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Table of Contents
RESEARCH ARTICLE
Year : 2019  |  Volume : 20  |  Issue : 2  |  Page : 106-110

Cultural practices and beliefs regarding newborn care in South India


College of Nursing, CMC, Vellore, Tamil Nadu, India

Date of Submission06-May-2019
Date of Acceptance30-Dec-2019
Date of Web Publication01-Jun-2020

Correspondence Address:
Mrs. Mary Jenifer
College of Nursing, CMC, Vellore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCN.IJCN_18_20

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  Abstract 

The days and weeks following child birth are a critical phase in the lives of mothers and newborn babies. According to the WHO, 45% of under-five deaths occur during the 1st month of life. Several factors contribute to neonatal mortality in India and one of the reasons is following harmful newborn care practices such as applying different unsterile material on the umbilical cord and instilling liquids and oils in the ears and nose. These practices are often associated with the cultural beliefs. The objective of this focused ethnography study was to bring forth a description of the cultural aspects of newborn care in South India and identify cultural themes related to newborn care which will help health professionals to understand and tailor interventions in the health-care setting. Three focus group discussions were conducted in the post-natal units of a tertiary hospital in South India using a semi-structured interview guide. Data from translated interviews were coded and categorised to identify cultural themes. Themes such as rituals, beliefs, resistance and adaptation and solutions evolved from the study. The study was successful in highlighting cultural practices and their meanings, which provides an insight for nurses on how to deliver educational messages, considering the cultural values and beliefs of the mothers.

Keywords: Cultural beliefs and practices, mothers, newborn care


How to cite this article:
Jenifer M, Benjamin EE. Cultural practices and beliefs regarding newborn care in South India. Indian J Cont Nsg Edn 2019;20:106-10

How to cite this URL:
Jenifer M, Benjamin EE. Cultural practices and beliefs regarding newborn care in South India. Indian J Cont Nsg Edn [serial online] 2019 [cited 2020 Dec 2];20:106-10. Available from: https://www.ijcne.org/text.asp?2019/20/2/106/285586


  Introduction Top


The days and weeks following childbirth – the post-natal period – are a critical phase in the lives of mothers and newborn babies. Most maternal and infant deaths occur in the 1st month after birth. In 2013, 2.8 million newborns died in their 1st month of life and 1 million of these newborns died on the 1st day.[1] It is estimated that each year around four million neonatal deaths occur almost exclusively in low-income countries like India.[2] The neonatal period is only 1/60th of the first 5 years of life but contributes 38% of the estimated 10.5 million under-five deaths occurring every year all over the world.[3]

Studies report that most newborns in low-income countries like India die at home while they are cared by mothers, relatives and traditional birth attendants who follow their own cultural practices and beliefs.[4] According to the WHO,[5] 45% of under-five deaths occurred during the 1st month of life. Several factors contribute to the mortality and one of the reasons is following of harmful practices such as inadequate cord care, discarding colostrum and feeding other foods which are based on cultural practices. Culture refers to the learned values, beliefs, norms and way of life that influence an individual's thinking, decisions and actions in certain ways.[6]

Cultural beliefs and practices prevailing in the community influence newborn practices and these cultural beliefs are not the same throughout India. A number of studies have suggested that if health professionals are intercultural competent and skilled in recognizing and working with patient/client values and beliefs, the client response will be enhanced and compliance to good practice will improve.[7]

Objective

The objective of this focused ethnography study was to bring forth a description of the cultural aspects of newborn care followed in Tamil Nadu, South India, and identify cultural themes related to newborn care, which will help health professionals to understand and tailor interventions in the health-care setting.

Design and Sampling

A qualitative research study with a focused ethnography design was used to elicit information on aspects of newborn care. While ethnography looks at describing culture of a group in general,[8] in focused ethnography, the researcher attempts to investigate specific beliefs and practices of particular illnesses or phenomenon in the lives of individuals or groups.[9] In this study, the phenomenon of interest was newborn care in Tamil Nadu, South India. A purposive sampling technique was adopted for selecting participants for the focus group discussion. Second-time mothers admitted in the post-natal wards, grandmothers and women relatives of other mothers who were admitted in the post-natal wards who were willing to be part of the focus group and gave consent to participate were included in the study.

Data Collection Procedure

A semi-structured questionnaire with open-ended questions was used to elicit participants' perspectives on their practices related to newborn care at home. Grandmothers and other relatives who have experience of taking care of newborns and mothers who have taken care of at least one newborn and those who were able to comprehend and speak English or Tamil were included as participants. Written informed consent was obtained from the participants prior to the study.

Three focus group interviews, with 8–10 members, one with second-time mothers, the other with grandmothers of neonates admitted in the post-natal units and the third with other women relatives of women admitted in the post-natal wards, were conducted in the regional language Tamil. The semi-structured interview guide had open-ended questions such as what were some of the baby care practices that were carried out at home, what was the importance of each activity and their beliefs related to the activities and what were some of the factors that they thought influenced the practices. The interviews lasted around 50 min. Interviews were audio recorded. Field notes also were included from encounters of newborn care practices observed by the researcher in the ward. The information was transcribed in Tamil and later translated to English. Meaningful information was coded and categorised into themes.


  Results and Discussion Top


Birth of a newborn brings a time of rejoicing for any family around the globe and newborn care at home is given much importance in many of the cultures. In India, newborn care practices differ between states and within states based on the region-specific or religion-specific beliefs and values.[10]

If any intervention on enhancing newborn care practices has to be effective, the cultural aspects of care at home need to be understood. The present study intended to qualitatively understand the cultural aspects of newborn care in contrast to other studies which attempted to quantify the practices and beliefs.[11] Nine mothers between the age of 20–40 years, 8 grandmothers and 8 female relatives between the age of 41–60 years participated in the focus group interviews. In each group, women talked about the general newborn home care practices from their perspectives. Analysis of data from all women brought forth four themes: rituals, beliefs, resistance and solutions.

Rituals

Women shared about many ritual practices that were carried out related to care of the newborn at home. Most women emphasised on baby bath, cord care and feeding practices.

Baby bath

Although baby bath is initiated in the hospital, the ritual bath generally given on the 9th or 11th day at home was considered important. The newborn was thought to be dirty until then. The ritual bath involved applying turmeric powder on the head (preferably on the anterior fontanel) and the hair was washed with shikakai (an indigenous powder made from the bark of Acacia concinna, a shrub) or chick pea flour. Most of them said that they used baby soap to wash baby's skin and a few mentioned that they used chick pea flour for washing the body. In most homes, the baby was exposed to the fumes of burned incense or burned garlic to dry the hair. The ceremonial bath is delayed for more than 1 week according to the present study, but another study from North India reported that the first ceremonial bath for newborn was given on the 3rd day when the mother also took her first bath after delivery.[11] The practice of rubbing dough (lentil/flour paste) over the body was found in 20% of mothers in a study done in Uttarakhand, North India, which was similar to the findings from this study.[10]

Almost all the women in this study said that the bath was given with hot water everyday. They emphasised that they would check the temperature of the water before giving bath. Massaging the body with oil, especially the extremities, was also an important aspect of everyday bath.

'I always check the temperature of the water by pouring on my hand and see whether baby can tolerate it. I massage the baby while giving bath as somebody who is assisting in bath pours the water' (Mother 1).

The act of giving bath involved more than one adult in many homes. In a study in another state in South India, similar results on using incense after bath and massaging during bath were found to be prevalent newborn care practices. Oil massage was followed by 95% of the mothers.[12] Oil massage for babies was also found to be a practice in 71% of the mothers in another study revealing that massage either before or during bath is a common practice in India.[10]

Cord care

Care of the umbilical cord was another area that was given much importance in newborn care. Almost all the women in the study believed that some traditional medicine had to be applied on the cord till it dried and detached. Most women in this study said that they practised applying coconut oil over the umbilical stump as coconut oil had good healing power. Sometimes, they used face powder/talcum powder on the cord after the baby bath.

'I have heard my grandmothers telling about the application of cow dung over the umbilical stump but it is not followed nowadays. Everybody used to apply only coconut oil, if not face powder will be applied over the raw areas of umbilical stump' (Mother 2).

The women in this study perceived that cow dung was not applied to the cord nowadays. However, findings from other studies suggest that substances such as talcum powder, turmeric,[13] oil, herbal paste,[14] ash or clay and antiseptic solutions [15] were applied on the cord similar to the practices of the women in the current study and dried cow dung powder was sometimes applied on the skin. Umbilical cord infection is a common cause of neonatal sepsis and mortality, and clean cord care practices such as avoiding application of indigenous substances and using antiseptics on the cord among mothers have shown to significantly reduce neonatal mortality.[15] Therefore, the findings about cord care practices elicit a need to educate mothers and other women in the family about clean cord care.

Breastfeeding, pre-lacteal feeds and other feeds

All the women said that breast milk had enough nutrients for the baby up to 6 months and promoted immunity in the baby. Irrespective of their literacy levels, all expressed that colostrum was important for the newborn and ensured that baby received colostrum. All women also ensured that breast milk was given to the newborn.

'I helped in initiating breastfeeding immediately after birth for my daughter and did not give pre-lacteal feeds as colostrum and breast milk provides so much of immunity for the baby and should be given for 6 months' (Grandmother 1).

Similar studies on breastfeeding practices in different parts of India found that majority of women (90% and 96%) gave colostrum and a small proportion of them discarded it. These findings denote that the practice of discarding colostrum although persisting in some parts of the country is becoming less prevalent than before.[16]

Although the practices related to colostrum had improved, and breast milk was thought important, the initiation of breastfeeding was delayed because of few other rituals. The data from the women in the present study revealed that giving pre-lacteal feeds such as sugar water and honey before initiating breastfeeding or along with breast feeding was common in many families. One mother's account suggested the practice of giving donkey's milk as pre-lacteal feed.

'If the baby is born at home we do not initiate breast feeding until the Mu'addhin comes and recites the prayer and says Adam in the ear of the baby if it is a boy baby and Eve if it is a girl baby. After that he gives some sugar water and then only we will initiate breast feeding' (Grandmother 2).

'My mother wanted to give Donkey's milk for my baby' (Mother 3).

Pre-lacteal feed is any food other than breast milk administered to a newborn before the initiation of breast feeding. Administering pre-lacteal feeds delays breastfeeding, and in a country like India where the neonatal mortality is high, this practice can be a vital factor influencing the neonatal/infant mortality. This has been highlighted by a study done in rural North India, in which it was found that about 40.1% of mothers gave one or other pre-lacteal feeds.[17]

Few mothers in this study said that they also gave cow's milk or water during the first 3 days, as they felt that their breast milk was inadequate. Most of the mothers gave warm water along with breast milk and all women encouraged the practice of giving a native medicine called 'vasambu' along with expressed breast milk. Even though colostrum was thought to be important, the delay in initiation of breastfeeding, addition of other unnecessary feeds, and also the risk of infection through unhygienic practices of feeding associated with pre-lacteal or other feed can be contributing factors to neonatal morbidity and mortality.

Beliefs

Bath

Women in this study believed that turmeric used during bath had an anti-infective property and using shampoo caused cold (common cold) for the baby. Exposure to the aromatic smoke from incense and burnt garlic also was believed to prevent the baby from getting respiratory infection. Almost all mothers, grandmothers and relatives said that they give bath to the babies by pouring large volume of hot water which they believed eased all the pain in the body of the baby and promoted good sleep. The effect of hot baths on improving sleep and reducing pain is well–documented, and therefore, their belief appears to be well grounded. They also massage the baby with coconut oil or baby oil and very few with olive oil before bath and some massage the baby while giving bath, as it was believed to help the baby to have good sleep and also a healthy growth. A randomised control trial found that coconut oil massage resulted in significantly greater weight increase,[18] showing that massage may have a positive effect on newborn's growth as the women in this study believed.

Many of the grandmothers believed that the nose had to be cleared by blowing into the nostril after bath as the newborn does not know to blow the nose to remove secretions.

'After bath it is good to blow into the nose and mouth of the baby to remove the sputum as the baby does not know how to blow it out' (Grandmother 3).

Instilling oil into the ears has been recorded in other studies, but the habit of blowing is not well-documented.[10] The practice of blowing into newborn's nose can cause damage to the mucosa and also can cause spread of infective organisms from the one who blows. Therefore, this practice has to be discouraged by educating the families about the harm that it could cause.

Cord care

Coconut oil was applied on the cord because it was believed to have healing property. This belief was replicated in other studies from different parts of India where turmeric and oil were applied on the umbilical cord.[13]

Breastfeeds and other feeds

In this study, all women believed that breast milk was the best food for the baby. They also thought that colostrum was essential for the baby as it had anti-infective property. They all therefore either practised or encouraged practice of giving colostrum for the newborn. However, in a study from North India, it was found that 63% did not give colostrum because they believed that colostrum is difficult to digest and will cause a lump to form in the stomach.[19] In another study, the mothers considered colostrum to be the stagnant breast milk that had accumulated during the entire period of gestation and so could be harmful if given to the newborn.[11]

Women in this study believed that pre-lacteal feed like sugar water was given to keep the baby happy throughout his/her life.

'We used to give sugar water/honey before initiating the breast feeding and then continue with breast feeding because we want the baby to be happy throughout the life hence starting with sweet' (Grandmother 4).

Few also believed that the mothers did not have enough milk for the baby and they did not want the baby to develop hypoglycaemia and hence went for pre-lacteal feeds like sugar water and honey. Most of them said that warm water was given to the baby to evacuate the stools if not passing for more than 2 days and gripe water/vasambu mixed with breast milk will be given for indigestion. They believed that vasambu can be applied over the abdomen if the baby was experiencing abdominal discomfort or pain.

Evil eyes

Protecting the newborn from evil powers was one of the great concerns for all the women in the study. They believed that tying black thread to the hand or leg, putting black bangles, keeping bindhi on the fore head, cheek and sole using kajal or burnt vasambu and following special rituals will ward off evil eyes. Similar beliefs were observed by similar practices in another study by Cacodcar in which tying black thread around the neck and waist of the baby and amulets to ward off evil were practised by 97.72% of the mothers.[20]

Most of them said that the mother and baby would not be taken out anywhere until the ceremonial bath is given. To protect the baby against evil spirit, the baby was not carried out of home after 6pm, and if the mother and baby were travelling, it was believed that they had to take neem leaf or Bible or a piece of coal with them. They believed that Bible or neem leaf or broom kept near the baby will ward off evil. Similar practices based on beliefs on evil spirit was projected in another study from North India where 74.7% would keep knife under the newborn's pillow and 16.7% of the mothers would keep matchbox under the baby's clothes [10] to ward off ghosts. Sunanda and Paul in their study in Mangalore reported that 65% of the women kept a stick, a broomstick or metal rod under their bed.[21] The application of kajal to prevent the effect of evil force was also expressed by mothers from other parts of India.[10]

They knew about some practices which they believed would help the newborn.

'We expose the baby to early morning sunlight everyday as the sunlight has got vitamin D and the power to prevent infection' (Relative 1).

Similar practices were noted in Reshma and Sujatha's study from Mangalore.[12]

Resistance and adaptation

Although women expressed about the rituals they generally followed and their beliefs, many of them were reluctant to follow some of the traditional practices as they were worried about the effects some practices had on the newborn.

'In olden days our mothers and grandmothers followed many traditional practices but we are scared to do it for our children and grandchildren. Now many hospitals have come and babies are born in the hospitals hence we follow the advice of the doctors and nurses' (Mother 4).

Mothers did not allow the grandmothers or relatives to blow into the nose or mouth of the baby or give other feeds as they were aware of the risk of infection through the influence of media and professional workers like nurses and doctors.

'My mother wanted to give Donkey's milk for my baby as it improves the immunity for the baby and also helps the baby to have better voice but I did not allow her to give because it was advised in the hospital' (Mother 3).

Although women in this study expressed their practices and beliefs related to normal newborn care at home, they said that they would bring the baby to hospital immediately if there was a problem.

'We do not give any home remedies for any problem that baby develops and take the baby immediately to hospital' (Grandmother 5).

'If the baby is looking yellow then we take the baby immediately to hospital' (relative 2).

They depended on health-care professionals in the hospitals for care of sick newborns revealing a positive health-seeking behaviour. This finding may be related to the fact that the participants were women who were in a tertiary care hospital at the time of interview and do not represent a wider population. A study done in rural and slum areas of North India revealed that the neonatal follow-up services were not utilised by majority of slum dwellers even for newborns who required medical attention and follow-up.[22]

Although majority of the women in this study felt that it was better to go with the advice of health professionals, few of them still wanted to follow the cultural beliefs as they had pressure from the family to follow traditional practices, especially from the in-laws and husband. They also verbalised that they had to depend on the older females in the family and follow the traditional practices as they were ignorant about newborn care.

'Old people take care of me and my child. I cannot do everything I like and not listen to them at all, hence sometimes I also adopt some of their suggestions' (Mother 5).

Mothers specifically expressed that they had to accept the cultural practices even if they did not believe in them to avoid problems with in the family especially with their in-laws and also to avoid being blamed if the baby became sick.

Solutions

Women who faced problems with being compelled to follow traditional newborn practices suggested family-centred teaching that involves their husbands and in-laws during antenatal visits. They believed that teaching the family would help with better compliance with the educational messages that are shared in the hospital than just targeting the antenatal women.

'Teaching about newborn care should be given to my husband and mother-in law not only to me. I can understand the problem of harmful practices being followed at home but my husband and mother-in law do not. Hence I am forced by my husband to follow what is being insisted by the elders' (Mother 5).

Mothers themselves gave an appropriate solution to prevent traditional cultural practices which are often more harmful than helpful.


  Conclusion Top


This qualitative study attempted to explore the cultural aspects of newborn care. The accounts of women in the study revealed that families followed many rituals with specific beliefs related to new born care. Although some practices had therapeutic uses, many of the practices that were being done could potentially harm the baby. Although information on new born care is delivered through health education to women attending antenatal clinics and to those who are in the post-natal units, the findings of this study highlights the dire need for educating not only the mothers but also the family as a unit regarding harmful practices and while emphasising the components of essential newborn care.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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