Perceived causes of adverse pregnancy outcomes and remedies adopted by Kalenjin women in rural Kenya

Abstract

BackgroundThere have been few studies about the basis on which women in developing regions evaluate and choose traditional rather than western maternal care. This qualitative study explores the socio-cultural perceptions of complications associated with pregnancy and childbirth and how these perceptions influence maternal health and care-seeking behaviours in Kenya.MethodsKalenjin women (n = 42) aged 18–45 years, who were pregnant or had given birth within the last 12 months, were interviewed. A semi-structured interview guide was used for data collection. A further nine key informant interviews with Traditional Birth Attendants (TBAs) who were also herbalists (n = 6), community health workers (CHWs) (n = 3) and a Maternal and Child Health (MCH) nursing officer (n = 1) were conducted. The data were analysed using MAXQDA12 software and categorised, thematised and analysed based on the symbolic dimensions of Helman’s (2000) ill-health causation aetiologies model.ResultsPregnancy complications are perceived as the consequence of pregnant women not observing culturally restricted and recommended behaviour during pregnancy, including diet; physical activities; evil social relations and spirits of the dead. These complications are considered to be preventable by following a restricted and recommended diet, and avoiding heavy duties, funerals, killing of animals and eating meat of animal carcasses, as well as restricting geographical mobility, and use of herbal remedies to counter evil and prevent complications.ConclusionDelay in deciding to seek maternal care is a result of women’s failure to recognise symptoms and maternal health problems as potential hospital cases, and this failure stems from culturally informed perceptions of symptoms of maternal morbidity and pregnancy complications that differ significantly from biomedical interpretations. Some of the cultural maternal care and remedies adopted to prevent pregnancy complications, such as restriction of diet and social mobility, may pose risks to the pregnant woman’s health and access to health facilities whereas other remedies such as restricting consumption of meat from animal carcasses and heavy duties, as well as maintaining good social relations, are cultural adaptive mechanisms that indirectly control the transmission of disease and improve maternal health, and thus should not be considered to be exclusively folk or primitive.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-2041-5) contains supplementary material, which is available to authorized users.

Changes in women's dietary diversity before and during pregnancy in Southern Benin

“…Strong socio‐cultural beliefs can lead to diet restrictions and contribute to either an absence of change or a decrease in WDDS before and during pregnancy. Studies in Burkina Faso, Kenya, Niger, and Nepal have shown that the factors that can be responsible for the change in food‐consumption patterns during pregnancy were the fear of having a large baby and beliefs held about certain foods (Christian et al, ; Huybregts et al, ; Riang'a, Nangulu, & Broerse, ; Rosen et al, ). In our study, we did observe small variations in some food group consumption.…”

Perceived Indigenous Perspectives of Maternal Health Care Services among Women of Marakwet, Kenya

“…The scholars alludes that the necklace is removed to allow the woman to give birth when the woman experiences labour pains [19]. This finding concurs with [31,32]. Hlatywayo, et al in a qualitative research among the Ndau People of Zimbabwe who report that even with the emergency of modern care, women wear beads as headbands and anklets for protection [32].…”

“…Social interaction is to avoid dangerous people or circumstance. Riang'a and others, who had reported similar finding, add that pregnant women are confined to the homestead to avoid coming into contact with "evil people" and are encouraged to carry charms to counter evil [31]. Meanwhile, the primary reason for limited sex is to avoid infection and/or any physical damage.…”

“…Similar cultural adaptive mechanisms that promote safe pregnancy and delivery and control the transmission of disease such as are well-documented [31]. Rianga, et al in qualitative reports that restriction of diet and social mobility are key cultural maternal care and remedies adopted for health and safe pregnancy [31]. Social interaction with strangers as well as sex is also limited.…”

“…For instance, the pregnant women is prohibited from viewing the body of a dead person [19]. In addition, Riang'a and company writes that abstinence from sexual intercourse during pregnancy in African societies is a common phenomenon and it is aimed at protecting the unborn baby as well as fragile mother [31].This infers that prevention and promotive care were synonymous with Marakwet norms and values. Further, research and application of harmless indigenous prevention approaches may unearth mechanism of mitigating diseases and conditions prevalent in the Marakwet environs.…”