The Influence of Religious Leaders on Use of Antenatal and Delivery Care in Sub-Saharan Africa: A Systematic Review

Background: Maternal health remains a critical public health concern in sub-Saharan Africa, and use of antenatal care (ANC) and delivery care can reduce mortality and improve health outcomes. Religious leaders are greatly regarded as influential figures in shaping health behaviors, though many of the recommendations to involve religious leaders in promoting maternal health are based on indirect evidence. To better understand the degree and nature of this influence, we aim to review existing evidence describing the influence of religious leaders on use of antenatal and delivery care in sub-Saharan Africa.

Methods: A systematic literature review was conducted using PubMed and ScienceDirect, and hand searches were conducted using Google Scholar. References of included studies were also reviewed. Studies were included if they reported religious leaders’ influences on ANC and/or delivery care among women in sub-Saharan Africa and were published between 2000 and June 2025 in English. We assessed risk of bias with the Mixed Methods Appraisal Tool (MMAT) and present our findings using a narrative summary and analysis.

Results: Five studies met our inclusion criteria and were conducted in Ethiopia, Ghana, and Nigeria. These studies generally included comparisons between intervention and control communities and demonstrated positive effects of involving religious leaders – often in partnership with other community leaders – on ANC and delivery care. Risk of bias assessments varied widely.

Discussion: Overall, evidence from this review strongly supports the integration of religious leaders into maternal health promotion strategies. We recommend engaging religious leaders who are well respected by the community, have undergone formal training, and who work alongside others in the community to participate in community- and individual-level outreach. Future efforts should focus on expanding trainings and opportunities for religious leaders to leverage their influence for improving maternal and neonatal outcomes.