“I was treated like a human being”: factors influencing women's preference for traditional birth attendants in Nigeria

Introduction Nigeria's maternal mortality ratio is the highest on the African continent, and the most severe in the world, accounting for more than a quarter (28%) of global maternal deaths. A key factor in the high maternal deaths is the low utilization of facility-based services for childbirth. Despite national and global efforts to promote skilled birth attendance, about half of Nigerian women still resort to Traditional Birth Attendants (TBAs) for childbirth. Understanding the barriers that hamper the use of Skilled Birth Attendants is crucial to reducing maternal mortality and morbidity in Nigeria. The aim of this study is to explore the factors that influence women's preference for Traditional Birth Attendants over formal health facilities in Nigeria. Methodology This is a qualitative study conducted in Kano and Oyo States in Nigeria. Specifically, Focus Group Discussions were conducted with women who have utilized TBAs for childbirth, community leaders, Civil Society Organizations (CSOs) and stakeholders. The research participants were purposively selected using the snowball sampling technique. The Dedoose software for analysis was utilized to generate codes from the data, and the analysis was thematically conducted according to Braun and Clarke's framework. Results The analysis highlights the intersection of socio-cultural, economic, and structural factors that sustain the prominence of TBAs, despite awareness of the potential health risks. Six main themes that significantly shaped women's choice for Traditional Birth Attendants were: (1) economic factors, (2) sociocultural and religious beliefs and practices, (3) mistreatment and abuse in health facilities, (4) compassionate care from TBAs, (5) lack of education and awareness, (6) accessibility and health system issues. While all these factors determined women's preference for Traditional Birth Attendants, the most profound is the abuse and dehumanizing treatment women receive from healthcare practitioners. This is contrary to the compassionate, women-centered, and respectful care that TBAs provide, making TBAs a preferred choice. Discussion The study concludes that effective maternal health policies and practices in Nigeria must integrate context-specific approaches that address cultural sensitivities, strengthen compassionate care and foster community-level trust in skilled birth attendants.