CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
With a maternal mortality ratio of 1000/100,000 live births; Nigeria has one of the largest burdens of maternal deaths in the world. (Oguniyi, Faleyimi et al 2003, UNDP 2001). The main medical causes of these deaths are haemorrhage, eclampsia, obstructed labour, sepsis and unsafe abortion (WHO 1999, Harrison 1997). It has been estimated that for every maternal death that occurs, 15 other women suffer chronic debilitating injuries (Moore 1991). Some of these morbidities (e.g. obstetric fistulae, palsy, infertility, gynaetresia and genital prolapse) have devastating social and psychological consequences for their victims, often for life. Poor utilization of modern obstetric care services contributes remarkably to the high prevalence of morbidities in developing nations including Nigeira (Ogunniyi, Faleyimi et al 2000, Ijadunola and Fatusi 2003). Studies show that majority of our women prefer to engage the services of traditional and spiritual midwives when pregnant (Udoma, John et al 2003, Etuk Etuk et al 2000). This is partly because the women easily identify with these midwives with whom they share common socio-cultural beliefs and practices (Udoma, John et al 2003).
The human instinct to protect life has led to the emergence of various beliefs and customs concerning health, dating back to the time of primitive tribes. These beliefs have been transferred from generation to generation as a component of the social and cultural structure, despite innovations in science and technology. Traditional health practices are observed in every region of the world with varying frequency.[1] Pregnancy and giving birth is an important transitional period in life, and because of this characteristic, it has been the source of many traditional beliefs and rituals throughout history in every cultural environment.[2,3] Health workers’ knowledge of traditional practices can play an important role in the protection and improvement of the health of the child and the mother.[3] Some traditional practices can delay the diagnosis of disease and have a direct adverse effect on the individual’s health status. For example, if a postnatal infection manifesting with a high fever and delirium is assessed as the folk belief of seeing a demon in a nightmare and if, instead of seeking medical help, rituals such as bringing the woman to a clergyman to pray or burning incense are followed, the sick woman may lose her life. Similarly, waiting for 3 of the daily calls to prayer before breastfeeding the baby can induce hypoglycemia, and related problems may develop.[4] Harmless traditional practices may have greater meaning for an individual than it might seem. Indeed, people continue to observe such practices not just because they are beliefs and traditions, but because they are meaningful to them. For example, women living in rural Zambia often do not want to deliver their babies in the hospital because traditional rituals performed with the placenta are not allowed there.[5] Studies performed in China have demonstrated that women feel safer and more at ease when they can access both traditional and modern medical assistance.[6,7] Knowledge of traditional beliefs and widely implemented social customs will enable the correction of those that might be harmful, and will increase the quality of care by recognizing harmless rituals with respect and understanding of the patient’s beliefs.[8] When viewed from this perspective, improving women’s health is directly related to being knowledgeable about traditional practices concerning pregnancy, birth, and the postpartum period. Sources related to improving the quality of obstetric healthcare emphasize the importance of providing care that is sensitive to a woman’s cultural background.[9,10] When harmless customs are seen and esteemed as components of traditional richness, a mutual relationship between health workers and women based on trust and respect can be established more easily. This study was performed with the goal of determining some of the traditional beliefs and practices observed by women related to maternal and neonatal care during pregnancy, birth, and the postnatal period.
Unfortunately, some beliefs and practices such as female genital mutilation and the traditional abhorrence of abdominal delivery have been identified as harmful to maternal health (chukwudebelu 2003). Although anthropological studies have also been carried out in our environment, these have tended to focus on traditional believes pertaining to childbirth (Udoma, Asuquo, Ekott 1999). There is paucity of community-based research seeking to investigate the traditional beliefs and practices pertaining to pregnancy from the antenatal to the postpartum period that could contribute to maternal morbidity in rural Akwa Ibom State, Nigeria. This study aims to bridge this gap in knowledge in the hope that the outcome will enable the formulation of polices aimed at overcoming the traditional practices and pregnancy related challenges in Essien Udim LGA to achieving a reduction in maternal morbidity in our environment.
1.2 Problem of the study
Most maternal and newborns deaths are caused by sociocultural variables, such as cultural and religious influences, and other social factors that impact personal choices. Every culture has certain enduring customs that represent societal values and have been passed down from generation to generation. Women are influenced by cultural and traditional norms of their ethnic origin regardless of whether they reside in an urban or rural location. This influences how they adjust to the postpartum time, and how they see providing postpartum maternal and infant care.
Poor utilization of modern obstetric care services has contributed remarkably to the high prevalence of morbidities in developing nations including Nigeira (Ogunniyi, Faleyimi et al 2000, Ijadunola and Fatusi 2003). Studies show that majority of our women prefer to engage the services of traditional and spiritual midwives when pregnant (Udoma, John et al 2003, Etuk Etuk et al 2000). This is partly because the women easily identify with these midwives with whom they share common socio-cultural beliefs and practices (Udoma, John et al 2003). It is on this basis that the study seeks to examine the traditional practices and pregnancy related challenges in Essien Udim LGA.
1.3 Objectives of the study
The major objective of the study is to examine the traditional practices and pregnancy related challenges in Essien Udim LGA
Following objectives include;
- To examine the traditional beliefs about causes of diseases in pregnancy and practices to prevent and treat them.
- To ascertain the antenatal care practices.
- To examine the delivery practices and experiences during childbirth.
- To know the Postpartum practices including management of common complications.
- To identify harmful traditional practices and provide guidance on counseling women during antenatal and postnatal education to improve maternal and infant health,
1.4 Research questions
- What are the traditional beliefs about causes of diseases in pregnancy and practices to prevent and treat them?
- What are the antenatal care practices?
- What are the delivery practices and experiences during childbirth?
- What are the Postpartum practices including management of common complications?
- What are the harmful traditional practices and provide guidance on counseling women during antenatal and postnatal education to improve maternal and infant health?
1.5 Scope of the study
The study centers on traditional practices and pregnancy related challenges in Essien Udim LGA. The study will be carried out in three hospitals in Essien Udim LGA among women and health care professionals in the LGA.
1.6 Significance of the study
The study will help to improve outcomes for women, children, and families, and their healthcare team.
The study will go a long way to assist in identifying harmful traditional practices and provide guidance on counseling women during antenatal and postnatal education to improve maternal and infant health, nurses and midwives would benefit from understanding traditional practices and beliefs related to maternal and infant care.
1.7 Study Limitation
This study was carried out as a descriptive research design using a sample of 37 women drawn from three separate hospitals in three different hospitals in Essien Udim LGA. As a result, the current study’s findings solely apply to women who took part in the country. Because convenience samples were employed, the findings may not be generalizable. How the women learned about these behaviors or who proposed them was not addressed. However, because the participants’ age, educational level, employment, and number of children varied, a rather comprehensive picture of cultural postpartum beliefs and behaviors among women in the LLGA was acquired. More studies should be conducted on the education of healthcare personnel to enable them to give culturally appropriate care to mothers and newborns.
