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BACKGROUND: Despite interventions improving maternal and newborn morbidity and mortality, progress has been sluggish, especially in hard-to-reach indigenous communities. Sociocultural beliefs in these communities more often influence the adoption of particular behaviors throughout pregnancy, childbirth, and postpartum. Therefore, this study identified sociocultural beliefs and practices during pregnancy, childbirth, and postpartum among indigenous pastoralist women of reproductive age in the Manyara region, Tanzania. METHODS: The study was a descriptive qualitative design. We used purposive sampling to select twelve participants among community members who were indigenous women of Manyara who had ever experienced pregnancy. In-depth interviews were audio-recorded and transcribed verbatim, and organized manually. We used manual coding and inductive-deductive thematic analysis. RESULTS: The study’s findings showed that sociocultural beliefs and practices are widespread, covering antenatal through childbirth to the postnatal period. Both harmful and harmless practices were identified. For example, the use of herbal preparations to augment labor was reported. Previously, most women preferred home delivery; however, the practice is changing because of increased knowledge of home delivery complications and the accessibility of the facilities. Nevertheless, women still practice hazardous behaviors like applying strange things in the birth canal after delivery, increasing the risk of puerperal infection. CONCLUSIONS: Sociocultural practices are predominant and widely applied throughout the peripartum period. These beliefs encourage adopting specific behaviors, most harmful to both mother and fetus. These sociocultural practices tend to affect the utilization of some essential maternal and child health practices. Eliminating unsafe peripartum practices will increase the use of medical services and ultimately improve outcomes for both mothers and their newborns. Public health interventions must recognize the cultural context informing these cultural practices in marginalized indigenous communities. Healthcare providers should routinely take the history of commonly traditional practices during the peripartum period to guide them in providing quality care to women by correcting all harmful practices.
We conducted the study in one of the villages in the Manyara region that was purposively selected. Manyara region is occupied by tribes such as Iraq, Hadzabe, Akie, Maasai, and Datooga. The main economic activities in Manyara include livestock keeping, hunting, and farming. In this region, indigenous people keep their distinct culture, including language. People from the Manyara community are believed to survive entirely on hunting, traditional features, and customs [9]. As a result, this region’s community members strongly believe in their traditions, customs, cultural practices, and beliefs. This study is descriptive qualitative research. We used qualitative methods to better understand the cultural practices during pregnancy, childbirth, and postpartum to identify practices that negatively affect maternal and newborn health and to help recommend interventions to abolish such harmful practices [10]. The study population included indigenous women of reproductive age (18 to 49 years) who have ever been pregnant and residing in the Manyara region and who were purposively recruited based on their availability during the data collection period. All participants were made aware of the study’s purpose, methodology, and the voluntary nature of their involvement before any data were collected. The study participants were also told that the information they submitted would be kept private and that only the researchers on the team could access it. The Institutional Research Review Committee of the University of Dodoma granted ethical clearance for the study. In March 2021, we conducted twelve in-depth interviews guided by the saturation principle. The principal investigator (PI) and a nurse/midwife research assistant (RA) conducted the interviews. Experience in conducting interviews, using recorders, and knowing maternal health issues were the criteria for selecting the research assistant. A one-day training was conducted for the RA to understand the purpose of the study comprehensively, when to obtain written informed consent from the participants not to influence data collection, what questions to ask, and how to probe. We used a semi-structured interview guide in the Kiswahili language to collect information. The interviews lasted 45 to 50 minutes and were led by two moderators: one (PI) who asked the questions and another (RA) who assisted and recorded the interview and took notes. The interviews were conducted in the private room chosen by the study participant. In the interview, the participants were asked eight questions, to mention a few: “Where do the pregnant women go for childbirth?”, What are the most familiar traditional practices usually society do and beliefs during pregnancy, childbirth, and delivery?”, “What foods do pregnant women eat or not eat?” and several follow-up questions. We uploaded the audio files into a secured computer with a passcode immediately after each interview. The interviews were transcribed verbatim in the Kiswahili language and then translated into English by a bilingual person who speaks Kiswahili and English fluently. Analysis was done manually to avoid losing the meaning of the participants’ expressions. We conducted a thematic analysis following the steps outlined by Braun and Clarke [11]. An iterative, inductive-deductive, team-based coding approach was employed to code and analyze the data [12]. Using a team-based approach, we developed the codebook after re-reading all the transcripts (familiarization with data). The qualitative team had three meetings where codebooks and memos were presented, codes were updated, and any existing disagreement was resolved. We generated themes that involved open-ended coding of several transcripts with no predetermined codes or categories. Coding was done directly onto the hard copies of the transcripts during multiple readings of the interviews. Independent from each other, we coded interviews transcript by transcript and then shared and compared our coding findings to reconcile differences, if any. All the codes from the codebook were applied to all twelve transcripts, then refined, reduced, and expanded them. The study participants’ quotes illustrate the key findings.
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