Determinants of Caesarean Section Refusal Among Parturients at Tertiary Hospitals in North West Nigeria: A Mixed-Methods Study

Caesarean section refusal by parturients requiring operative delivery is a clinically urgent challenge that compounds maternal and perinatal mortality risk in Nigerian tertiary hospitals, yet its determinants in the North West zone have not been empirically investigated. This mixed-methods study examines the determinants of caesarean section refusal at three tertiary hospitals in Kano, Kaduna, and Sokoto States. A quantitative survey enrolled 160 parturients who had refused or delayed caesarean recommendation during their current or previous delivery, supplemented by in-depth interviews with 20 women and 15 obstetric providers. Logistic regression identified independent determinants of refusal. Fear of surgical death (OR 4.8), financial inability to pay (OR 3.9), husband non-consent (OR 4.2), and negative prior caesarean experience (OR 3.1) were the strongest determinants. Religious objection was expressed by 28 percent of refusers but was rarely the sole determinant. Providers reported that financial discussion was the most time-consuming component of refusal management. Qualitative findings reveal a deep community narrative attributing caesarean to maternal weakness and subsequent infertility. The study provides the first empirical determinant profile for caesarean refusal in North West Nigeria and recommends structured informed consent counselling frameworks, social support linkage for financial barriers, husband involvement in decision counselling, and targeted community messaging to dispel caesarean misconceptions. Keywords: caesarean section refusal, determinants, North West Nigeria, informed consent, obstetric decision-making