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Background: Pregnancy and childbirth are socio-cultural events that carry varying meanings across different societies and cultures. These are often translated into social expectations of what a particular society expects women to do (or not to do) during pregnancy, birth and/or the postnatal period. This paper reports a study exploring beliefs around childbirth in Nepal, a low-income country with a largely Hindu population. The paper then sets these findings in the context of the wider global literature around issues such as periods where women are viewed as polluted (or dirty even) after childbirth. Methods: A qualitative study comprising five in-depth face-to-face interviews and 14 focus group discussions with mainly women, but also men and health service providers. The qualitative findings in Nepal were compared and contrasted with the literature on practices and cultural beliefs related to the pregnancy and childbirth period across the globe and at different times in history. Results: The themes that emerged from the analysis included: (a) cord cutting & placenta rituals; (b) rest & seclusion; (c) purification, naming & weaning ceremonies and (d) nutrition and breastfeeding. Physiological changes in mother and baby may underpin the various beliefs, ritual and practices in the postnatal period. These practices often mean women do not access postnatal health services. Conclusions: The cultural practices, taboos and beliefs during pregnancy and around childbirth found in Nepal largely resonate with those reported across the globe. This paper stresses that local people’s beliefs and practices offer both opportunities and barriers to health service providers. Maternity care providers need to be aware of local values, beliefs and traditions to anticipate and meet the needs of women, gain their trust and work with them.
This study consisted of primary qualitative research on traditional practices around pregnancy, childbirth and the puerperium in rural Nepal. A qualitative approach was considered appropriate for exploring the views of women and health care providers [9]. The study setting was both PNC clinics in a community hospital and participants’ homes, open fields and the village health post in two villages in rural Nepal (identified as A and B for the purpose of this paper). The new mothers went to these clinics for check-ups and vaccinations. The health service characteristics were similar between village A and B. In village A, there were two health posts and a primary health care centre nearby. In village B, the hospital was a community hospital with maternity services (Basic Emergency Obstetric Care Centre) and there were two health posts. Data collection took place in July 2012. As qualitative methods are most appropriate for exploring complex phenomena [9], interviews and focus groups (FG) were used to explore behaviour and practice [10, 11]. Face-to-face interviews and FGs were conducted with: (a) women with a recent pregnancy and/or with a child under the age of two; (b) their mothers-in-law; (c) their husbands; and (d) healthcare workers in the area. The sampling was purposive and potential participants were recruited through a network of health centres and women’s groups. Purposive sampling was conducted in order to obtain a broad view of perspectives from a range of participants that included health workers and health service users of diverse social classes. As various ethnicities exist in Nepal (Gurung, Newari, Tamang, etc.) each with their own practices, any cultural issues raised by participants around childbirth were explored in-depth and the all-female interview team enabled postnatal practices to be probed [12]. The FGs and interviews lasted some 45 min each and were recorded (with permission), translated and transcribed [12]. First, five semi-structured interviews involving eight health workers were conducted in English by the first author (SS), as the participants spoke English, typical of higher caste/educated/health professionals in Nepal [13]. The researcher did not have a dual (clinical) role. The interviews were conducted in offices to explore the responses of the participants and gather more and deeper information by probing their answers. Secondly, fourteen FGs (each with 3-9 participants to keep the group manageable but yield good discussion) were conducted in participants’ homes, open fields or the village health post with the aid of a Nepali translator. The latter was a maternal health researcher, as recommended in a study by Pitchforth and van Teijlingen [10]. The qualitative data were analysed independently by two of the researchers (SS and EvT) using a thematic approach. They then compared and contrasted the findings to minimise bias and to ensure the reliability of the data [13]. The Nepal Health Research Council granted ethical approval for the qualitative study (Reg. No. 37/2011 on 1/08/2011). Consent was obtained from each individual participant, and participants were assured that they were able to withdraw, if they so wanted. The literature review on global PNC provision and utilisation was undertaken alongside the qualitative data collection to offer suggestions for areas to explore during or after the interviews/focus groups. We searched the following electronic databases: PubMed (or Ovid MEDLINE), EMBASE, Cochrane Library, PsycINFO, Scopus, Wed of Science, WHO (World Health Organization), CINAHL and Popline. Databases were searched from the start of the database until May 2013 for cultural issues, practices and beliefs. Inclusion criteria were: English language; qualitative and quantitative research; primary studies; all health care settings, including general practice, midwifery, outpatient, clinics, hospitals; all participants; with no time limit. Exclusion criteria were non-English language, papers that did not contain primary research or did not focus on maternity and childbirth. The search terms were ‘cultural practices’, ‘cultural practices AND beliefs related to postpartum/natal period’, and finally ‘40 AND days AND postnatal AND belief’. The term ‘40 days’ was included as a search term as it was mentioned in the interviews and the initial literature search revealed that these 40 days are considered the postpartum period [14]. The qualitative findings are presented first and the captured key study themes are then put into context through an analysis of the global literature.
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