This study describes the experiences of women in rural Bangladesh, and the cultural practices related to how they take care of themselves and their babies, in the early postnatal period. Bourdieu’s concepts of habitus, capital and field for the theoretical framework, and ethnography as the method for this study. Data was gathered through emmersion in the field for six months, participant observation, document collection and in-depth interview techniques to gain deep understanding of women’s everyday lives and practices during the postnatal period. Indepth intereviews were undertaken with 28 mothers who had had at least one live child within the five years before the date of data collection, in Purba Sharifabad village of Barisal Division in Bangladesh.
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The findings of this study identify some significant issues related to culture playing a huge role in the experiences of women during the postnatal period. The participants received physical, emotional and spiritual care and support from three distinct sources: family, institutions and non-institutions. Rural women felt happy and comfortable receiving support from family members and non-institutional care providers that include the village doctor, homeopaths, traditional birth attendants and spiritual healers, as they trusted and believed in them. Other factors such as familiarity, availability, tradition, poverty and low cost of treatment played a large role in the women receiving care from these sources. In terms of institutional support, rural women did not rely on skilled birth attendants (like doctors and midwives), as their cultural norms, beliefs, lack of education and lack of money and resources restricted them from seeking care and support from these sources during childbirth and the postnatal period. Several reasons were given for this, including poor transportation and long distances to health facilities, fear of doctors and of caesarean sections, the presence of male doctors, the high costs of services, shyness, the practice of purdah (The Muslim tradition of veiling; the term refers to both the practice and the ideology of segregating women from men) and the perceived low quality of care in facilities.
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The findings show that many women suffer from physical and psychological difficulties after childbirth, which they report as having a negative and long-term effect on their well-being. Rural women experienced a number of physical difficulties during childbirth and the postnatal period, including prolonged labour, retained placenta, perineal pain, vaginal tearing, shaking, fainting, problems feeding and postpartum bleeding. Mothers reported common physical difficulties their newborns experienced such as cold and fever, low birth weight, jaundice and problems defecating. Many of these problems were related to the cultural practices that women followed in the early postnatal period. Women in this study followed the rituals of seclusion during the early postnatal period, which sometimes hampered the prompt recognition of difficulties and the treatment of their babies’ illness by restricting them from seeking care from skilled birth attendants. Therefore, women depended on traditional practices to treat themselves and their babies. Further, women and their babies were not well assessed, counselled or supported by a skilled birth attendant after childbirth, despite the fact that to ensure safe motherhood, an immediate and subsequent assessment is necessary for both mother and baby after birth. Many women described psychological depression caused by several factors, such as family conflict, the absence of their husband, their inability to go to their parents’ house, feeling unhappy about having a baby girl, a lack of family support and financial difficulty, which all negatively affected women’s mental well-being and their daily functioning in the postnatal period.
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The key findings of this study highlight the role of culture in the experiences of women during the postnatal period, and reveal that cultural practices, beliefs and traditions are deeply embedded in the lives of rural women. This study focuses on cultural practices which have an effect on the choices of women regarding care and support from a healthcare facility. Culture together with poverty and low levels of education leads them to resist healthcare from a skilled birth attendant and encourages them to believe in and trust traditional care practices during childbirth and the postnatal period. Therefore, the findings of this study may contribute to future policies, planning, programmes and research in Bangladesh by providing an understanding of the importance of culturally and socially rooted traditional beliefs and cultural practices. These need to be addressed for maternal and newborn healthcare initiatives to be effective, particularly in rural Bangladesh.