Social and cultural factors impact the health of pregnant women in a multitude of ways, especially in settings where traditional beliefs contradict or replace modern medical practices, and where the everyday needs of pregnant women are not recognised.
Improving maternal health is a crucial step in improving global health. As a major component of WHO’s Millennium Development Goals, there have been a plethora of policy changes, improvements in medical care and grassroot projects implemented around the world. Yet, there is still a long way to go, with 830 women dying from preventable causes related to pregnancy and childbirth every day.  99% of these mortalities occurred in developing countries in 2016.  In this post, we will discuss factors affecting antenatal and postnatal (collectively, perinatal) health of woman at home.
Cultural practices surrounding pregnancy
One key way in which socio-cultural norms and practices endanger the health of pregnant women is their substitution for modern medical practices. This is particularly true of low-resource settings where there is a greater reliance on traditional values and beliefs - perhaps a direct result of a lack of education about modern medicine or a lack of effective medical practices.
In South East Madagascar, over one fifth of deaths in women aged 15-49 are linked to pregnancy or childbirth and only 44% of births are attended by a skilled health provider. Many pregnant women will visit traditional midwives or healers (known as ombiasa), with herbs being the most common form of treatment. While there is no direct risk in taking these herbs, it is the replacement of modern drugs with these herbs that may be having a negative impact. 
Furthermore, when pregnant women have symptoms of illness, traditional ideas mean that these symptoms are interpreted as being a result of poisoning witchcraft by jealous individuals - for example, one study participant said: “One of my neighbours died after the delivery and her baby as well died one week after she died. She died from getting poisoned - that’s what the family says but I don’t know much about it. (Interviewer: Did they take her to the doctor?) No, they only took her to the church.” 
Cultural practices and traditional ideas that contradict modern medical advice are not restricted to Madagascar but are a common occurrence in many countries - for example, the people of Lagos State in Nigeria hold the belief that pregnant women should be discouraged from eating particular foods, including fruit, vegetables and certain high-caloric foods; these are foods that tend to be nutritionally important during pregnancy. 
The role of gender dynamics in pregnancy
For most countries, gender dynamics imposed by social norms play an important role in determining the health of pregnant women. The most adverse effects are seen in rural areas of developing countries. Heavy workloads for pregnant women in addition to their unfavourable position in the society beget unhealthy and high risk circumstances for mother and child.
In rural Gambia, women often report that they worked longer hours than their male counterparts.  During the dry season, it was observed that men usually sat together and chatted throughout the day as women (pregnant or otherwise) had to go to the farms, pick groundnut and come back home to prepare a meal out of the profits they made from the day’s work. Even as they approached their delivery date, they had to participate in daily activities that were too strenuous and were not able to get sufficient rest. This physically and emotionally draining labour was further complicated by issues of polygamy and co-rivalry between wives.
In addition, talking about pregnancy and sex-related issues is taboo. Men are ignorant to the needs of pregnant women and thereby are less likely to share the workload, resolve disputes between wives and give money for regular clinical check-ups. Several participants in the Gambian study even said that asking for money resulted in domestic violence. These issues are widely reported in rural sub-Saharan Africa.
How can we improve the health of pregnant women in cultures where such deep-rooted traditional values persist?
Ultimately, there is no simple solution to the deep-rooted socio-cultural factors that play such a significant role in the health of pregnant women. These factors, whether they be gender norms that mean women must continue to take on greater domestic workloads than men well into their pregnancies, or traditional practices that lead to pregnant women receiving insufficient medical care, are ingrained into the lifestyle of a population.
Gradual and persistent strategies combining education (both about health care practices during pregnancy and about gender equality), policy changes that give pregnant women the right to stop working, and ways to combine religious and modern medical practices, could provide the potential for change. Addressing delicate issues like the taboo of pregnancy and the social stigma against men taking a more active role in the household is difficult. Grassroots projects that teach men and women about pregnancy may be a way forward. Increased education and land ownership among women has been shown to empower them and give them autonomy over their spending. However, without simultaneously dealing with the deep-rooted norms that are adversely affecting perinatal health, it is likely that these societies will continue to turn a blind eye to women’s health.
WHO, 2016. Maternal mortality. Media centre. http://www.who.int/mediacentre/factsheets/fs348/en/
Morris, J.L., Short, S., Robson, L., Andriatsihosena, M.S., 2014. Maternal health practices, beliefs and traditions in southeast Madagascar. African journal of reproductive health 18, 101–117.
Ajiboye, O.E., Adebayo, K.A., 2012. Socio-Cultural Factors Affecting Pregnancy Outcome Among the Ogu Speaking People of Badagry Area of Lagos State, Nigeria. International Journal of Humanities and Social Science 2, 133–144.
Hill P, Lowe, M., Chen DR, Song-Lih J, 2016. Social and Cultural Factors Affecting Maternal Health in Rural Gambia: An Exploratory Qualitative Study
About the Authors:
Niveditha is a second year Maths student at the University of Cambridge. She has an avid interest in policy, health and mathematics and is constantly trying to find a way to combine all three.
Keemia is a second year Biological Natural Sciences student at the University of Cambridge, with a focus in Neuroscience and Psychology. She is passionate about using scientific research in combination with an understanding of cultural factors to work towards improving global health policy.