Breaking the silence: barriers to maternal healthcare utilisation among women in South-South Nigeria.

Background: Despite awareness of the benefits of facility-based deliveries, many women in Sub-Saharan Africa (SSA) still deliver outside healthcare settings, often without skilled birth attendants. Access to maternal healthcare encompasses affordability, physical accessibility, and acceptability. Objective: This study aimed to explore the factors influencing maternal healthcare utilisation in South-South Nigeria, with a focus on identifying the "silences" surrounding women's access to care, and understanding the facilitators, barriers, and suggested improvements. Methods: An exploratory qualitative design was adopted to investigate women's perceptions of the hidden factors influencing maternal healthcare utilisation. Data were collected from women of reproductive age (20-49 years) in one of the tertiary health hospitals in Nigeria. Eight semi-structured interviews were performed and transcribed. Data were analysed thematically using the Silences Framework. Results: Three themes emerged: facilitators, barriers, and suggestions. Facilitators included women's recognition of skilled providers and the safety offered by emergency care. Despite dissatisfaction, many continued facility use due to trust in medical expertise. Barriers included negative staff attitudes, breaches of confidentiality, domestic violence, financial constraints, and systemic inefficiencies. Stigma further silenced discussion of sensitive issues, reinforcing under-utilisation. Some women turned to traditional birth attendants or private clinics, valuing compassion despite costs or risks. Suggestions centred on staff training in compassionate care, improved monitoring, better equipment, and stronger policies to uphold dignity and privacy. Conclusion: The study emphasises the importance of addressing both systemic issues and interpersonal dynamics to improve maternal healthcare services. Women balance the perceived necessity of skilled care with negative experiences in formal facilities. While competence drives use, poor attitudes and systemic gaps reduce trust. Tackling both structural and interpersonal barriers is critical. Respectful, culturally sensitive care and stronger accountability are essential. These findings offer practical guidance for reforming maternal healthcare in Nigeria.