A systematic review of challenges, impacts and burdens of cesarean section on the mental health and well-being of pregnant mothers, and family in Nigeria

Cesarean section (CS) rates are increasing globally, yet in low-resource settings such as Nigeria, limited integration of maternal mental health services may heighten psychological vulnerability. This systematic review synthesises evidence on the psychological impacts of CS on mothers and families in Nigeria. A systematic search was conducted across four databases (PubMed, Scopus, African Journals Online, and CINAHL), and grey literature sources were searched for relevant articles following PRISMA guidelines. Two independent reviewers completed screening, data extraction, and quality appraisal using the Mixed Methods Appraisal Tool. Narrative synthesis was applied to reporting the results. Ten studies were included. The evidence demonstrated that CS was consistently associated with elevated psychological morbidity, including postpartum depression, anxiety symptoms, and post-traumatic stress disorder (PTSD). Emergency CS was a strong predictor of PTSD, with a reported higher likelihood. Evidence highlighted fear, loss of control, and feelings of inadequacy following CS. Sociocultural stigma framing CS as a sign of weakness or culturally constructed belief of spiritual failure amplified psychological distress. Only a minority of affected women accessed mental health care. Spousal distress and family-level psychological burden were also reported, indicating broader household impact. Protective factors included spousal support, respectful maternity care, religious coping, and peer support. CS imposes a substantial multilayered psychological burden on Nigerian mothers and their families, yet the health system lacks integrated mental health support. Routine screening, family-centered counselling, and community stigma reduction are urgently required. Policy must mandate postpartum mental health screening, institutionalize respectful maternity care, and scale low-cost psychosocial interventions for CS families.

Grisbrook MA, Dewey D, Cuthbert C, et al. Associations among caesarean section birth, post-traumatic stress, and postpartum depression symptoms. Int J Environ Res Public Health 2022;19:4900. DOI: https://doi.org/10.3390/ijerph19084900

Garthus-Niegel S, von Soest T, Vollrath ME, Eberhard-Gran M. The impact of subjective birth experiences on post-traumatic stress symptoms: a longitudinal study. Arch Womens Ment Health 2013;16:1-10. DOI: https://doi.org/10.1007/s00737-012-0301-3

Minani P, Ross A. Strengthening caesarean birth: Sub-Saharan Africa health system evaluation: scoping review. Afr J Prim Health Care Fam Med 2024;16:e1-11. DOI: https://doi.org/10.4102/PHCFM.v16i1.4128

Abajobir A, Sidze EM, Wainaina C, et al. The epidemiology of maternal mental health in Africa: a systematic review. Arch Womens Ment Health 2025;28:997-1089. DOI: https://doi.org/10.1007/s00737-025-01563-4

National Population Commission (NPC) Nigeria and ICF. Nigeria demographic and health survey 2023–24: key indicators report. 2024. Available from: https://share.google/GfwjR38elfrgRPY9T

Akadri AA, Imaralu JO, Salami OF, et al. Robson classification of caesarean births: implications for reducing caesarean section rate in a private tertiary hospital in Nigeria. BMC Pregnancy Childbirth 2023;23:243. DOI: https://doi.org/10.1186/s12884-023-05557-x

WHO. WHO recommendations on non-clinical interventions to reduce unnecessary caesarean sections. 2018. Available from: https://www.who.int/publications/i/item/9789241550338

Adewuyi EO, Akosile W, Olutuase V, et al. Caesarean section and associated factors in Nigeria: assessing inequalities between rural and urban areas—insights from the Nigeria Demographic and Health Survey 2018. BMC Pregnancy Childbirth 2024;24:538. DOI: https://doi.org/10.1186/s12884-024-06722-6

Anih AI, Ogunbode OO, Okedare AO. Decisional conflict amongst women undergoing caesarean section in health facilities in Ibadan, Nigeria. West Afr J Med 2023;40:269-76.

Benton M, Salter A, Tape N, et al. Women’s psychosocial outcomes following an emergency caesarean section: a systematic literature review. BMC Pregnancy Childbirth 2019;19:535. DOI: https://doi.org/10.1186/s12884-019-2687-7

Michael IT, Michael TO. ‘It’s not a weakness’: lived experiences, support systems, and emotional wellbeing in caesarean birth among postpartum women in Nigeria. Student’s J Health Res Afr 2025;6:11. DOI: https://doi.org/10.51168/sjhrafrica.v6i9.1994

Michael TO, Agbana RD, Naidoo K. Exploring perceptions of caesarean sections among postpartum women in Nigeria: a qualitative study. Women 2024;4:73-85. DOI: https://doi.org/10.3390/women4010006

WHO. Mental Health Atlas 2020: Nigeria country profile. 2022. Available from: https://www.who.int/publications/m/item/mental-health-atlas-nga-2020-country-profile

Jidong DE, Husain N, Ike TJ, et al. Maternal mental health and child well-being in Nigeria: a systematic review. Health Psychol Open 2021;8:20551029211012199. DOI: https://doi.org/10.1177/20551029211012199

Adeyemo EO, Oluwole EO, Kanma-Okafor OJ, et al. Prevalence and predictors of postpartum depression among postnatal women in Lagos, Nigeria. Afr Health Sci 2020;20:1943-54. DOI: https://doi.org/10.4314/ahs.v20i4.53

Tsiga-Ahmed FI, Umar MU, Adamu AL, et al. Incidence of postpartum depression among women with postpartum haemorrhage in Kano, northern Nigeria. npj Womens Health 2024;2:32. DOI: https://doi.org/10.1038/s44294-024-00031-1

Fatoye FO, Oladimeji BY, Adeyemi AB. Difficult delivery and some selected factors as predictors of early postpartum psychological symptoms among Nigerian women. J Psychosom Res 2006;60:299-301. DOI: https://doi.org/10.1016/j.jpsychores.2005.04.012

Ukpong DI, Owolabi AT. Postpartum emotional distress: a controlled study of Nigerian women after caesarean childbirth. J Obstet Gynaecol 2006;26:127-9. DOI: https://doi.org/10.1080/01443610500443386

Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. DOI: https://doi.org/10.1136/bmj.n71

PRISMA 2020 flow diagram for systematic reviews and meta-analyses. Available from: https://www.prisma-statement.org/prisma-2020-flow-diagram

Hong QN, Fàbregues S, Bartlett G, et al. The Mixed Methods Appraisal Tool (MMAT) version 2018. Educ Inf 2018;34:285-91. DOI: https://doi.org/10.3233/EFI-180221

Popay J, Roberts HM, Sowden A, et al. Guidance on the conduct of narrative synthesis in systematic reviews. Lancaster, UK: Institute for Health Research; 2006.

Sotonye FO, Chukwuma O, Alfred TA. Evaluation of the psychological distress experienced by spouses of women undergoing anaesthesia for caesarean section. Port Harcourt Med J 2019;13:7-12. DOI: https://doi.org/10.4103/phmj.phmj_4_19

Ikeako LC, Iteke OC, Ezegwui HU, et al. Prevalence and correlates of postpartum depression among women visiting postnatal clinic in a tertiary health institution in southeast Nigeria. Orient J Med 2018;30:43-51.

Adewuya AO, Ologun YA, Ibigbami OS. Post-traumatic stress disorder after childbirth in Nigerian women: prevalence and risk factors. BJOG 2006;113:284-8. DOI: https://doi.org/10.1111/j.1471-0528.2006.00861.x

Odufuwa OT, Olaniyan O, Okuonzi SA. Determinants of mental healthcare-seeking behavior of postpartum women in Ibadan, Nigeria. Front Glob Womens Health 2022;3:787263. DOI: https://doi.org/10.3389/fgwh.2022.787263

Chinawa A, Awoere. Postpartum depression among mothers as seen in hospitals in Enugu, South-East Nigeria: an undocumented issue. Pan Afr Med J 2016;23:180. DOI: https://doi.org/10.11604/pamj.2016.23.180.8244

Gelaye B, Rondon MB, Araya R, Williams MA. Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries. Lancet Psychiatry 2016;3:973-82. DOI: https://doi.org/10.1016/S2215-0366(16)30284-X

Kolawole I, Fawole A. Postoperative pain management following caesarean section in University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria. West Afr J Med 2004;22:305-9. DOI: https://doi.org/10.4314/wajm.v22i4.28052

Daly B, Young S, Marla R, et al. Persistent pain after caesarean section and its association with maternal anxiety and socioeconomic background. Int J Obstet Anesth 2017;29:57-63. DOI: https://doi.org/10.1016/j.ijoa.2016.10.004

Ayers S, Bond R, Bertullies S, Wijma K. The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework. Psychol Med 2016;46:1121-34. DOI: https://doi.org/10.1017/S0033291715002706

Elom NA, Nwimo IO, Ilo CI, et al. Belief towards caesarean section: a community based study of male partners in Ebonyi State, Nigeria. SAGE Open Med 2022;11:20503121221147810. DOI: https://doi.org/10.1177/20503121221147810

Okagua KE, Okagua J. Patients perception of the quality of consent for caesarean sections in a tertiary health facility in Port Harcourt, Southern Nigeria. Niger Health J 2020;19:148-57.

Iwuagwu AO. “Ọmụgwọ” as unpaid labor? The perceptions of postpartum caregiving among older grandmothers in Southeast Nigeria. Innov Aging 2023;8:igad069. DOI: https://doi.org/10.1093/geroni/igad069

Ojukwu C. Is mode of delivery a determinant of postpartum health-related quality of life in Nigerian women? Niger J Med 2020;29:628-33. DOI: https://doi.org/10.4103/NJM.NJM_119_20

Loto OM, Adewuya AO, Ajenifuja OK, et al. Cesarean section in relation to self-esteem and parenting among new mothers in southwestern Nigeria. Acta Obstet Gynecol Scand 2010;89:35-8. DOI: https://doi.org/10.3109/00016340903280966

Howard LM, Oram S, Galley H, et al. Domestic violence and perinatal mental disorders: a systematic review and meta-analysis. PLoS Med 2013;10:e1001452. DOI: https://doi.org/10.1371/journal.pmed.1001452

Arisukwu O, Igbolekwu CO, Oyekola IA, et al. Spousal support during pregnancy in the Nigerian rural context: a mixed methods study. BMC Pregnancy Childbirth 2021;21:772. DOI: https://doi.org/10.1186/s12884-021-04135-3

Boateng KHT, Asirifi SKA, Cyriaano P, et al. Exploring determinants of caesarean section preference among pregnant women at Tamale Teaching Hospital. J Med Sci Health 2025;11:188-96. DOI: https://doi.org/10.46347/jmsh.v11.i2.24.322

Mersha AG, Abebe SA, Sori LM, Abegaz TM. Prevalence and associated factors of perinatal depression in Ethiopia: a systematic review and meta-analysis. Depress Res Treat 2018;2018:1813834. DOI: https://doi.org/10.1155/2018/1813834

Bodin E, Peretti V, Rouillay J, et al. Posttraumatic stress disorder and emergency cesarean delivery: Incidence and risk factors. Gynecol Obstet Fertil Senol 2022;50:240-60. [Article in French]. DOI: https://doi.org/10.1016/j.gofs.2021.12.015

Federal Ministry of Health Nigeria. National Strategic Plan for Maternal, Newborn and Child Health 2024–2028. 2024. Available from: https://nationalqoc.fmohconnect.gov.ng/wp-content/uploads/2023/10/MEAL-PLAN-2022-2027-FINAL-VALIDATED-RMNCAEHN7203.pdf.

Ashinze PT, Adeola J, Adeleye VM. Evaluating Nigeria’s recently announced free cesarean delivery initiative. AJOG Glob Rep 2025;5:100448. Erratum in: AJOG Glob Rep 2025;5:100518. DOI: https://doi.org/10.1016/j.xagr.2025.100518

Sun L, Wang S, Li XQ. Association between mode of delivery and postpartum depression: a systematic review and network meta-analysis. Aust N Z J Psychiatry 2021;55:588-601. DOI: https://doi.org/10.1177/0004867420954284

Federal Republic of Nigeria. National Mental Health Act, 2023. Available from: https://share.google/ONXvm7LQ3g7ZKxK99.