What urban–rural differences exist in cultural norms and maternity care preferences: a cross-sectional study among women receiving antenatal, postnatal, and child under 5 years health services in Bo District, Sierra Leone

Abstract

Introduction To assess rural–urban differences in cultural norms, traditional practices and preferences for culturally responsive maternity care in Bo District, Sierra Leone. Exploring urban–rural differences is essential because women living in these settings often experience distinct cultural influences and healthcare barriers that shape maternity care preferences and may require context-specific interventions. Methods Facility-based descriptive cross-sectional study at Bo Government Hospital (urban) and Tikonko Maternity Center (rural). Participants were 500 pregnant women, postpartum mothers and mothers of children under 5 years of age who attended maternal/child health services and resided in Bo for ≥6 months. Data were collected through interviewer-administered structured questionnaires using an Open Data Kit system called ONA—a mobile platform. Trained research assistants conducted face-to-face interviews in participants’ preferred language (Krio or Mende), recorded responses electronically in real time and obtained informed consent before data collection. Outcomes included religion, family type, marital status and 10 culturally responsive strategies (1866 multiple-response selections). χ 2 tests, proportion differences and 95% CIs assessed rural–urban differences. Results Residency was not associated with religion (p=0.901), family type (p=0.235) or marital status (p=0.541). Cultural competence training was most endorsed (26.6%). Urban women preferred integrating safe traditional practices into facility care (χ²=9.742, p=0.0018), whereas rural women preferred language-support services (χ²=26.044, p<0.001). Other strategies showed no meaningful rural–urban differences. Conclusions Both groups valued culturally respectful maternity care. Cultural competence training was a priority, while preferences for traditional-practice integration and language support indicated context-specific urban and rural needs, informing culturally responsive interventions and policy in Sierra Leone.