Nigeria has one of the highest maternal mortality burdens globally. Improving maternal outcomes requires a better understanding of how women experience care across pregnancy, childbirth and the postnatal period. This study explored women’s maternal healthcare experiences across the perinatal continuum in Nigeria, with a focus on how challenges emerge and interact over time.

Longitudinal qualitative study using patient journey mapping.

Public primary, secondary and tertiary healthcare facilities in Abuja, Nigeria.

12 pregnant women were purposively sampled. Each woman participated in two rounds of in-depth interviews: once in late pregnancy and again 2–6 weeks postpartum. All participants completed both interview rounds.

Data were collected through 24 semistructured in-depth interviews conducted longitudinally to capture changes in women’s experiences before and after childbirth. Interview guides were informed by existing maternal health frameworks. Transcripts were analysed using reflexive thematic analysis and organised across five stages of the maternal healthcare journey: Awareness, Consideration, Access, Treatment and Recovery.

This study introduces a five-stage framework: Awareness, Consideration, Access, Treatment and Recovery, to comprehensively explore maternal healthcare experiences. The findings reveal systemic inefficiencies at every stage of the pregnancy journey, from limited awareness of pregnancy test kits to unreliable booking systems and inadequate postpartum mental health support. This study highlights how early-stage barriers cascade into later phases, unlike traditional research that focuses only on clinical interactions. This study emphasises the importance of maternal care accessibility and recovery support, moving beyond a treatment-centric lens. 

This study presents a transformative framework for understanding maternal healthcare as a continuum of interconnected experiences. The research offers actionable insights to enhance maternal health outcomes through stage-specific strategies. The globally adaptable framework provides policymakers and healthcare practitioners with a roadmap to improve maternal healthcare systems in Nigeria and beyond. This holistic approach lays the foundation for reducing maternal mortality while ensuring equitable care for all.

Despite the widespread use of community-engaged research (CEnR) in public health, there is a lack of practical guidance for ensuring research transparency while fostering collaboration between researchers and patient communities.

In this article, we propose the Five Nested Dolls Community-Engaged Research Framework (Five Dolls CEnR) as a tool to assist researchers in enhancing the transparency of CEnR and fostering collaboration between researchers and patient communities throughout all phases of CEnR.

Each of the five dolls represents a meaningful aspect of CEnR, such as patient engagement in research, conceptual framework, research design, findings and researchers’ positionality. In alignment with feminist standpoint theory, Five Dolls CEnR is based on a nesting design principle to demonstrate the influence of researchers’ experiences, perspectives, values, beliefs and assumptions on a research process.

To ensure transparency of the research process and foster collaboration in CEnR, the authors have described self-reflexivity and self-disclosure, two multidisciplinary concepts, as strategies. This framework consists of a series of steps and questions to promote self-reflexivity and self-disclosure of researchers at each doll level.

As a multidisciplinary framework, Five Dolls CEnR can be used across disciplines and throughout the planning, implementation and dissemination phases of a study.