Maternal Health Practices, Beliefs and Traditions in Southeast Madagascar
Abstract
Contextualising maternal health in countries with high maternal mortality is vital for designing and implementing effective health interventions. A research project was therefore conducted to explore practices, beliefs and traditions around pregnancy, delivery and postpartum in southeast Madagascar. Interviews and focus groups were conducted with 256 pregnant women, mothers of young children, community members and stakeholders; transcripts were analysed to identify and explore predetermined and emerging themes. A questionnaire was also conducted with 373 women of reproductive age from randomly selected households. Data was analysed using STATA. Results confirmed high local rates of maternal mortality and morbidity and revealed a range of traditional health care practices and beliefs impacting on women’s health seeking behaviours. The following socio-cultural barriers to health were identified: 1) lack of knowledge, 2) risky practices, 3) delays seeking biomedical care, and 4) family and community expectations. Recommendations include educational outreach and behaviour change communications targeted for women, their partners and family, increased engagement with traditional midwives and healers, and capacity building of formal health service providers. (Afr J Reprod Health 2014; 18[3]: 101-117)
Keywords: maternal health, pregnancy, birth, postpartum, Madagascar, socio-cultural
RésuméLa mise en contexte de la santé maternelle dans les pays à forte mortalité maternelle est essentielle pour la conception et la mise en œuvre des interventions de santé efficaces. Un projet de recherche a donc été mené afin de déterminer les pratiques, les croyances et les traditions autour de la grossesse, l'accouchement et le post-partum dans le sud-est de Madagascar. Des entrevues et des discussions en groupes cibles ont été organisés auprès de 256 femmes enceintes, mères de jeunes enfants, membres de la communauté et parties prenantes; les transcriptions ont été analysées afin d'identifier et d'explorer des thèmes prédéterminés et émergents. Un questionnaire a également été mené auprès de 373 femmes en âge de procréer dans des ménages choisis au hasard. Les données ont été analysées à l'aide de STATA. Les résultats ont confirmé des taux locaux élevés de mortalité et de morbidité maternelle et ont révélé une série de pratiques et de croyances traditionnelles de soins de santé ayant une influence aux comportements axés sur la santé des femmes. Nous avons identifié plusieurs barrières socioculturelles à la bonne santé: 1) le manque de connaissances, 2) les pratiques à risque, 3) le retard dans la prise de décision de rechercher des soins biomédicaux, et 4) les attitudes de la famille et de la communauté. Nos recommandations comprennent la sensibilisation pour le changement de comportement qui vise les femmes, leurs partenaires et leurs familles, une plus grande engagement avec les sages-femmes et les guérisseurs traditionnels, et le renforcement des capacités des prestataires de services de santé formels. (Afr J Reprod Health 2014; 18[3]: 101-117)
Mots-clés: grossesse, naissance, accouchement, Madagascar, socioculturel, santé maternelle
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