Learning from mother-infant dyads in urban India: Identifying sociocultural factors influencing perinatal and early childhood outcomes

摘要

The burden of maternal and child mortality and morbidity occurs largely in resource-poor settings, with India a primary source of this burden. The perinatal period has been identified as a critical time to intervene to improve health outcomes since large upstream determinants, such as maternal education, poverty and the poor status of women are known contributors. Less understood is the complex interplay of social, cultural and family factors operating in the urban milieu influencing perinatal health and wellbeing. To address this problem, an ethnographically-informed study was conducted in Bangalore, South India, employing in-depth, qualitative, formal encounters with 36 participants from a nested cohort, plus observations and informal encounters with participants, their families and health care providers. Analysing and triangulating the data provided unique insights into the sociocultural milieu of mother-infant dyads in urban India. The following were key findings: 1.Women utilised varied sources of support throughout the perinatal period – predominantly their mothers and female kin, but urbanisation had led to some dyads being more vulnerable due to limited support. 2.A rich repertoire of cultural practices persisted throughout the perinatal continuum, but change was evident. Traditional food patterns were stronger than health messages; however, breastfeeding was the cultural norm. There was little expectation of individual choice in major life events of marriage, pregnancy or childbirth. 3.Women displayed considerable confusion over their right to health care; there was mistrust of government health services, and a socially-restrictive framework resulting in health care choices that seemed arbitrary, irrational and self-defeating. 4.Critical domains involved in women’s agency and autonomy were women’s participation in employment, in group-action, and mobility freedom. Household decision making was considered a joint rather than individual responsibility.The qualitative research in Bangalore was complemented by a systematic review and synthesis of qualitative research conducted in low resource settings, exploring traditional and cultural practices and beliefs influencing the perinatal continuum.Given the currency of diverse cultural beliefs and practices, as revealed here, public health policymakers and practitioners should respond to findings from recent qualitative research and tailor contextually specific perinatal policies and practices to optimise maternal, newborn and child health.