence of elders
significantly reduced support for facility delivery. Mistrust of healthcare
workers, perceived disrespect, and fear of hidden charges also discouraged
facility utilization. Qualitative narratives highlighted that TBAs were
preferred due to cultural alignment, affordability, flexible payment systems,
and emotional support. Facility-based delivery in Nasarawa State is constrained
by intersecting socio-cultural, economic, and health-system barriers.
Strengthening male involvement, improving community, facility trust, addressing
transport and affordability constraints, and integrating TBAs into supervised
referral frameworks are vital. A context-specific Health Belief Model (HBM) is
proposed to guide interventions.
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