Evolving pediatric and neonatal therapeutics depend not only on clinical innovation but on the quality-of-care women receive before delivery. Midwives' cultural competence (CC) shapes antenatal care (ANC) satisfaction and facility-based delivery uptake, both upstream determinants of neonatal survival in Sub-Saharan Africa (SSA), where Nigeria alone contributes roughly 20% of global maternal deaths. The aim is to synthesis evidence on whether culturally competent midwifery care improves ANC satisfaction and, by extension, the pathway to safer, facility-based neonatal outcomes in SSA. Methods: A PRISMA 2020-compliant mixed-methods systematic review searched six databases (PubMed, CINAHL, CENTRAL, EMBASE, Scopus, Web of Science) and supplementary sources for studies published January 2013–March 2025. Eligible studies mapped a CC intervention or exposure onto Campinha-Bacote's five-construct model and reported ANC satisfaction. Quality was appraised using RoB 2.0, ROBINS-I, NOS, CASP, and MMAT; certainty was rated with GRADE and CERQual. Results revealed that twelve studies from seven countries showed a consistent positive association between midwives' CC and ANC satisfaction (adjusted odds ratios 1.48–4.05), a known predictor of continued ANC engagement and facility-based delivery, the entry point for neonatal therapeutic access. Provider attitude and empathy outweighed technical skill as satisfaction drivers. Evidence certainty was Low-to-Moderate. In Conclusion, Culturally competent midwifery care functions as an upstream therapeutic lever, improving the maternal engagement pathways that determine whether newborns reach facility-based care. Embedding CC into midwifery training strengthens the foundation on which pediatric and neonatal therapeutics depend.

Oburoh Ethel Temisanren is a PhD Student of ACE-PUTOR, University of Port Harcout, Rivers State Nigeria. She is a registered Nurse, Midwife and Paediatric Nurse, MSc MCH, with PhD in midwifery Ongoing.