An experience-informed qualitative narrative of factors influencing choice of birthplace among suburban women of Calabar Municipality, Nigeria

Abstract

<title>Abstract</title> Background In many low and middle-income countries, childbirth services are frequently insufficient, unavailable, or prohibitively expensive, leading to poor health outcomes for women and their families. Primary health centers majorly deliver limited childbirth services in Africa, and different factors affect the uptake of these services by women. Our study aimed to investigate the factors influencing the choice of birthplace among the suburban population of Calabar Municipality in Nigeria. Methods This study used a descriptive qualitative design to elicit participants’ opinions and factors influencing the choice of birthplace among pregnant women, traditional birth attendants (TBAs), and healthcare workers (HCWs) in the Calabar Municipality. Participants were selected via convenience sampling followed by a snowball technique. Ten interviews were conducted among TBAs and HCWs, while three focus group sessions were conducted among pregnant women. Data were analyzed using a narrative analysis approach with NVivo v12. Results Seven themes emerged from our findings, representing the influencing factors for choice of birthplace: i) Unpredictability of labor and situational constraints, ii) Preference for personal choice and comfort, iii) PHC accessibility and staff behavior, iv) Financial constraints and cost considerations, v) Importance of prenatal care and health practices, vi) Complications and referral challenges, vii) Cultural practices and community influence. Conclusion Findings from this study highlight that the preference for TBAs was largely due to poor hospitality and care offered by PHC workers. This highlights the importance of fostering empathetic and compassionate care by PHC staff to encourage greater uptake of professional healthcare services. Since the high cost associated with professional healthcare services was a major deterrent, there is an urgent need to address the financial burden through cost reduction, health insurance financing, or subsidizing services, which is essential to enhance maternal and child health outcomes while promoting equitable care to skilled birth care.