Facilitating and limiting factors of cultural norms influencing use of maternal health services in primary health care facilities in Kogi State, Nigeria; a focused ethnographic research on Igala women.

BACKGROUND: Facilitating factors are potential factors that encourage the uptake of maternal health services, while limiting factors are those potential factors that limit women's access to maternal health services. Though cultural norms or values are significant factors that influence health-seeking behaviour, there is a limited exploration of the facilitating and limiting factors of these cultural norms and values on the use of maternal health services in primary health care facilities. AIM: To understand the facilitating and limiting factors of cultural values and norms that influence the use of maternal health services in primary healthcare facilities. METHODS: The study was conducted in two primary healthcare facilities (rural and urban) using a focused ethnographic methodology described by Roper and Shapira. The study comprised 189 hours of observation of nine women from the third trimester to deliveries. Using purposive and snowballing techniques, data was collected through 21 in-depth interviews, two focus group discussions comprising 13 women, and field notes. All data was analyzed using the steps described by Roper and Shapira (Ethnography in nursing research, 2000). RESULTS: Using the enabler and nurturer constructs of the relationships and the expectations domain of the PEN-3 cultural model, four themes were generated: 1, The attitude of healthcare workers and 2, Factors within primary healthcare facilities, which revealed both facilitating and limiting factors. The remaining themes, 3, The High cost of services, and 4, Contextual issues within communities revealed factors that limit access to facility care. CONCLUSION: Several facilitating and limiting factors of cultural norms and values significantly influence women's health-seeking behaviours and use of primary health facilities. Further studies are needed on approaches to harness these factors in providing holistic care tailored to communities' cultural needs. Additionally, reinvigoration and strengthening of primary health facilities in Nigeria is critical to promoting comprehensive care that could reduce maternal mortality and enhance maternal health outcomes.

Gender role beliefs and adolescent pregnancy in Colombia: findings from the 2015 DHS survey.

This study investigated the association between gender role beliefs and the prevalence and likelihood of experiencing pregnancy among 8525 young women and girls aged 13-19 years in Colombia. The primary outcome of interest was adolescent pregnancy. Retrospective cross-sectional analysis utilised data from the 2015 Demographic and Health Survey (DHS) in Colombia, which included an add-on questionnaire on gender relations. Our analysis measured both pregnancy prevalence and pregnancy likelihood in relation to gender role beliefs. With one exception, young women who disagreed with traditionally conforming gender roles had a lower prevalence of pregnancy and were less likely to experience pregnancy than those who agreed with them. The highest likelihood of pregnancy prevalence and likelihood was found among those who agreed with statements suggesting male dominance and those who agreed with women's homemaking responsibilities. The greater the adherence to traditionally conforming gender role beliefs, the higher the likelihood of experiencing pregnancy during adolescence. Girls' and young women's adherence to traditional gender role beliefs appeared to be a risk factor for adolescent pregnancy. Our findings support Colombia's current sex education policies and practices within the framework of gender equity, and evidence the link between gender equity and girls' and young women's reproductive health.

Pressure to not feel bad among (different-sex) romantic partners: prevalence, and correlates.

Western society generally highly values happiness. As a result, people sometimes experience pressure not to feel negative emotions. In this study, we comprehensively investigated this pressure, and how it manifests itself, in adult romantic relationships. Specifically, we first examined when, how often and how intensely people experience pressure not to feel bad from their romantic partners (94 different-sex couples). Additionally, we investigated (both between- and within-person) how this pressure is related to context (presence of, contact and or conflict with a partner), emotional processes (i.e. experienced sadness and anxiety, emotion suppression, and how their partner perceived their affect), and relationship well-being. Using experience sampling methodology data (6/14 reports per day over one week) we found that although participants generally did not experience strong pressure from their partner, they experienced some feelings of pressure about 50% of the time. Furthermore, within-person predictors associated with negative processes/emotions (i.e. negative emotions, conflict, emotion suppression) were related to the momentary frequency (odds) and/or intensity of perceived pressure not to feel bad. At the between-person level, individuals who experience more sadness, anxiety and reported suppressing their emotions more often tended to experience more and/or stronger pressure. Only weak associations with relationship well-being were found.

How people react to suicidal ideation: The effect of suicide literacy, suicide stigma, and expressive suppression.

INTRODUCTION: The purpose of this study is to understand the role of suicide literacy and suicide stigma in laypeople's intention to recommend professional help in Korea. Additionally, the study focuses on the role of expressive suppression as a sociocultural factor. METHODS: Participants read vignettes depicting either subclinical distress or suicidal ideation and answered questions measuring suicide literacy, stigma, and expressive suppression. Mediated moderation analyses were used to examine the interactions between these factors. RESULTS: The result found the significant effect of expressive suppression. The mediating effect of suicide stigma on the relationship between suicide literacy and recommendation of professional help was significant for those who do not suppress their emotions. This result indicates that when individuals were not hesitant to express negative emotions, high suicide literacy lowered suicide stigma and led to more willingness to recommend professional help. CONCLUSIONS: The results showed that expressive suppression acts as a barrier deterring Koreans from professional help for their mental health. The findings underscore the importance of sociocultural factors such as expressive suppression in developing suicide prevention strategies.

Cultural Dimensions Moderate the Association between Loneliness and Mental Health during Adolescence and Younger Adulthood: A Systematic Review and Meta-Analysis.

Cultural factors, such as country or continent, influence the relationship between loneliness and mental health. However, less is known about how cultural dimensions moderate this relationship during adolescence and younger adulthood, even if these dimensions manifest as country or continent differences. This study aims to examine the potential influence of Hofstede's cultural dimensions on this relationship using a three-level meta-analysis approach. A total of 292 studies with 291,946 participants aged 10 to 24 were included in this study. The results indicate that cultural dimensions, such as individualism vs. collectivism, indulgence vs. restraint, power distance, and long-term vs. short-term orientation, moderated the associations between loneliness and social anxiety, stress, Internet overuse, and negative affect. The association between loneliness and mental health was not moderated by cultural dimensions, such as masculinity and uncertainty avoidance. These findings suggest that culture's influence on the association between loneliness and mental health is based on a domain-specific mechanism.

The role of education and income as protective factors against intimate partner violence and HIV exposure among Kenyan women.

Introduction: Intimate partner violence (IPV) is a public health problem that impacts approximately one in three women worldwide in their life-time. The purpose of the study was to explore the lived experiences of women teachers and violence in Kenya. It also explores the intersection between intimate partner violence, HIV risk, and gender inequality. Method: Data were collected through two focus groups of a total of 15 women teachers. We recruited women ages 21-44 from two geographically diverse urban and rural schools. The data were analyzed using a thematic analysis method to identify text themes and meaning patterns. Results: Three contextual experiences emerged: socio-cultural influences of gender norms, masculinity and patriarchy; uneven power dynamics; and institutionalized gender inequality. Discussion: Findings suggest that education alone is not sufficient to end GBV. Comprehensive and gender transformative governmental policy approaches are needed to mitigate GBV in Kenya.

Tracking the emergence of an organized use of space: A direct comparison of the spatial patterning within Middle and Upper Paleolithic open-air sites.

Although the 'organization of space' is said to be one of the defining characteristics of modern human behavior, the identification and documentation of such organization has proven to be elusive, especially as rendered in artifact patterning. Without directly comparing artifact patterns within multiple sites, there is no benchmark with which to conclude one site to be more or less 'organized' than another. We can objectively identify patterns within the distribution of archaeological materials, but the decision of whether that patterning constitutes as 'organized' is entirely subjective without a comparative model. In this paper, I present the results of a study in which the spatial distribution of artifacts within nine Middle and Upper Paleolithic sites in France are directly compared to one another, and discernible changes in patterning can be identified. The differences in spatial patterning between the Middle and Upper Paleolithic sites suggest that the organization of space likely became increasingly formalized into and throughout the Upper Paleolithic alongside other cultural norms of behavior. Though more sites are needed to thoroughly document this phenomenon, this study suggests that direct comparisons of spatial patterning have the potential to yield more objective results on the question of spatial organization.

Happiness with Circumcision Status, Not Status Itself, Predicts Genital Self-Image in a Geographically Diverse Sample.

Research exploring the impact of penile circumcision on aspects of body image is scarce and few studies have considered the potential roles of attitudinal factors toward one's own circumcision status. The purpose of the present study was to assess the potential relationship between one's circumcision status, happiness with circumcision status, genital self-image, and sexual functioning. The present study also examined how happiness with circumcision status varied across geographic regions. A total of 205 participants (102 circumcised, 103 not circumcised) completed a study through online recruitment methods. Participants reported being born in the United States (n = 80), Canada (n = 23), and various countries within Latin America (n = 22), Europe (n = 49), Asia (n = 13), Africa (n = 11), and Oceania (n = 7). Participants who were not circumcised reported significantly greater happiness with their circumcision status than participants who were circumcised. However, genital self-image, sexual body image, and sexual functioning did not significantly differ by circumcision status. Instead, participants who reported being happier with their circumcision status reported better genital self-image and less body exposure avoidance during sex, but sexual function did not differ by happiness. Although researchers hypothesized that happiness with circumcision status would depend on whether one fits in with the majority circumcision status within their region of origin, results did not support this. Participants who were circumcised tended to have less happiness with their circumcision status than non-circumcised participants regardless of region of birth. These findings support a small body of the literature which suggests that the psychosexual impact of penile circumcision may rely more on attitudinal factors toward circumcision status than actual circumcision status.

The copita question: Exploring alcohol consumption among Latina women.

We explored whether Dominican women underreport alcohol consumption according to questionnaire wording and examined factors associated with their alcohol use through structured interviews in Spanish. We measured consumption with the word "alcohol" and with the common colloquialisms "copita/trago/vinito." We used logistic regressions to examine associations between alcohol consumption, demographics, and alcohol-related norms. Of 419 female participants, 411 completed alcohol-related questions. Most (n=343, 83.5%) were current drinkers and 88 (21%) reported having never consumed alcohol but also that they occasionally drink a "copita/trago/vinito." This indicates alcohol use is potentially underreported among Dominican women. Alcohol-related research should incorporate culturally sensitive language to improve accuracy.

Exploring Factors Influencing Cervical Cancer Prevention Behaviors: Unveiling Perspectives of Conservative Muslim American Women in Virginia.

Understanding the complexities surrounding cervical cancer prevention methods and hesitancy among conservative Muslim American women is crucial in addressing health disparities. This qualitative study aimed to delve into the religious, behavioral, and socio-cultural factors influencing Muslim women's decisions regarding cervical cancer screening (CC-S) and HPV vaccination (HPV-V) in Virginia, USA. Through interviews with 10 Muslim women residing in Virginia, qualitative data were collected as part of a mixed-method cross-sectional study conducted between August and September 2021. Findings revealed that participants had limited knowledge about cervical cancer, CC-S, and HPV-V, with notable themes emerging, such as cultural influences, misconceptions, language barriers, and challenges posed by the intricate US healthcare system. Future research should focus on exploring these barriers to mitigate the impact of cervical cancer within the Muslim population.

Socio-cultural context of adolescent sexuality and youth friendly service intervention in West Gojjam Zone, Northwest Ethiopia: a qualitative study.

BACKGROUND: Recognizing that adolescents face barriers in accessing services, may feel embarrassed, face stigma on sexual matters, or have concerns about judgmental providers, youth-friendly service (YFS) has been introduced to deliver health services that meet the sexual and reproductive health (SRH) needs of young people. Evidences on the role of YFS in addressing the socio-cultural norms influence unmarried adolescent SRH behaviour are limited. Therefore, this study explore whether the socio-cultural norms influencing adolescent SRH behaviour vary between youth friendly service program and non Program areas in West Gojjam Zone, North West Ethiopia. METHODS: Qualitative case study design was employed to explore the socio-cultural context of adolescent sexuality. Purposive sampling was used to identify study participants. Data were collected from 112 participants both from YFS program and non-program areas using semi-structured in-depth interviews, key informants, and focus group discussions guides. A total of 18 key informant interviews, twelve FGDs and four in-depth interviews were conducted. Participants were comprised from unmarried adolescents, parents, religious leaders, community elders, health professionals, teachers, and unmarried adolescents who experienced SRH problem. Thematic analysis was used to summarized the data. RESULTS: The socio-cultural norms related to adolescent sexuality in both YFS program and non-program areas indicated that the community is intolerant to premarital sex, SRH service utilization (eg., contraceptive use) by unmarried adolescent; and discourage SRH communication with unmarried adolescents. According to the participants, premarital sex and SRH service use were not accepted by the community. Moreover, participants believed that, having communication on SRH issues with unmarried adolescents are equivalent to encouraging them to initiate sex, therefore, should not be practiced. CONCLUSION: The socio-cultural norms influencing adolescent sexual behaviour were more or less the same between settings. In both areas, the socio-cultural context discourages YFS intervention like SRH communication and service use. Also, the YFS program does not modify the socio-cultural norm affecting adolescent sexuality. Therefore, the YFS interventions strategies should give due emphasis to the socially accepted sexual norms like sexual abstinence.

Socio-cultural implications for women's menstrual health in the Pacific Island Countries and Territories (PICTs): a scoping review.

BACKGROUND: Globally, experiences of menarche and subsequent menstruation are embedded in social and cultural beliefs, norms and practices. Menarche is an important developmental milestone in sexual and reproductive health (SRH) for females. Menarche is intertwined with socio-cultural norms, beliefs and practices, which can impact on women's ability to manage menstruation with dignity. This paper reviews the social and cultural factors that affect women's ability to effectively manage their menstrual health and hygiene (MHH) in Pacific Island Countries and Territories (PICTs). METHODS: A scoping review was conducted following PRISMA scoping review guidelines and inclusion/exclusion criteria. An online search was conducted for peer-reviewed publications in Medline/OVID; Medline/PubMED; PsycINFO; CINAHL; Scopus and JSTOR, and Google Scholar. A search for grey literature was conducted in Google Scholar and websites of international and local organizations. Experts in the field also contributed additional references. Extracted data were summarised in an Excel spreadsheet. Searches were conducted between May and June, 2019, and then repeated in July, 2020. RESULTS: A total of 11 studies were included; 10 qualitative and one mixed methods study. Studies were conducted in Melanesian (n = 9), Polynesian (n = 1) and Micronesian (n = 1) PICTs. All 11 studies reported elements of societal and personal factors; ten studies reported evidence relating to interpersonal factors; nine studies reported elements relating to environmental factors; and two studies presented evidence linked to biological factors. Managing menstrual health with dignity is challenging for many women and girls because menstruation is associated with menstrual taboos and shame. CONCLUSION: This review found that the MHH experiences of women in PICTs are affected by social and cultural beliefs, norms and practices. Beliefs, norms and practices about menarche need to be incorporated in SRH planning, programs and education in order to be relevant to diverse village and urban settings.

A Qualitative assessment of adolescent-parent sex talk in Ghana.

Young people's views on sexuality in sub-Saharan Africa are poorly understood. We know little about what they think of their sexual upbringing and how it influences their sexual and reproductive health decisions and behaviors. Guided by feminism and an intersectionality framework, the current study uses narratives from purposefully sampled adolescents and parents from rural households within Adaklu District, one of the eighteen districts in the Volta Region of Ghana, to examine parents' and young people's perceptions of young adolescents' acquisition of sexuality knowledge, their sexual encounters and experiences, and the overall dynamics in educating young adolescents aged 16-19 years about sex. Specifically, we explored the types of sexuality issues parents discussed with their wards at home, and where appropriate, analyzed the inherent gender disparities in these discussions. Generally, parents agree that young people should know about sex. However, they emphasized that sexuality education should be age-specific and should be guided by cultural values and religious faith. Adolescents' exposure to multiple sources, including parental upbringing, the media, and information from peers, determines the extent they either engage or not engage in sexual activities. Parent-adolescent conversations were structured along gender lines, emphasizing adolescent girls' needs due to their perceived vulnerability compared to boys. While some of the findings support earlier views in terms of a very conservative, morally scripted way of training young people, it also suggests that young people's sexual upbringing is not as repressive as previous studies would make it appear. Young people keep pushing the boundaries as they develop agencies to learn about sex from multiple sources. Therefore, policies seeking to promote young people's sexual and reproductive rights in Ghana should pay close attention to what young people know about sex and how they know what they know, recognizing that their knowledge-seeking is part of human development and not inherently "bad".

Conversations about sexual activity within Haitian families: implications for HPV vaccine uptake.

Objective: Parents play an integral role in young adults' sexual health including human papillomavirus (HPV) vaccine decision-making. The objective of this study was to explore conversations regarding sexual activity in Haitian households and the influence of such conversations on young Haitian women's HPV vaccine discussion with their parents.Methods: From a large university in the southeastern United States, 30 Haitian-American college women (ages 17-26) were recruited for semi-structured in-depth interviews. The interviews were recorded and transcribed verbatim. Interview transcripts were analyzed using thematic analysis.Results: Most participants stated that they either did not have conversations regarding sexual activity or the conversations that they had were described as 'uncomfortable' or 'awkward'. Many participants stated that once parents knew that HPV is sexually transmitted, their discussions about the vaccine would be considered an announcement of their sexual debut or sexual activity. Hence, many decided to not discuss the HPV vaccine with their parents.Conclusion: Findings have important implications for HPV vaccine uptake. Results showed that a lack of conversations about sexual activity within Haitian households led to limited discussions about the HPV vaccine among young Haitian-American college women and their parents. Future HPV vaccine uptake efforts should integrate familial and cultural beliefs about female sexuality, while focusing on cervical cancer prevention.

Effectiveness of a Module Based Training on Nurses' Attitude Towards Social Norms and Beliefs That Support Abuse Among women with Mental Illness.

Violence against women is a priority public health issue. Women with mental illness are at a double disadvantage. While social norms and beliefs either support or confront violence against women, research is limited on this issue. A randomized controlled design was adopted for the present study. This study was aimed to evaluate the effectiveness of module-based training in changing nurses' attitudes towards norms and beliefs that support violence against women in mental health care settings. In this study, 68 nurses were randomly assigned to either the experimental or control group (34 in each group). After receiving the training program, the mean scores on norms and beliefs and justifiability of abuse scales were significantly higher in the experimental group compared to the control group (p < 0.05). The results confirmed the positive impact of the training program in changing nurses' attitudes. However, further studies are required to draw firm conclusions on the effectiveness of the training intervention.

Violence Against Women with Mental Illness and Social Norms and Beliefs: Nursing Professional Perspective.

Violence against women is a priority public health issue globally and women with mental illness are at double disadvantage. While social norms and beliefs play a critical role in influencing violence among women, limited or no research is available from India. To explore nurses and nursing students' views on social norms and beliefs that support Violence against women with mental illness. A descriptive cross-sectional survey was carried out among randomly selected registered nurses and nursing students (N = 209) using self-reported questionnaires. Majority of the participants confronted norms (76.7%) and situations that justify (67.7%) abuse among women with mental illness. Nurses reported more negative attitudes than nursing students with regard to norms and beliefs (t = - 2.714, p < 0.007) and justifiability of abuse (t = - 3.089, p < 0.002). The findings suggest suitable academic programs to extinguish the prevailing cultural beliefs that support abuse in women with mental illness.

Occupational choices of school-going adolescents: a study in the Pitseng Area, Leribe District, Lesotho.

INTRODUCTION: Adolescents require opportunities to engage in occupations and need to have the requisite aptitude and agency to choose the occupations they want or need to engage in. Occupations are defined as the everyday activities that people choose to engage in individually or as groups that bring meaning and purpose to their lives. These occupations can be chosen or enforced. There is a paucity of literature around the occupations that adolescents in rural contexts choose and the meaning underlying their choices. This study explored the occupations of school-going adolescents of Pitseng, Lesotho, to gain insight into adolescent behaviour, and the strategies needed to develop sustainable health promotion programs for adolescents in this area. METHODS: A descriptive qualitative research design was used. Purposive sampling was used to recruit 47 adolescents aged between 13 and 15 years from three high schools in Pitseng, Leribe district, Lesotho. Data was collected using focus group interviews after consent was obtained from the parents or caregivers and assent from the adolescents. Data were analysed thematically using Braun and Clarke's method. RESULTS: Three main themes emerged from the study: realities of customary rural life, facilitators of occupational engagement, and wellbeing versus risky behaviour. Participation in daily routine occupations, cultural norming, resource scarcity, school milieu and leisure engagement were subthemes derived under the first theme. The subthemes identified under the theme facilitators of occupational engagement were intrinsic motivation, and vicarious modelling and peer support. The third theme encompassed the conceptualisation of wellbeing and risky behaviour as subthemes. The adolescents were found to engage in risky behaviour to escape the monotony in their daily lives. This could be attributed to them having fewer choices for recreational activities during their free time. Some adolescents were able to improvise and attempted to enjoy their lives with fewer occupational choices. The natural environment, coupled with creativity, facilitated the engagement of adolescents in fun activities. CONCLUSION: The dominant influences relating to the adolescents' occupational choices and participation in activities were the impoverished rural context and the traditional inherited practices. The protracted timeframes for completing basic activities and household responsibilities and the scarcity of resources for leisure led to a restricted range of leisure activities. The traditional cultural context influenced gender-based differences in the manifestation of occupations. Despite the challenges, the adolescents showed resilience, creativity and a strong desire to improve their futures. Moreover, in this culturally steeped environment, the school and the community chief may be the two best entry points for organisations planning to facilitate health promotion programs. They are recognised and sanctioned power bases in rural communities. Recommendations for education, leisure, health promotion and further study were made for Pitseng.

'I'd say I'm fat, I'm not obese': obesity normalisation in urban-poor South Africa.

OBJECTIVE: In the past decade, South Africa's obesity epidemic has increased in both children and adults, and being overweight is becoming the norm. Several contributing factors lead to the normalisation of obesity. One of these is the culturally entrenched likeness of larger body sizes or shapes within a milieu of easily accessible unhealthy food and beverages. This qualitative study advances knowledge about the influence of socio-cultural norms and obesogenic environments on weight under estimation and 'obesity normalisation' amongst black South Africans living in an urban setting. DESIGN: A theory-based qualitative study used focus group discussions (FGDs) with a semi-structured interview guide. FGDs were transcribed verbatim and analysed thematically using a constant comparison method. SETTING: Soweto, Johannesburg, South Africa, is a setting which has undergone rapid urbanisation and nutrition transition with ubiquitous availability of processed and fast-foods. PARTICIPANTS: Adults older than 18 years living in Soweto (n 57). RESULTS: There is a wide misperception about obesity amongst black Africans living in an urban setting in Soweto. Participants who admitted to being fat or overweight did not view themselves as such. This could be attributed to unchanging socio-cultural factors that reinforce the acceptability of bigger bodies and living in obesogenic environment. CONCLUSIONS: Without addressing socio-cultural norms that attribute bigger bodies to beauty and wealth, motivating individuals to address weight gain will prove difficult especially for populations living in obesogenic environments. A multi-faceted strategy is required to address obesity in urban South African settings.

Where boys don't dance, but women still thrive: using a development approach as a means of reconciling the right to health with the legitimization of cultural practices.

Human rights language has become a common method of internationally denouncing violent, discriminatory or otherwise harmful practices, notably by framing them as reprehensible violations of those fundamental rights we obtain by virtue of being human. While often effective, such women's rights discourse becomes delicate when used to challenge practices, which are of important cultural significance to the communities in which they are practiced. This paper analyses human rights language to challenge the gender disparity in access to health care and in overall health outcomes in certain countries where such disparities are influenced by important cultural values and practices. This paper will provide selected examples of machismo and marianismo discourses in certain Latin American countries on the one hand and of female genital cutting/excision (FGC/E) in practicing countries, both of which exposed to women's rights language, notably for causing violations of women's right to health. In essence, a reflective exercise is provided here with the argument that framing such discourses and practices as women's rights violations. Calling for their abandonment have shown that it may not only be ineffective nor at times appropriate, it also risks delegitimizing associated discourses, norms and practices thereby enhancing criticisms of the women's rights movement rather than adopting its principles. A sensitive community-based collaborative approach aimed at understanding and building cultural discourses to one, which promotes women's capabilities and health, is proposed as a more effective means at bridging cultural and gender gaps.

Religious, socio-cultural norms and gender stereotypes influence uptake and utilization of maternal health services among the Digo community in Kwale, Kenya: a qualitative study.

BACKGROUND: Maternal health outcomes in resource-limited settings are typically influenced by supply-side factors affecting the provision of quality health services. The extent to which demand-side factors contribute to this influence is unclear. We aimed to explore how individual and community-wide factors influenced uptake and utilization of maternal health services among the Digo community residing in Kwale County of coastal Kenya. METHODS: Between March and December 2015, we conducted 5 focus group discussions (FGDs) and 15 in-depth interviews (IDIs) with members of the Digo community predominant in Kwale county, Kenya. Respondents were sampled purposively and included female (pregnant and postpartum) as well as male adult community members. A thematic content analytic approach was used. RESULTS: There were a total of 47 FGD respondents, including 15 (32%) females with a median (interquartile, IQR) age of 38 (27-55) years and 6 (3-8) children. Majority (40%) reported attaining secondary-level education. All IDI respondents were female with a median (IQR) age of 27 (24-35) years and 4 (2-5) children. Majority (80%) had attained primary-level education. We found that religious and socio-cultural norms as well as gender stereotypes were important influences on the uptake and utilization of maternal health services, including facility-based delivery and contraception. Key amongst this was the unspoken deference to the counsel of a prominent matriarchal figure in the decision-making process. CONCLUSIONS: Among the Digo community of coastal Kenya, a unique social-cultural context comprising of a religious and gendered value belief system influences women's reproductive health and rights. These findings highlight the important role of demand-side factors in influencing maternal health outcomes. In addition to addressing supply-side factors, programs in such settings should aim to address factors that leverage inherent social capital to drive demand for maternal health services ensuring that they are not only effective, but also responsive to the local context.