Stigma, Cultural Belief, and Family Decision-Making in Emergency Caesarean Section: A Qualitative Study of Women in Southeast Nigeria

This study examined how stigma, cultural belief, and family decision-making authority shape women's acceptance of emergency CS in Southeast Nigeria. A qualitative, interpretivist design employing Interpretative Phenomenological Analysis was adopted. In-depth interviews and focus group discussions were conducted with 52 women aged 18 years and above who had undergone emergency CS in Enugu, Ebonyi, and Imo States, purposively sampled to achieve maximum variation in age, parity, education, and religious affiliation. Data were analysed through a case-by-case and then cross-case procedure, supported by a structured coding framework. Four inter-related patterns emerged. First, husbands, or in their absence other senior male relatives, held the formal authority to consent to CS, functioning as gatekeepers to care even when women themselves recognised the danger first, though mothers-in-law and sisters occupied a further, sometimes decisive, layer of influence. Second, CS was persistently framed as evidence of a failure of womanhood, most vividly through a “Hebrew woman” narrative idealising unaided vaginal delivery, producing post-operative stigma that some younger, urban, and more educated women actively resisted, while others, including women of high parity, described the stigma as compounding rather than easing with repeated childbearing. Third, traditional and spiritual explanatory frameworks, including ancestral and herbal interpretations of obstetric complications, at times delayed biomedical care before it was sought. Fourth, fear of death, distance from a capable facility, cost, and the woman's own health literacy shaped how the other three patterns played out in practice. Stigma, cultural belief, and family decision-making authority operate as an independent and, at times, decisive barrier to timely CS acceptance in Southeast Nigeria, concentrated chiefly at the point of family decision-making. Interventions to reduce emergency, as opposed to planned, CS in this setting should engage husbands and family decision-makers directly, rather than treating the pregnant woman as the sole locus of the decision.

: caesarean section, stigma, family decision-making, Nigeria, Interpretative Phenomenological Analysis

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