Postpartum sex taboos and child growth in Tanzania: Implications for child care

Abstract

The social context and cultural meaning systems shape caregivers' perceptions about child growth and inform their attention to episodes of poor growth. Thus, understanding community members' beliefs about the aetiology of poor child growth is important for effective responses to child malnutrition. We present an analysis of caregivers' narratives on the risks surrounding child growth during postpartum period and highlight how the meanings attached to these risks shape child care practices. We collected data using 19 focus group discussions, 30 in‐depth interviews and five key informant interviews with caregivers of under‐five children in south‐eastern Tanzania. Parental non‐adherence to postpartum sexual abstinence norms was a dominant cultural explanation for poor growth and development in a child, including different forms of malnutrition. In case sexual abstinence is not maintained or when a mother conceives while still lactating, caregivers would wean their infants abruptly and completely to prevent poor growth. Mothers whose babies were growing poorly were often stigmatized for breaking sex taboos by the community and by health care workers. The stigma that mothers face reduced their self‐esteem and deterred them from taking their children to the child health clinics. Traditional rather than biomedical care was often sought to remedy growth problems in children, particularly when violation of sexual abstinence was suspected. When designing culturally sensitive interventions aimed at promoting healthy child growth and effective breastfeeding in the community, it is important to recognize and address people's existing misconceptions about early resumption of sexual intercourse and a new pregnancy during lactation period.

“When I Breastfeed, It Feels as if my Soul Leaves the Body”: Maternal Capabilities for Healthy Child Growth in Rural Southeastern Tanzania

“…In addition to women's heavy workload, the early introduction of complementary feeding was shown to be influenced by cultural schemas, especially those framing sexual activity and the view of a new pregnancy during lactation period as harmful to the growth of the baby. Similar schemas have also been reported by previous ethnographic studies conducted in Tanzania [27,35,36]. Our findings point to the need for open discussions between health workers and mothers about cultural issues related to breastfeeding, and for health workers to be more respectful of cultural models.…”

“…Both pre-service and in-service training for health service providers—including TBAs and CHWs—on cultural competence [ 37 , 38 ] could help bridge the gap between biomedical and local explanations of breastfeeding, and thus improve parent–health worker communication [ 39 ]. As suggested by Mchome et al [ 27 ], health workers could also focus on addressing the existing misconceptions around breastfeeding, such as those related to sexuality and a new pregnancy during the lactation period in their health promotion activities.…”

“…A mother’s ability to (breast)feed her infant was also shaped by socio-cultural conversion factors, including (i) the cultural schema that a new pregnancy during lactation period spoils a mother’s breast milk [ 27 ]; (ii) the cultural schema that an infant’s persistent crying at night indicates that the child is “born with hunger” ( mtoto amezaliwa na njaa ), and therefore cannot be satisfied by the mother’s breast milk; (iii) the belief that a child’s reduced interest in breastfeeding is caused by threats from mdudu (unseen evil spirit) residing in the mother’s body. These beliefs were not held by the mothers alone, but were widespread in the community, including among the TBAs and CHWs who supported the mothers in the feeding process.…”

Local contextual factors of child stunting found via shared values of stakeholder groups: an exploratory case study in Kaffrine, Senegal

“…We did not have anthropological training but came from a background of developing authentic indicators for local sustainability (33,36) , co-developed over years of action research (37) . But reviewer feedback pointed us to related anthropological work, and we now realise that the WVIS_plus_PEX:FGD approach has much in common with the established anthropological concept of cultural schema (45) , the methods of focused ethnographic studies (46) and communitybased participatory research (47) and that these have been applied in nutrition studies already (27,28,48) .…”

Ik zie, ik zie wat jij niet ziet... : Werken op het snijvlak van de biomedische en sociale wetenschappen in onderzoek naar groei van kinderen

“…Through observations, interviews, and group discussions with mothers, fathers, and older women, she gained deep insights into the realities surrounding child growth (Figure 7). An important finding of her research was that child growth is related to sexual abstinence of the mother after childbirth (Mchome, Bailey et al 2020). Zaina found that it is customary for a mother to be told that she should not have sex until two years after giving birth so that she can fully devote herself to the care of her child, and that failing to do so could retard the child's growth.…”