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There is no greater joy than the birth of a healthy baby and no greater tragedy than the death of a mother and her baby following a complicated pregnancy or difficult labor, especially when it occurs due to the refusal of caesarean birth. As often as one thousand times a day, women die while giving birth. Many of which occur due to the refusal of caesarean delivery in some low resource settings (1,2). Caesarean section (CS) as an operative technique has contributed immensely to improved obstetric care throughout the world (1.2). It serves as a surgical procedure facilitating rapid delivery of the baby when prolongation of the pregnancy and/or labor is deemed undesirable and the vaginal route is not feasible (3). The incidence of CS in most health institutions in Nigeria ranges between 20 and 30% (4), but globally, it is about 10% to 35% (5). Current improvements in the technique of CS, safer anesthesia, newer and potent antibiotics and availability of blood transfusion services have now made CS safer. In addition, with better education and enlightenment, it is becoming more acceptable to women and their families (6). Due to the current safety of the procedure, several CS are done for various justifiable medical and non-medical indications with favorable outcomes (7,8). These may have contributed a lot to the increased rate of the procedure in both low and highincome countries of the world. However, in some low-income countries like Nigeria, many women and their families still have numerous negative perceptions regarding caesarean delivery. In these settings, women who had caesarean delivery were considered as weaklings and a reproductive failure (6). Failure to deliver vaginally may be attributed to a curse on an unfaithful woman (1,6). Rather, vaginal delivery in such settings is considered as the proof of womanhood (9,10). Other reasons adduced for the aversion to CS by women in developing countries include the morbidity and mortality from the procedure, prolonged hospital stay and perceived high cost of hospital bills. A large number of people in low-income countries Abstract Objectives: Globally, caesarean section (CS) has immensely contributed to improved obstetric outcome in circumstances where vaginal delivery is not feasible. However, in some low-income countries, there is aversion to the procedure. The aim of this study was to determine the level of awareness and socio-cultural barriers to the acceptance of CS. Materials and Methods: A cross-sectional study was conducted among 344 parturients at Federal Teaching Hospital in Abakaliki, from October 1 to November 30, 2016. Data were collated using a self-administered questionnaire and was analyzed using SPSS version 20.0 and conclusions were drawn by means of descriptive statistics. Results: All the respondents were aware of CS as an operative abdominal procedure for delivery; of these, over one-tenth (14.0%; 48/344) had experienced the procedure previously. Over four-fifths (82.3%; 283/344) of those who have had a previous CS were wellinformed about the indications. About one-fifth (20.3%; 70/344) did not accept CS for any reasons. The major barriers to acceptance were being considered by peers as a reproductive failure (29.2%; 7/24), high cost (20.8%; 5/24) and religious beliefs (12.5%; 3/24). Conclusions: Majority of antenatal attendees had a significant awareness of CS and the indications. Moreover, a vast majority had morbid aversion towards it; due to numerous, non-evidence based socio-cultural reasons. Therefore, adequate health education, female empowerment, access to free or affordable antenatal care service, elimination of harmful, religious/cultural beliefs and myth regarding caesarean delivery are necessary to curb this ugly trend if we hope to achieve the sustainable development goals related to maternal health.

Perception and Socio-cultural Barriers to the Acceptance of Caesarean Delivery in A Tertiary Hospital in Abakaliki, South East Nigeria