African Journal of Food, Agriculture, Nutrition and Development Rural Outreach Program ISSN: 1684-5358 EISSN: 1684-5374 Vol. 4, Num. 1, 2004

African Journal of Food Agriculture Nutrition and Development, Vol. 4, No. 1, 2004

Student Section

MATERNAL DIET DURING POSTPARTUM SECLUSION: AN ETHNOGRAPHIC STUDY AMONG THE SWAHILI OF PEMBA, TANZANIA

Lucy Thairu

Lucy Thairu
Mailing address: 222 savage Hall, Cornell University , Ithaca , New York
Email: Lnt3@cornell.edu

Code Number: nd04011

Introduction

In Pemba , as in many other parts of the world, the first 40 days after birth constitute a period during which the mother and the newborn are secluded from the larger community. A cultural rationale for this seclusion is the belief that postpartum bleeding and discharge make the mother "unclean" [1,2]. Because of this perceived uncleanliness, a new mother is isolated, and her interactions with people beyond her immediate family restricted so that she does not "contaminate" them [1]

During the seclusion, a new mother is not allowed to work or to do anything that is physically exhausting-this may permit her to rest and regain strength, and offer her an ideal opportunity to enjoy the newborn baby. She may also be restricted from eating certain foods and/or special foods may be added to her diet [3]. After forty days (the actual length of time may vary) a woman often resumes her normal activities such as farming, fetching water and cooking [3].

The purpose of this study was to provide an in-depth description of maternal diet during the early postpartum period. The study was carried out within the framework of an ethnographic inquiry investigating care of the mother and the infant during postpartum seclusion in the northern district of the Pemba island of Tanzania .

Methods

In-depth ethnographic interviews were conducted with 46 respondents from Wete hospital and from Chasasa, a suburb of Wete town (the largest town in the Northern district of Pemba). Respondents included 21 mothers, 12 family members, 2 hospital nurses, 5 traditional birth attendants ( mkunga ), 2 traditional healers ( mganga ), 1 religious leader ( shekhe ) and 2 elderly men.

As none of the respondents spoke English, all interviews were carried out in Kiswahili. Most interviews (37 out of 46) were tape-recorded and transcribed using standards required for conversation analysis, which includes notation of hesitations, pauses in conversation and laughter [4]. Where interviews were not tape-recorded, extensive notes were made and typed up the same day. With the help of two research assistants, each write-up was reviewed and additional items and discrepancies marked in order to identify sources of difference and to make further notes and adjustments to the write-up.

Standard procedures for analyzing qualitative text (field notes and interview transcripts) were used. Following the recommendation of Ryan et al. [5] we began by creating a "key word in context" list from the field notes and transcripts and moved on to develop concepts and categories. Using this "grounded" approach to coding permitted context-sensitive analysis in a fashion that is not possible with pre-fabricated codes [6].

Results

While a mother is in postpartum seclusion, foods recommended include those believed to:

• 'Squeeze dirty blood' out of her womb: honey eaten with bread, tea spiced with ginger, fenugreek (a plant called uwatu whose grains are commonly used for making curry or for treating stomach problems in women) and oranges;
• Increase her milk supply: octopus, squid, wrasse fish (locally known as pono), roasted cassava and chicken;
• Soothe her body: hot porridge, and;
• Provide strength: rice cooked without coconut milk and ugali (a thick gruel made of corn meal).

Restricted foods are thought to make the woman get severe postpartum stomach cramps. These foods include :

• Foods perceived as having a strong smell such as samaki wa tasi (a black colored fish), eel, samaki wa msange and samaki wa ngogo (the last two are local fish which have a strong smell),
• Foods believed to be greasy such as mandazi (East African doughnuts) and;
• Other foods such as meat, beans and bananas.

Discussion

This study was carried out within the framework of an ethnographic inquiry investigating care of the mother and the infant. As we interviewed respondents, foods eaten by the mother during postpartum seclusion were often mentioned. Because we followed a flexible approach that allowed new questions to be asked throughout the course of data collection - which is one of the strengths of ethnographic research. In subsequent interviews, we asked respondents to provide a list of foods that were eaten, and to further clarify why each of these was consumed. This meant that some questions that were asked in later interviews might not have been asked of all respondents in earlier interviews, and makes it difficult to quantify the results [7].

With regard to maternal nutrition during the early postpartum period, in a population where many women may be under-nourished, if prescribed foods are of better quality than those normally eaten, a change in diet may be beneficial for the lactating mother. However, in a setting where an estimated 20% of pregnant women are severely anemic [8] restrictions of foods such as meat - a good source of bio-available iron, could be detrimental for maternal health and nutrition.

Conclusion

In this study, although the focused ethnography of the Swahili of Pemba, Tanzania allowed us to identify foods added or restricted from the mother's diet, it does not allow us to find out if the overall effect is better or worse. Further studies combining ethnographic and quantitative approaches (such as dietary, clinical and biochemical assessments) are needed to give comprehensive answers to this question.

Acknowledgements

I wish to extend my sincere gratitude to Dr. Rebecca J. Stoltzfus (Cornell University), Dr. Mahdi Ramsan and Mzee Khatib (Pemba Public Health Laboratory), Nadra and Wahida (Research Assistants) as well as the mothers, family members and health professionals who collaborated in this study.

References

1. Ngubane H Body and mind in Zulu medicine: An ethnography of health and disease in Nyuswa-Zulu thought and practice. Academic press, London . 1977.
2. Jewkes RK and K Wood Problematizing pollution: dirty wombs, ritual pollution, and pathological processes. Med Anthropol 1999; 18 : 163-186.
3. Whittaker A Birth and the Postpartum in Northeast Thailand : Contesting modernity and Tradition . Med Anthropol 1999; 18 : 215-242.
4. Seale C and D Silverman Ensuring Rigor in Qualitative Research . Eur J Public Health 1997; 7 : 379-384. \
5. Ryan GW and HR Bernard Data management and analysis methods. Handbook of qualitative research, Sage publications, Newbury Park . 2000 : 669-802.
6. Miles MB and MA Huberman Qualitative data analysis: an expanded sourcebook. Sage publications, Newbury Park . 1994.
7. Bentley M, Gavin L, Black M and L Teti Infant feeding practices of low-income, African American adolescent mothers: an ecological, multigenerational perspective . Soc Sci Med 1999; 49: 1085-1100.
8. Stoltzfus RJ and J Tielsch Preventing unnecessary blood transfusions in young children and pregnant women in Africa through effective primary health care: A proposal submitted to the Eugene and Mary B. Meyer Center for Advanced Transfusion Practices and Blood Research. The Johns Hopkins School of Medicine. 2003.

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