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Research Article

Stigma, Silence, and Substance Use: A Qualitative Study of Barriers to Care Among Pregnant Women in Nigeria

Authors

  • Barakat Olajumoke Kolawole Department of Public Health, Faculty of Allied Health Sciences, Kwara State University, Malete, Nigeria https://orcid.org/0000-0001-9549-4987

    kolawolebarakat2@gmail.com

  • Felix Oluwafunso Famotire School of Health Information Management, Lagos University Teaching Hospital, Nigeria
  • Esther Olamide Ayodele Department of Theatre and Media Arts, Federal University Oye-Ekiti, Nigeria
  • Emmanuella O. Emma-Ekwealor Department of Community Medicine, Bingham University, Abuja, Nigeria
  • Olatokun Tobiloba Philip Department of Internal medicine, Obafemi Awolowo University, Nigeria
  • Sakina Abubakar Department of Nursing, General Hospital Funtua, Katsina State, Nigeria

Abstract

While substance use during pregnancy poses significant risks to maternal and fetal health globally, limited qualitative evidence exists on how cultural stigma and silence function as barriers to healthcare access in Sub-Saharan African contexts, particularly Nigeria. This qualitative study aimed to explore the lived experiences of pregnant women with substance use issues in Nigeria, examining how stigma and silence shape healthcare-seeking behaviors and treatment access. Using a descriptive qualitative design informed by phenomenological approaches, we conducted in-depth semi-structured interviews with 100 pregnant women across four Nigerian states (Lagos, Kano, Rivers, and Borno) and eight focus group discussions between March and September 2023. Participants were recruited through purposive and snowball sampling. Data were analyzed using Braun and Clarke's six-phase thematic analysis approach. Thematic analysis identified five interconnected barriers: (1) pervasive cultural stigma surrounding substance use during pregnancy; (2) silence as both a coping mechanism and barrier to care; (3) healthcare provider inadequacies including judgmental attitudes and insufficient addiction training; (4) limited access to specialized treatment services; and (5) negative family and community influences on help-seeking behaviors. Participants reported intense fear of disclosure, discrimination, and social ostracization, which significantly deterred engagement with appropriate care. A majority (93%) experienced shame and guilt, while 89% faced financial constraints to accessing services. Stigma and silence constitute formidable, multilayered barriers requiring comprehensive interventions targeting cultural attitudes, healthcare provider training, and service availability to improve maternal and fetal health outcomes in Nigeria. This study contributes in-depth qualitative understanding of the mechanisms through which stigma operates at individual, interpersonal, and structural levels in the Nigerian context.

Keywords:

Healthcare Barriers Maternal Health Nigeria Pregnancy Qualitative Research Stigma Substance Use Thematic Analysis

Article information

Journal

Journal of Life Science and Public Health

Volume (Issue)

1(2), (2025)

Pages

60-68

Published

29-11-2025

How to Cite

Kolawole, B. O., Famotire, F. O., Ayodele, E. O., Emma-Ekwealor, E. O., Philip, O. T., & Abubakar, S. (2025). Stigma, Silence, and Substance Use: A Qualitative Study of Barriers to Care Among Pregnant Women in Nigeria. Journal of Life Science and Public Health, 1(2), 60-68. https://doi.org/10.69739/jlsph.v1i2.1017

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