Abstract
BackgroundLao People’s Democratic Republic (Lao PDR) has the highest maternal mortality rate (MMR) and infant mortality rate (IMR) due to traditional practice and beliefs on pregnancy, delivery and postpartum. The objective of this study was to get a better understanding of cultural beliefs and practices surrounding pregnancy, ANC and postpartum care among rural women in Lao PDR.MethodsEight focus group discussions and 52 interviews were carried out with delivered women, husbands, mothers, traditional birth attendants, head villagers, Lao Women’s Union members and healthcare workers, in Khammouane and Champasack provinces in Lao PDR. In order to accurately grasp participants’ perceptions and understandings, content analysis was used to analyze the transcripts.ResultsMost women in the study claimed to have attended ANC, but participants also explained that it was unnecessary to attend ANC and give birth at a clinic if the woman felt healthy. Factors that discouraged ANC attendance and giving birth at clinics included: time and money constraints; the perceived necessity of giving birth on a “hot bed”; the need for “mother-roasting” after giving birth; the belief that preparing for a birth was a bad omen for the birth; the belief that colostrum is unhealthy for the newborn child; and the preference for cutting the umbilical cord with a piece of sharpened bamboo.ConclusionsHarmful cultural practices such as discarding colostrum should be discouraged; beneficial practices such as family involvement in birthing and keeping a mother warm after birth could be integrated into biomedical practice. Given the prevalence and importance of the cultural understandings we have described in this study, it is clear that proposed changes in cultural practices need to be addressed with sensitivity and that community stakeholders and trusted leaders will need to be involved.
Highlights
Lao People’s Democratic Republic (Lao PDR) has the highest maternal mortality rate (MMR) and infant mortality rate (IMR) due to traditional practice and beliefs on pregnancy, delivery and postpartum
One explanation for the comparatively high MMR and IMR rates is that as of 2012 62.5 % of births in Lao PDR still took place at home, and only 54.2 % of births were to women who had received antenatal care (ANC) [1]
What aspects of traditional care are especially important to rural villagers? Which practices conflict with biomedical understandings and practices, possibly discouraging women and their families from attending health centres, and which practices are harmless and possibly even beneficial? The goal of the study is to gain knowledge about rural Laotian birthing practices and preferences in order to help improve ANC services, encourage villagers to use them, and decrease the MMR and IMR in rural Lao PDR
Summary
Lao People’s Democratic Republic (Lao PDR) has the highest maternal mortality rate (MMR) and infant mortality rate (IMR) due to traditional practice and beliefs on pregnancy, delivery and postpartum. One explanation for the comparatively high MMR and IMR rates is that as of 2012 62.5 % of births in Lao PDR still took place at home, and only 54.2 % of births were to women who had received antenatal care (ANC) [1] Those who do not attend ANC and who give birth at home are more likely to be poor, uneducated, and to live far from health facilities [3,4,5]. They are more likely to be from highland or smaller ethnic groups [4] and to adhere to traditional beliefs and practices [6] All of this suggests that in order to lower the MMR and IMR in Lao PDR a better understanding of pregnancy and birthing practices and attitudes in rural areas is needed. What aspects of traditional care are especially important to rural villagers? Which practices conflict with biomedical understandings and practices, possibly discouraging women and their families from attending health centres, and which practices are harmless and possibly even beneficial? The goal of the study is to gain knowledge about rural Laotian birthing practices and preferences in order to help improve ANC services, encourage villagers to use them, and decrease the MMR and IMR in rural Lao PDR
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