Stakeholder-perceived barriers and facilitators to the effective dissemination and implementation of doula support services in Bayelsa State, Nigeria

Background: Doula support services broadly seen as continuous, non-clinical emotional, physical, and informational support during pregnancy, childbirth, and the postpartum period are widely recognized for improving maternal and newborn outcomes and promoting respectful, woman-centered maternity care. Despite strong global advocacy, the dissemination and implementation of doula services in low- and middle-income countries such as Nigeria remain limited. This study emphasizes the importance of understanding stakeholder-perceived barriers and facilitators to inform context-appropriate implementation strategies within existing health systems.

Materials and Methods: Using a descriptive cross-sectional survey design, the study was conducted across selected tertiary health institutions and relevant regulatory and administrative health structures in Bayelsa State, Nigeria. A census sampling approach recruited 101 participants, comprising midwives and nursing directors. Data were collected through a validated and reliable researcher-developed questionnaire rated on a four-point Likert scale, with analysis based on descriptive statistics.

Results: Findings highlight several critical barriers to effective dissemination and implementation of doula support services. These include limited awareness of the doula role and benefits, inadequate and inconsistent funding, absence of standardized training curricula and certified trainers, infrastructural and workforce constraints, lack of clear national policies and regulatory frameworks, and persistent sociocultural beliefs surrounding childbirth. In contrast, key facilitators identified were the presence of experienced midwives, strong community engagement and cultural acceptability, existing dissemination channels, partnerships with governmental and non-governmental organizations, and increasing global evidence and funding prioritization for maternal and newborn health.

Conclusion: Overall, doula support services are perceived as acceptable and potentially feasible within Bayelsa State’s maternal health system. However, successful integration and scale-up require deliberate policy endorsement, sustainable financing mechanisms, stakeholder sensitization, and the development of standardized training and regulatory frameworks to ensure long-term sustainability.