Cultural Diversity in Childbirth Practices in a Rural Community in Southern Nigeria

Tuesday, 10 November 2015: 10:40 AM

Ekpoanwan E. Esienumoh, PhD, MPH, BSc, RN/RM, FWACN
Department of Nursing Science, University of Calabar, Calabar, Nigeria, Calabar, Nigeria
Idongesit I. Akpabio, PhD, MSc, MPA, BSc, RN/RM, FWACN
Department of Nursing Science, University of Calabar, Calabar, Nigeria
Josephine B. Etowa, RN, PhD
School of Nursing, University of Ottawa, Ottawa, ON, Canada
Heather Waterman, PhD, BSc, RN
School of Nursing, Midwifery and Social Work, University of Manchester, United Kingdom, Manchester, England

Cultural diversity refers to the differences between people based on shared ideology and valued set of beliefs, norms, customs and meanings evidenced in a way of life. Knowledge of cultural diversity is important at all levels of nursing and midwifery care as this addresses ethnic and racial differences where applicable. Additionally, such knowledge can strengthen and broaden the healthcare delivery system through conceptualization of illness and development of treatment models.

It is acknowledged that in a typical nurse/midwife-patient/client encounter, there is interplay of three cultural systems namely, the culture of the nurse/the profession, culture of the patient/client and culture of the setting.  Therefore, nurses and midwives have to be culturally competent to facilitate the delivery of good quality healthcare in settings with diverse health values and practices. Nigeria is marked by people with diverse cultures which consequently create a challenge to the healthcare providers. These cultural variations also are thought to influence birth practices. Diversity in birth practices is also globally acknowledged in literature.

The overarching aim of this study is to acquaint nurses/midwives and other healthcare providers with the cultural birth practices of community members in Bakassi Local Government Area in Southern Nigeria and their diversity from the nursing/midwifery culture. Reported in this presentation, are the findings from the fact-finding phase of an action research project on the prevention of maternal mortality in that rural community.

Ethnography design was utilised. Data were generated through in-depth individual interviews of twenty-nine women of childbearing age to gain understanding of their cultural beliefs and practices on childbirth. Four focus group discussions were held with some other women of childbearing age, menopausal women/ mothers-in-law and traditional birth attendants. Observations of five traditional birth attendants and one midwife in their places of practice were also undertaken. Participants were selected through purposive and snowball sampling.

Thematic data analysis was undertaken and diversity in birth practices between the traditional indigenous culture and nursing/midwifery culture depicted in the following themes emerged: child pregnancy; nutritional taboos; imposition of decision on care; preference for traditional birth attendants; prayer as source of safety in childbirth; position for delivery; utilisation of traditional sanitary towels; care in delivery emergencies; midwives ethnocentrism and culture imposition. The findings were inputted into the planning phase of the action research project for critical reflection and action.


It is concluded that cultural diversity explicitly exists in the nurse/midwife and client interaction in this setting. Therefore, to create a positive impact on maternal care, nurses, midwives and other healthcare providers should deliberately seek to understand the culture of the people and adopt the harmless ones. This would require flexibility in professional practice. Where the culture is inimical to health, the health providers should democratically and collaboratively motivate the clients to critique their practices with the hope of possible repudiation. This study has implication for the provision of culturally competent care for women of childbearing age.