Cultural Factors Affecting the Decision-making to Seek Maternal Care: Ethnography in a Nigerien Rural Village

Abstract

Introduction: This study elucidates the cultural factors affecting decision-making to seek maternal care in rural Niger, which records one of the highest MMR.
Methods: Ethnographic fieldwork (participant observation, ethnographic interview and documentation) was conducted in a Nigerien rural village and data were analyzed qualitatively.
Results: The decision-making was affected by a value system holding that "to mention sexuality in public is regarded shamefulness", "delivery is part of daily life", "clinic should be used only when there are problems during delivery", "Albeeri (great adult) never make mistakes". The value of shame resulted in pregnant women tending to conceal their pregnancy and an absence of opportunity for public reproductive health education. The notion that a woman who cannot endure pain is not an Albeeri encourages pregnant women to rely on folk medicine without complaining about any abnormal symptoms and to continue working until shortly before delivery. The exclusion of any person, even a doula, from the scene of delivery in order to avoid witchcraft contributes to unassisted home delivery. These interacting factors cause delayed care. On the other hand, when complications are foreseen during pregnancy, the family’s elder women assess the pregnant woman’s condition and evacuate her to a clinic without her appeal. In case of first delivery, women go back their fathers’ houses to deliver and receive their mothers’ support and women rest for 40 days postpartum.
Conclusion: The decision-making is influenced by culturally-defined values related to sex, perceptions of the scene of delivery and abnormalities, and a social structure esteeming elders, and these factors cause a delayed care. However, cultural values also lead to mutual help complementing maternal care. Therefore, it is important for the betterment of maternal health to improve the quality of existing health services and also to link it to the culturally-based childbirth support system.