News

Some Traditional Practices May Affect Maternal Health in Sierra Leone

A maternal and child health aid examines an expectant mother at a local clinic in Sierra Leone
A maternal and child health aid examines an expectant mother at a local clinic in Sierra Leone

Among many cultures in Africa, traditions protect the health of women and children, and the family. Some ethnic groups encourage women to breastfeed their infants for over a year, thus encouraging the safe practice of greater spacing between pregnancies.

And in Sierra Leone, a Krio saying, “Bad children may not be thrown into the bush” (“Bush noh de foh trwoe bad pikin”) guarantees that children will not be disowned by the family, no matter how difficult they are.

But other traditions and practices are harmful, say many health care professionals, and contribute to the country’s high rates of maternal and child mortality.

Lack of power

Dr. Ibrahim Thorlie, the consultant obstetrician and gynecologist at the Princess Christian Maternity Hospital in Freetown, says some traditions may prevent women from receiving needed medical treatment during a pregnancy.

Thorlie sits behind a large wooden desk in his office at the hospital, in a white doctor’s coat and a stethoscope around his neck. The echo of crying infants drifts through the half-open door.

For cultural and economic reasons, some families strive to have as many sons as possible
For cultural and economic reasons, some families strive to have as many sons as possible

He says he has found that women often have little control over whether they receive medical or hospital care during pregnancy.

“Tradition says before you go anywhere, the husband must approve. I think that is [also a question of finances], because the husband in the traditional African home provides the funds. So if you want to go and if you don’t have funds,” he says, “you can’t go.”

Studies by UNICEF and the World Health Organization confirm those views.

A survey by the two UN agencies shows that most women in rural areas are prevented from receiving pre-natal care from qualified providers, in part because tradition bars them from interacting with anyone other than their spouse or female members of their family while pregnant.

Some women, especially those who are circumcised, will refuse to allow themselves to be examined by a male doctor or by a nurse who is not circumcised.

Little control over family size, health care

Tradition also impacts the number of children a woman has and the frequency of births.  Women may have little say in these decisions, because they are typically made by male head of families.

Some ethnic groups favor boys as a way to perpetuate the family name.  Sons are also usually responsible for the care of aging parents and for performing the parent’s burial rites, says the Inter-African Committee on Traditional Practices, an international network of non-governmental organizations working to improve health maternal and child care.

Many families have large numbers of children in the belief that some will not live to adulthood. UNICEF figures show that half of the nearly nine million children under five who die each year are in sub-Saharan Africa.

Culture and diet

Tradition may affect the health of a woman in other ways. They may be among the last to eat nutritious food at the family table. In some ethnic groups, the woman is discouraged from eating meat and eggs during pregnancy, says Brima Abdulai Sheriff, director of Amnesty International in Sierra Leone.

In some traditions, pregnant women are discouraged from eating healthy foods, like chicken or eggs. In others, men often receive the best, and most nutritious, foods at the family table.
In some traditions, pregnant women are discouraged from eating healthy foods, like chicken or eggs. In others, men often receive the best, and most nutritious, foods at the family table.

“If she prepares a chicken,” he says, “all she can eat is wings, feet, the neck and the head. The fleshy and nutritious part is given to the husband. This is a show of love to your husband. In some communities, [it is believed] if you [give a pregnant woman] meat, she will give birth to a child who is a witch.”

He says pregnant women may harm their unborn child by fasting, which he says can deprive the fetus of needed nutrients.

Stifling debate

Traditions may also discourage open debate about maternal care.

Women are not to complain, says Dr. Peter Sikana, describing the private nature of pregnancy and childbirth. Sikana is a reproductive health and emergency obstetric care technical advisor for the UN Population Fund in Freetown.

“There are some tribes where a woman is left alone to go through the process of labor, and she’s not supposed to make noise even if she’s in pain; it’s believed to be [a sign of] strength that [tends to work] against quality care for a woman.” Going to a clinic, he says, is a sign of moral failure.

UNICEF says Sierra Leone leads the world in maternal mortality, with 2,100 deaths for every 100,000 births
UNICEF says Sierra Leone leads the world in maternal mortality, with 2,100 deaths for every 100,000 births

Sometimes, traditional beliefs in Sierra Leone blame women for difficult pregnancies.

One saying equates women to a calabash. When a woman dies during childbirth, the calabash is said to be “broken,” and shame is brought on the community. In some parts of the country, complications during delivery are attributed to infidelity, according to a recent Amnesty International report, Out of Reach: The Cost of Maternal Health in Sierra Leone.

“Often, time and energy are wasted in trying to obtain a confession instead of ensuring that the woman, who is in agony as the baby fails to emerge, has access to the necessary obstetric care,” says the study.

Maternal and child health may also be influenced by spiritual values, says Dr. Sikana.

“There may be religious influences,” he says, “where people believe whatever God gives you is what you have. Whatever happens is attributed to God – you must have a certain [predetermined] number of children, so people don’t go for family planning.” The life or death of the mother and infant may be God’s will, with little attention paid to the support of health care workers.

Not all cultural practices are harmful to mothers and infants, says Dr. Donald Bash-Taki, a prominent private medical practitioner at one of Sierra Leone’s oldest medical institutions, Connaught Hospital in the busy center of Freetown.

The answer, he says, is to use medical providers who share the same cultural norms as their patients.

“There are some ethnic groups [that], because of their own beliefs, do not like women to [go to] public [care centers] to have deliveries,” he says. “But (if) you use [health care workers from] those ethnic groups, it can overcome that problem to see that, yes, all care and delivery occurs within the community. So again, if you work within the community, give more community ownership [of] these programs, and then it will work.”

Pregnant women waiting to see nurse at Kroo Bay Community Health Centre in Freetown, Sierra Leone
Pregnant women waiting to see nurse at Kroo Bay Community Health Centre in Freetown, Sierra Leone

Community leadership

Powerful traditional figures, such as local chiefs, can play a big role in ensuring that superstitions and cultural practices do not stand in the way of maternal and child health, says Mohammed Mansere, a supervisor of traditional birth attendants.

“We should use the influence of the paramount chiefs, the section chiefs, to give them a mandate that whenever a woman is pregnant, she should immediately go to the health facility, instead of wasting time.”

He also says medical information should be translated into local languages for the mother and health care workers.

Women’s rights activists say one key to reducing the influence of harmful practices lies in enhancing women’s political clout. Many are working with local women’s groups to help elect women to office.

They say a stronger voice of women in government and within families will help create a new tradition of better health for pregnant women and their babies in Sierra Leone.

This is part 7 of our 15 part series, A Healthy Start: On the Frontlines Maternal and Infant Care in Africa

« Prev: Birth Attendants Series Index Next: Emergency Care »

 

This forum has been closed.
Comments
     
There are no comments in this forum. Be first and add one

Featured Videos

Your JavaScript is turned off or you have an old version of Adobe's Flash Player. Get the latest Flash player.
Expelled from Pakistan, Afghan Refugees Return to Increased Hardshipi
X
Ayesha Tanzeem
May 28, 2015 6:48 PM
Undocumented refugees returning to Afghanistan from Pakistan have no jobs, no support system, and no home return to, and international aid agencies say they and the government are overwhelmed and under-resourced. Ayesha Tanzeem has more from Kabul.
Video

Video Expelled from Pakistan, Afghan Refugees Return to Increased Hardship

Undocumented refugees returning to Afghanistan from Pakistan have no jobs, no support system, and no home return to, and international aid agencies say they and the government are overwhelmed and under-resourced. Ayesha Tanzeem has more from Kabul.
Video

Video Britain Makes Controversial Move to Crack Down on Extremism

Britain is moving to tighten controls on extremist rhetoric, even when it does not incite violence or hatred -- a move that some are concerned might unduly restrict basic freedoms. It is an issue many countries are grappling with as extremist groups gain power in the Middle East, fueled in part by donations and fighters from the West. VOA’s Al Pessin reports from London.
Video

Video Floodwaters Recede in Houston, but Rain Continues

Many parts of Texas are recovering from one of the worst natural disasters to hit the southwestern state. Heavy rains on Monday and early Tuesday caused rivers to swell in eastern and central Texas, washing away homes and killing at least 13 people. As VOA’s Greg Flakus reports from Houston, floodwaters are receding slowly in the country's fourth-largest city, and there likely is to be more rain in the coming days.
Video

Video 3D Printer Makes Replica of Iconic Sports Car

Cars with parts made by 3D printers are already on the road, but engineers are still learning about this new technology. While testing the possibility of printing an entire car, researchers at the U.S. Department of Energy recently created an electric-powered replica of an iconic sports roadster. VOA’s George Putic has more.
Video

Video Al-Shabab Recruitment Drive Still on In Kenya

The al-Shabab militants that have long battled for control of Somalia also have recruited thousands of young people in Kenya, leaving many families disconsolate. Mohammed Yusuf recently visited the Kenyan town of Isiolo, and met with relatives of those recruited, as well as a many who have helped with the recruiting.
Video

Video US Voters Seek Answers From Presidential Candidates on IS Gains

The growth of the Islamic State militant group in Iraq and Syria comes as the 2016 U.S. presidential campaign kicks off in the Midwest state of Iowa.   As VOA’s Kane Farabaugh reports, voters want to know how the candidates would handle recent militant gains in the Middle East.
Video

Video A Small Oasis on Kabul's Outskirts Provides Relief From Security Tensions

When people in Kabul want to get away from the city and relax, many choose Qargha Lake, a small resort on the outskirts of Kabul. Ayesha Tanzeem visited and talked with people about the precious oasis.
Video

Video Film Festival Looks at Indigenous Peoples, Culture Conflict

A recent Los Angeles film festival highlighted the plight of people caught between two cultures. Mike O'Sullivan has more on the the Garifuna International Film Festival, a Los Angeles forum created by a woman from Central America who wants the world to know more about her culture.
Video

Video Kenyans Lament Losing Sons to al-Shabab

There is agony, fear and lost hope in the Kenyan town of Isiolo, a key target of a new al-Shabab recruitment drive. VOA's Mohammed Yusuf visits Isiolo to speak with families and at least one man who says he was a recruiter.
Video

Video Scientists Say Plankton More Important Than Previously Thought

Tiny ocean creatures called plankton are mostly thought of as food for whales and other large marine animals, but a four-year global study discovered, among other things, that plankton are a major source of oxygen on our planet. VOA’s George Putic reports.
Video

Video Kenya’s Capital Sees Rise in Shisha Parlors

In Kenya, the smoking of shisha, a type of flavored tobacco, is the latest craze. Patrons are flocking to shisha parlors to smoke and socialize. But the practice can be addictive and harmful, though many dabblers may not realize the dangers, according to a new review. Lenny Ruvaga has more on the story for VOA from Nairobi, Kenya.
Video

Video Iowa Family's Sacrifice Shaped US Military Service for Generations

Few places in America have experienced war like Waterloo. This small town in the Midwest state of Iowa became famous during World War II not for what it accomplished, but what it lost. As VOA’s Kane Farabaugh reports, the legacy of one family’s sacrifice is still a reminder today of the real cost of war for all families on the homefront.

VOA Blogs