A Qualitative Study of Migrant Nigerian Mothers' and Midwives' Perceptions of Cultural Competency in Antenatal Care

Maternal mortality is increased in Black women, particularly migrant African women. Although there are various causes for this disparity, maternal mortality reports have consistently stated that poor utilisation of antenatal care increases a woman’s risk of dying. Cultural factors have been acknowledged as influencing migrant women’s access and engagement with antenatal care. However, there are limited studies that document the cultural factors that are important to migrant Black African women during antenatal care provision. The aim of this study was to explore cultural competency in routine antenatal care and how this meets the needs of migrant Nigerian women. A qualitative descriptive approach was adopted for this study which was conducted in two London NHS Trusts. One-to-one interviews were undertaken with fifteen recently migrated Nigerian women who had delivered a baby in the last year at either Trust. In addition, two focus groups were conducted, each consisting of four midwives who worked at each Trust and had experience of providing routine antenatal care. The cultural competency models of Campinha-Bacote (2002) and Papadopoulos et al. (1998) were used as the conceptual framework. The findings show that midwives are aware of the importance of cultural competency during routine antenatal care provision. Four themes emerged from the focus group’s discussions: (1) antenatal care in the midst of cultural ambiguity, (2) lack of space for cultural understanding, (3) preserving culture and individuality and (4) cultural hesitancy and impediments. The one-to-one interviews with Nigerian mothers revealed a complex picture of their antenatal care experiences consisting of eight themes: (1) overlooking of culture during pregnancy care, (2) sharing but not exposing culture, (3) cultural expectations of antenatal care, (4) navigating pregnancy within two cultures, (5) cultural opinions on information needs, (6) essence of care versus cultural knowing and skill, (7) culturally embraced communication and interactions and (8) respectfulness across cultures. This study shows that women are not asked about their culture during routine antenatal care provision and that women hide or protect their culture. Mothers valued their culture however, traversing pregnancy in a new country was prioritised over their cultural needs. This study also highlights that midwives’ ability to demonstrate cultural competency during antenatal care provision is impacted by societal, personal, professional, and organisational factors. This research confirms the connectedness and gaps between midwives’ practice and migrant Nigerian women’s experiences of cultural competency in antenatal care.