The transition of childbirth practices among tribal women in Gujarat, India - a grounded theory approach

Abstract

BackgroundUnder the National Rural Health Mission, the current emphasis is on achieving universal institutional births through incentive schemes as part of reforms related to childbirth in India. There has been rapid progress in achieving this goal. To understand the choices made as well as practices and perceptions related to childbirth amongst tribal women in Gujarat and how these have been influenced by modernity in general and modernity brought in through maternal health policies.MethodA model depicting the transition in childbirth practices amongst tribal women was constructed using the grounded theory approach with; 8 focus groups of women, 5 in depth interviews with traditional birth attendants, women, and service providers and field notes on informal discussions and observations.ResultsA transition in childbirth practices across generations was noted, i.e. a shift from home births attended by Traditional Birth Attendants (TBAs) to hospital births. The women and their families both adapted to and shaped this transition through a constant ’trade-off between desirable and essential’- the desirable being a traditional homebirth in secure surroundings and the essential being the survival of mother and baby by going to hospital. This transition was shaped by complex multiple factors: 1) Overall economic growth and access to modern medical care influencing women’s choices, 2) External context in terms of the international maternal health discourses and national policies, especially incentive schemes for promoting institutional deliveries, 3) Socialisation into medical childbirth practices, through exposure to many years of free outreach services for maternal and child health, 4) Loss of self reliance in the community as a consequence of role redefinition and deskilling of the TBAs and 5) Cultural belief that intervention is necessary during childbirth aiding easy acceptance of medical interventions.ConclusionIn resource poor settings where choices are limited and mortality is high, hospital births are perceived as increasing the choices for women, saving lives of mothers and babies, though there is a need for region specific strategies. Modern obstetric technology is utilised and given meanings based on socio-cultural conceptualisations of birth, which need to be considered while designing policies for maternal health.

Satisfaction with childbirth services provided in public health facilities: results from a cross- sectional survey among postnatal women in Chhattisgarh, India

“…A review of Indian studies reveals only one qualitative study that mentions this malpractice [44]. However, other qualitative studies have reported that pain levels during labour and childbirth were considered to be ‘good’ by the Indian respondents [35,36,44]. To the best of our knowledge, no Indian study has yet explored the association between perineal wound suturing without local anaesthesia and birth satisfaction; however, our data show an association between perineal suturing without local anaesthesia and fear of childbirth [53], which in turn influences satisfaction with childbirth services.…”

“…The multi-front promotion of institutional childbirths by the Government of India has resulted in an exponentially increasing number of women coming to hospitals with the chief expectation of ensuring the safety of themselves and their neonates [35–38]. However, the expansion in the number of labour rooms and necessary resources and infrastructure, especially in public health facilities, has not been proportional to rising demand [36,39,40]. Labour rooms have become crowded and understaffed and face shortages of equipment and material [17,40] and the documentation processes around childbirth have been described to be ‘too much to do concurrently with actual care provision’, with care providers relying on verbal communication rather than maintaining written documentation of decision-making around childbirth [17,41].…”

Women’s suggestions on how to improve the quality of maternal and newborn hospital care: a qualitative study in Italy using the WHO standards as framework for the analysis

“…However, as documented in a recent systematic review [20], what matters to women during childbirth is still relatively poorly documented. Specifically, among 35 studies identified by the systematic review [20], all had a very small sample (ie, maximum 35 women), with the only exception being a study in Sweden (908 women), one in Australia (202 women), and one in India (85 women) [21][22][23]. Additionally, these studies did not documented suggestions of women, collected after delivery, on how to improve QMNC, but rather expectations before delivery [21,22] or changes in cultural belief through generations [23].…”

Non-use of Janani Avam Bal Suraksha Yojana in a district of Bihar: ensuring safe deliveries needs strategy modification

“…17 The health system needs to find innovative and effective ways to strengthen midwifery and ensure the availability of and accessibility to safe delivery practices at community level. 18…”