Socio-Cultural and Economic Barriers to Facility-Based Delivery: Perspectives of Men and Community Gatekeepers in Nasarawa State

This study examined the socio-cultural and economic barriers influencing the uptake of facilitybased delivery in Nasarawa State, Nigeria, from the perspectives of men and community gatekeepers, while proposing policy recommendations for strengthening male engagement and traditional birth attendant (TBA) collaboration.A mixed-methods cross-sectional design was employed, combining quantitative data from 443 married men across Akwanga, Keffi, and Lafia LGAs, alongside qualitative insights from 12 FGDs, 21 KIIs, and 46 IDIs with male decision-makers, TBAs, elders, and health workers.Quantitative data were analyzed using descriptive statistics, chi-square tests, and logistic regression (p < 0.05).Qualitative data were thematically coded to explore cultural norms, economic barriers, gendered decision-making, and perceptions of health facilities.Economic constraints, including financial hardship (61.2%), transport limitations (57.8%), and long distances to facilities (54.9%), were the most frequently cited barriers.Socio-cultural beliefs that childbirth is a strictly female domain, community reliance on TBAs (48.5%), and the influence of elders significantly reduced support for facility delivery.Mistrust of healthcare workers, perceived disrespect, and fear of hidden charges also discouraged facility utilization.Qualitative narratives highlighted that TBAs were preferred due to cultural alignment, affordability, flexible payment systems, and emotional support.Facility-based delivery in Nasarawa State is constrained by intersecting socio-cultural, economic, and health-system barriers.Strengthening male involvement, improving community, facility trust, addressing transport and affordability constraints, and integrating TBAs into supervised referral frameworks are vital.A context-specific Health Belief Model (HBM) is proposed to guide interventions.