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Table 3 Thematic network analysis framework (from codes to global themes)

From: Why Muslim women in Northern Ghana do not use skilled maternal healthcare services at health facilities: a qualitative study

Codes Basic themes identified Organizing themes Global themes
-There is joy in pregnancy and childbirth. 1. Pregnancy and childbirth are fulfilling biological functions women perform 1. Pregnancy and childbirth is role fulfilment, self actualization and empowerment Muslim Women’s experiences of pregnancy and childbirth
-Women feel accomplished in giving birth safely.
-A woman can die while pregnant or giving birth 2. Pregnancy and Childbirth is dangerous – you either die or live 2. Pregnancy and childbirth can be a dangerous event
-Pregnancy and childbirth is an anxious phase of a woman’s life
-Pregnancy makes women highly dependent on others
-A pregnant woman needs care, love and empathy to be able to deliver safely 3. Care during pregnancy is important for safe delivery 3. Muslim women want skilled attendance at birth
-Women should go to hospital when pregnant 4. Hospital delivery is good  
-It is good to deliver in a hospital
-Midwives can help to deliver women safely
-Muslim women are required to preserve bodily sanctity 5. It is a religious duty in Islam for women to preserve bodily sanctity 4. Religious obligation to maintain bodily sanctity limits Muslim women’s ability to access skilled care Barriers to accessibility and utilisation of skilled maternal healthcare services by Muslim women
-Muslim women must dress properly
-Muslim women must cover up their bodies
-Covering is one of the religious rules and duties in Islam
- People who bear no relationship with Muslim women must not see their nakedness
-There is no privacy in hospital birth 6. Muslim women values privacy in health facilities when accessing maternal healthcare services 5. Lack of privacy in health facilities is a disincentive for Muslim women’s use of skilled care
-Privacy is not given attention in health facilities
-It is difficult to fulfil Islamic requirement to preserve bodily sanctity
-There is privacy in homebirth but not in hospitals
-TBAs usually cover the perineal area of a labouring woman’s vagina
-Caregivers do not ask how Muslim women feel 7. Muslim women want respect when receiving maternal healthcare services 6. Healthcare providers’ insensitivities to Muslim women’s needs and concerns limit their access to skilled care
-Nurses are disrespectful
-Caregivers disrespect and disregard Muslim women’s preferences and cultural values relating to pregnancy and childbirth
-Caregivers do not take Muslim women’s religious and cultural needs into account
-Maltreatment and scolding is dehumanizing
-Caregivers want women to obey instructions without question
-Caregivers must respect their clients
-Circumcision of male infants is a requirement in Islam 8. Culturally and religiously inappropriate care and health information does not promote effective communication between caregivers and Muslim women  
- Information on circumcision is usually unavailable in health facilities
-There is poor communication between women and caregivers
-Caregivers lack understanding of Muslim women’s religious needs
-Muslim women alone do not make decisions regarding access to skilled care 9. Muslim women lack decision-making autonomy and depend on other people to making decisions regarding use of skilled care services 7. Muslim women’s lack of decision-making autonomy constrains their access to, and use of skilled maternal healthcare services
-Urban women participate more in decision-making
-Women with secondary or higher participate more in decision-making
-Husbands are important decision-makers
-Mothers-in-law play crucial roles in decision-making
-Women must be submissive
-Women must be obedient