Abstract
BackgroundThe prevalence of complementary medicine use in pregnancy and lactation has been increasingly noted internationally. This systematic review aimed to determine the complementary medicine products (CMPs) used in pregnancy and/or lactation for the benefit of the mother, the pregnancy, child and/or the breastfeeding process. Additionally, it aimed to explore the resources women used, and to examine the role of maternal health literacy in this process.MethodsSeven databases were comprehensively searched to identify studies published in peer-reviewed journals (1995–2017). Relevant data were extracted and thematic analysis undertaken to identify key themes related to the review objectives.ResultsA total of 4574 articles were identified; 28 qualitative studies met the inclusion criteria. Quantitative studies were removed for a separate, concurrent review. Herbal medicines were the main CMPs identified (n = 21 papers) in the qualitative studies, with a smaller number examining vitamin and mineral supplements together with herbal medicines (n = 3), and micronutrient supplements (n = 3). Shared cultural knowledge and traditions, followed by women elders and health care professionals were the information sources most accessed by women when choosing to use CMPs. Women used CMPs for perceived physical, mental-emotional, spiritual and cultural benefits for their pregnancies, their own health, the health of their unborn or breastfeeding babies, and/or the breastfeeding process. Two over-arching motives were identified: 1) to protect themselves or their babies from adverse events; 2) to facilitate the normal physiological processes of pregnancy, birth and lactation. Decisions to use CMPs were made within the context of their own cultures, reflected in the locus of control regarding decision-making in pregnancy and lactation, and in the health literacy environment. Medical pluralism was very common and women navigated through and between different health care services and systems throughout their pregnancies and breastfeeding journeys.ConclusionsPregnant and breastfeeding women use herbal medicines and micronutrient supplements for a variety of perceived benefits to their babies’ and their own holistic health. Women access a range of CMP-related information sources with shared cultural knowledge and women elders the most frequently accessed sources, followed by HCPs. Culture influences maternal health literacy and thus women’s health care choices including CMP use.
Highlights
The prevalence of complementary medicine use in pregnancy and lactation has been increasingly noted internationally
Women access a range of complementary medicine product (CMP)-related information sources with shared cultural knowledge and women elders the most frequently accessed sources, followed by Health Care Professionals (HCPs)
Studies from Low Income Economy* (LIC) and Lao People’s Democratic Republic (LMIC) countries included in the present review identified that traditional and cultural beliefs contribute to CMP use in pregnancy and lactation, and that women view herbal and traditional medicines as being safer, more effective, affordable and more accessed than pharmaceutical medications, [47, 57, 62, 72]
Summary
Study selection The search strategy generated 4574 citations after duplicates were eliminated (Fig. 1). TBAs Traditional Birth Assistants or Attendants, Biomedical HCPs biomedically trained health care practitioners - nurses, midwives, doctors and obstetricians; CAM HCPs Western complementary medicine health care practitioners including naturopaths and herbalists trained in Western Herbal Medicine aLIC low income economy, LMIC lower middle income economy, UPIC upper middle income economy, HIC high income economy according to The World Bank Classifications [33], based on 2015 gross national income per capita b Complementary medicine type discussed in the paper, as identified by the first author (LAJB) c For the purposes of this review and analysis of the identified studies, the first author (LAJB) conceptualised the continuum of childbearing from pregnancy, birth, the early postpartum period, longer postpartum period and breastfeeding as separate but related stages another [48] without information on how many HCPs participated. These themes and subthemes are further elaborated in Additional file 4
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