Cultural Beliefs and Practices in Sub-Saharan Africa Influencing Use of Maternal Health Services: A Systematic Integrative Review of Qualitative Research

Abstract

Maternal health services are provided to women worldwide during pregnancy, delivery and after delivery to reduce maternal complications and death. However, due to the lack of access and inefficient use of these services worldwide, 287,000 women died in 2020, equivalent to a daily maternal death of 800. In sub-Saharan Africa, cultural beliefs and practices are significant predisposing factors to maternal mortality. However, there have been limited strategies to address women’s cultural needs around childbirth. This review explores these cultural beliefs and practices and how such influence women’s use of maternal health services in sub-Sahara Africa. Gaps in the literature were identified to promote a more in-depth exploration in future research that could improve holistic and culturally focused maternal health strategies. A qualitative literature search was conducted between 2010 and 2022. Data were analysed using the thematic synthesis technique. The review is registered with PROSPERO (registration number CRD42023410958). A database search identified 1308 hits, of which 41 qualitative studies met the inclusion criteria. Three major themes emerged from the literature: cultural systems, cultural beliefs and practices around pregnancy and childbirth, and cultural beliefs and practices after childbirth. Two subthemes that emerged within the cultural system theme are the role of traditional birth attendants and the patriarchal system. The subthemes that emerged in the theme of cultural beliefs and practices around pregnancy and childbirth are belief in witchcraft, the use of herbs, the stigma attached to caesarean section, delivery positions, skilled male attendants and home delivery. Finally, two subthemes that emerged with cultural beliefs and practices after birth are cultural beliefs surrounding the disposal of the placenta and the use of contraceptives. To improve maternal health outcomes, a more holistic understanding and address of cultural beliefs and practices around pregnancy and childbirth is critical in sub-Saharan Africa.