Cultural beliefs and practices on perinatal death: a qualitative study among the Lango community in Northern Uganda

Abstract

Background Perinatal death has profound psychosocial effects on women and their families. Sociocultural contexts influence the burden, rituals and bereaved’s support. Little is known about cultural beliefs and practices related to perinatal death. This study explored the cultural perspectives of the Lango community on perinatal death. Methods This study utilised a focused ethnographic design anchored on a symbolic interactionist framework to understand the meanings attached to beliefs and practices on stillbirth or neonatal death among the Lango community in Lira District, Northern Uganda. Participants were sampled purposively for FGD while key informants were identified through snowballing technique. Data were audio recorded in Lango, transcribed, and later translated, a codebook was developed and data entered into Atlas. ti version 8.4.26 and then coded. It was analysed both deductively and inductively into themes. Results Stillbirth and early neonatal death both attract similar rituals as would an older child. Burial is not rushed and is attended by family members and close friends. Stillbirths and children that die before naming are buried without names. Bereaved families are comforted and encouraged about future pregnancies. Currently, Lango associates the deaths to biomedical explanations such as teenage pregnancies, inadequate pregnancy care, health system challenges and poor health-seeking behaviour, unlike previously when they were attributed to consequences of unacceptable social behaviours, superstitious beliefs and witchcraft. Antenatal care and health facility childbirths are currently preferred over traditional practices for good pregnancy outcomes. Conclusion Stillbirth or early neonatal death is viewed as the death of a child, different from other settings. Thus, rituals are performed to honour, create memory, and maintain the connection with deceased babies. Bereaved parents are supported. Health care workers need to provide culturally sensitive support to parents after perinatal loss. The prevailing beliefs of perinatal death cause in terms of biomedical explanations consistent with known determinants and preference for health facility care for prevention creates an opportunity for improving perinatal health.

Perinatal palliative care in sub-Saharan Africa: recommendations for practice, future research, and guideline development

“…Though pediatric PC in LIMCs has witnessed some growth in the past several years, this has largely focused on supporting EOL care for older children with conditions like human immunodeficiency virus (HIV) and malignancies ( 15 , 43 – 45 ). Perinatal-Neonatal PC is poorly described in global resource-constrained settings, with the limited existing literature focused on how cultural and structural factors limit support of mothers who have suffered stillbirths ( 46 – 49 ). In LMICs, differences in the socio-cultural, religious/spiritual and legal environment, with limited and inconsistently available resources limit the applicability of evidence-based approaches derived in HICs.…”