The Faith-Family-Fear Triad: A Systematic Review of Socio-Cultural and Psychological Barriers to Caesarean Section Acceptance in Nigeria.

Abstract

Despite its life-saving potential, the utilization of Caesarean section (CS) in Nigeria remains suboptimal, hindered by significant non-economic barriers. This study conducted a systematic reviewed of the socio-cultural and psychological drivers of CS refusal, focusing on the interplay of faith, family and fear. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, the study synthesized evidence from 14 peer-reviewed articles published between 2014 and 2026. The synthesis reveals a reinforcing triadic system of resistance. Fear emerges as the most pervasive barrier, characterized by deep-seated anxieties regarding mortality, surgical pain, and secondary infertility. These psychological hurdles are frequently amplified by communal narratives and faith-based interpretations that prioritize spontaneous vaginal delivery over medical intervention, often framing CS as a spiritual failure. Furthermore, family structures specifically husbands and extended relatives function as critical gatekeepers who frequently override maternal autonomy in decision-making. These findings emphasize that CS acceptance across Nigeria is profoundly shaped by cultural context rather than clinical awareness alone. While these national findings provide a comprehensive overview of the Nigerian landscape, they offer critical insights for localized interventions, such as those within the Delta State health system. To improve obstetric outcomes, it is recommended that interventions prioritize specialized antenatal counseling to mitigate fear while actively engaging male partners and religious leaders to reframe the Caesarean section as a life-saving necessity rather than a personal or spiritual deficit.