Table 2.

Major themes, subthemes, and meanings of unclear concepts.

Major themes	Subthemes	Meaning of terms/concepts
Perceived causes of perinatal death		The perceived cause of perinatal death, as per respondents’ perception, is the primary reason that directly leads to perinatal death, while contributory conditions are factors that may not directly cause perinatal death but contribute to the risk or severity of the situations. “Shotelai” represents Rhesus disease caused by blood incompatibility (Rhesus factor). Religious beliefs: Attributions, practices, and support systems: The belief is that perinatal death is a consequence of parental sins or transgressions. Adherence to traditional practices: Childbirth customs, beliefs about loss, and remedial customs. Community knowledge gaps: Common practices that can hinder access to healthcare. Barriers to empowerment: Decision-making, access to healthcare, and reproductive rights. Cultural mediators: Bridging cultural gaps, providing culturally sensitive care, and advocating for women’s reproductive rights.
Theme 1: Spiritual shadows	Moral misinterpretations. Cultural superstitions. Spiritual confusion.
Theme 2: Harmful traditional customs	The heavy hand of tradition. A clash of healing practices. Pregnancy myths.
Theme 3: Obstetric causes	Common obstetric complications. Common risk factors.
Contributory conditions for perinatal death
Theme 4: Barriers to empowerment	Voicelessness and power imbalance.
Theme 5: Geographic and economic challenges	Transportation disasters. Isolation from healthcare. Economic barriers. Community knowledge gaps.
Theme 6: The healthcare quality challenges	Unacceptable healthcare gaps. Internal conflict. Adherence to traditional practices.
Theme 7: Emotional turbulence	Workplace strains. Societal judgments.
Theme 8: Culture and midwives as cultural mediators	Cultural competence as connection. Trust deficits. Advocacy gaps in care. Lack of professionalism. Training and motivation deficiencies. Emotional balance in healthcare.