Social cultural practices influencing stillbirth in Sub-Saharan Africa

Abstract

Background: Stillbirth remains a significant global health concern, especially in Sub-Saharan Africa. Sub-Saharan Africa accounts for 45% of all stillbirth occurrences globally. A little over 40% of stillbirths in Sub-Saharan Africa happen in the labour room but underreporting, especially in rural areas, makes this figure unreliable. Considering this prevalence, current research into the main causes of stillbirth in Sub-Saharan Africa has highlighted certain beliefs and practices that influence pregnancy outcomes in the region. The negative effects of these practices are still unclear and warrant further investigation. This review aims to identify and analyse literature on the social and cultural practices that influence stillbirth among pregnant women in Sub-Saharan Africa. 

Methods: The PEO (Population, Exposure, and Outcomes) framework was used to guide the search strategy and seven electronic databases were searched for studies published from 2014 to 2024. Furthermore, a grey literature search and manual search of the reference lists of the included studies were carried out to guarantee the thorough inclusion of relevant studies that could have been missed during the first search. After de-duplication, full-text screening was performed once the titles and abstracts were assessed. Lastly, pre-established inclusion and exclusion criteria were used to select the included studies, which then generated the study's findings. 

Results: The initial search recognized 1,832 studies, of which 10 were included in the systematic review, with the majority being qualitative ethnographic studies. The study identified five major social-cultural practices that influence Sub-Saharan Africa, including food taboos and restrictions, use of herbal medicines during pregnancy, preference of traditional birth attendants over skilled birth attendants, engagement in strenuous activities, and delay in referral to maternal health services 

Conclusion: Among the five major practices outlined, food taboos/restrictions and the use of herbal medicines during pregnancy were the most discussed in the included studies. All outlined practices proved to be major factors that influence stillbirth in Sub-Saharan Africa. Understanding and addressing these social-cultural practices can inform targeted interventions toward improving the risk of stillbirth among pregnant women in Sub-Saharan Africa. Recommendations for eliminating harmful social and cultural practices that influence stillbirth should involve the government, global health organisations, and specialized healthcare professionals, by actively providing essential support for eliminating these negative practices in low resource settings.