Perceptions of cultural competency in antenatal care amongst midwives and Nigerian mothers in the UK- A qualitative descriptive study

BACKGROUND: Recently migrated Black African women in the United Kingdom (UK) have an increased maternal mortality rate linked to reduced or non-engagement with routine antenatal care. Cultural factors are suggested to impact on utilisation of antenatal care. AIM: To explore the perceptions of cultural competency during routine antenatal care amongst midwives and recently migrated Nigerian mothers in the UK and identify the cultural factors that are valued by midwives and mothers. METHODS: A generic qualitative approach involving two focus groups with eight midwives and 15 one-to-one interviews with mothers was undertaken between March 2023 and May 2024. Conventional content analysis was used to analyse the data. SETTING: The setting was two NHS Trusts in London, which were in the top ten boroughs for births to African mothers. The mothers were recent migrants to the UK ( less than five years), who had received routine antenatal care in the UK and had delivered a live baby in the last year. Midwives who had current or previous experience of providing routine antenatal care were invited to participate. FINDINGS: The findings show that midwives are aware of the importance of cultural competency during routine antenatal care provision. Four themes emerged from the focus groups' 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. CONCLUSION: This study reveals that migrant Nigerian women are not routinely asked about their culture during antenatal care provision and either choose to hide or reveal their culture, therefore exploration of their cultural values and needs are dependent on midwives' cultural competence. 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. These findings emphasis the importance of midwives having a focused discussion of a woman's culture to integrate any cultural preferences into antenatal care provision and a requirement for organisational policy and professional guidance to focus on the culture of the woman. STATEMENT OF SIGNIFICANCE: Black African women, particularly recently migrated Nigerian women, experience poorer access to antenatal care linked to cultural factors leading to increased maternal mortality. Cultural insensitivity of healthcare professionals creates mistrust and negatively influences migrant Nigerian women's engagement with antenatal care services. This study highlights the significance of culture on migrant Nigerian women's health seeking behaviour and decision-making during pregnancy. The findings emphasis the importance of midwives being more responsive to the cultural preferences of migrant Nigerian women and that cultural competency is a core component in achieving quality personalised antenatal care.