Cross-cultural aspects of pregnancy and breast feeding

Abstract

Despite recent efforts to expand health care services to a broader segment of the world's population, the majority of the world's babies are still born without the benefit of modern health care services. A large proportion of these deliveries are performed by TBAs (traditional birth attendants). Health programs could be more rapidly expanded if these TBAs, who constitute an already existing resource, were trained in modern delivery methods and integrated into the modern health care system. TBAs provide community members with not only delivery services, but with emotional support and practical assistance both before and after the birth. TBAs are valued members of the community and can be more influential than outside medical personnel in encouraging community members to modify and improve existing practices surrounding pregnancy and childbirth. Some of the traditional practices are beneficial while other are harmful. In traditional societies, pregnancy and childbirth are viewed as important and joyful events, but events which are associiated with a high element of risk. Numerous rituals and practices have been developed over the years to help obviate these risks. In some societies the pregnancy is kept a secret until quite late in order to trick evil spirits who might wish to harm the fetus. Taboos, especially food taboos, are common during pregnancy and mishaps tend to be ascribed to evil spirits. The birth usually takes place in a secluded area of the house with the TBA in attendance. After dleivery, the mother and infant are often kept in isolation for 7-40 days in order to protect the infant during this vulnerable time from evil spirits. This practice is advantageous as it helps create a close bond between the mother and child and promotes successsful lactation. During this time the TBA visits the new mother and gives her massages, hot baths, and emotional support. This valuable TBA function is commonly referred to as the doulu function. A number of countries, such as the Sudan and Indonesia have national training programs aimed at helping TBAs provide their clients with more effective health care while continuing to provide them with the traditionally expected supportive services.