Background
Methods
Study site
Selection of sample and recruitment of participants
Measures/Topics of interest
Domains | Grand-tour question | Care-seeking behaviors | Matrone Practices | Medicinal Plant Use | Interactions and relationship between formal and informal providers |
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Questions | I'd like to start by asking for your opinion on the current state of reproductive health in this area. I do not know what reproductive health services are available in this area, like from doctors and matrones. Could you tell me about this? | In your opinion, what may influence people to seek reproductive health care from traditional village level providers or doctors or midwives at the CSB? | From what you know of the people of the village, for what reason do they come to a Matrone for reproductive health care and for what reason do they come to doctors or midwives for reproductive health care? | Can you tell me what you know about medicinal plants and how they are used in this region? | Is there something that you believe would improve reproductive health in your area? Is there a service that needs to be improved or anything that you suggest that would help women? |
I have heard about a plant found in this region that may have uterotonic properties. It may be used as a traditional medicine in the same way that a uterotonic would be used – administered to induce uterine contractions. Can you tell me about that? | Do you believe that it is possible for the formal and informal sectors to work together to improve the health of women? | ||||
Probes | Please describe clientele who seek your reproductive health services – age groups, social classes, marital status, etc. | How are the services received at the village-level and at the CSB the same or different? | Do they visit a matrone many times or just one time before going to the CSB? | Walk me through the process- step by step. What is done to gather and prepare the plant? Once the plant has been prepared, what is the first step for using it? Then what must happen? Please tell me the entire process from when the woman is given the plant until it is finished and the woman has recovered. | If a woman experiences complications like you mentioned, will she be able to reach the hospital? How does she get there? |
In your opinion, are these services enough to meet the needs of people in this area? | Can you tell me what factors would be influencing people to seek reproductive health services from a Matrone or traditional healer rather than at the CSB? | How does a matrone know if she can do it (assist the woman in delivery) or if she can't? | Can women afford the cost of care in the hospital? | ||
What is the difference between the care provided at the doctor/midwife versus the care provided by matrones? | What do people do here to promote reproductive health? | Do people seek matrones for other reproductive health services? | Do you think that the plants work as the traditional providers and women intend them to? | How do you think women are treated when they go to the hospital? | |
Can you tell me about the acceptability of family planning here? What methods do people use, if any? | Do all Matrones provide the same services? | Have you ever heard of women having problems during or after using this plant? What problems might she have? | Are there barriers to collaboration between the formal and informal health providers? | ||
If a woman becomes pregnant and she did not intend to, what can she do? | What benefits might there be to collaboration? |
Interview data analysis
Plant specimen and chemical analysis
Ethical considerations
Results
Matrone practices
Administration of tambavys
It depends on the sickness; maybe the woman is bleeding too often, or maybe she has a problem in her womb. Then, there are appropriate plants to be boiled and drunk as tea. (Nala, Matrone)
Medicinal Plants Used During Delivery | ||
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To Aide in Delivery/Accelerate Delivery
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To Treat Retained Placenta/Deliver Placenta
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To Treat Postpartum Hemorrhage
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Amborabea
| Fankamora (Tambavy containing several unidentified plants) | Atafanaa
|
Balsama | ||
Antambaa
| Fandatsakahitra | Fakantsilo |
Fankamora (Tambavy containing several unidentified plants) | Ravi-fizoka | Tafana |
Ravimboara | ||
Fandatsahana | Romba | |
Takilba | Takilba | |
Dantoroa/Denturusa
|
Medicinal Plants Used in Fertility Regulation | |||
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For Family Planning
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As Abortifacient
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To Wash the Womb
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Medicinal plants Used for Post Abortion Care
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Flo Leaf & Tsimangarato | Ahilava (Stem) | Nokoehy | Fandava Tsidihika followed by Tanantrandraka |
Avocado Leaf | Rainmandaly | ||
Nifin’akanga (Stem) | Tanantrandraka | ||
Romba (with Cytotec) | Vahazo | ||
Vatolalaka | Vanilla (with a “tasteless” tea) | ||
Velonahantona |
Medicinal Plants that Health Providers Associate with Complications | |
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Fankamora: | Nifin’akanga/Ahilava (Stems): |
Rapid Contractions
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Sepsis Infection
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Hypertonia
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Perforated Uterus
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Hemorrhage from Cervical Tear
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Indications for uterotonic tambavy use and the response of physicians
Tambavys as abortifacients
I do not dare show people about it because it is delicate. It is delicate because there is a dosage to respect. If it is too much, it may bring about hemorrhage. That is why I do not attend an abortion, neither do I show people how to do it. (Anja, Matrone)
When I was in the maternity [hospital], in one day you could have three cases of complications from abortion and from using these plants for other methods. (Julien, Doctor)
When a woman comes to me after an abortion, I always know. I first ask her "did you commit abortion?" She says, "Yes." And I ask her who did it, a Malagasy or a foreigner. If she says that a Malagasy did it, I tell her to go back there for a cure because it can "harm" my hands. That is to say, it can bring misfortune to my hands. It "hurts" my hands and people won't come to me anymore. (Rinà, Matrone)
Tambavy use during labor
Some women come [to a health facility] due to hemorrhage because the contractions are too fast and bring about the tear of the cervix… the contraction provokes hypertony of the uterus…[Women] only have access to that plant at the matrone. Only the matrone knows how to use it. It probably works because the uterus is contracting strongly indeed. It works like oxytocin. (Aina, Midwife)
I do not know what the plant is but some women who come here after being to the matrone suffer of placenta retention. Those women are given a tea by the matrone called Fankamora that quickens the delivery. When the woman drinks that tea, contractions are more intense and the baby is delivered but just after that, the cervix contracts and the placenta is trapped. Then the woman is sent to hospital and we have to relax the cervix to free the placenta… It is totally closed. You can just see the umbilical cord. And then, we ask them to buy some antispasmodics to relax the spasms. Antispasmodics are used to relax the muscles and once it is relaxed, the placenta is delivered. I do not know the name of the plant but I just know that the tea is called Fankamora…It is quite frequent (Aina, Midwife).
Dosage
We do not know what the side effects might be. The problem is that the matrone does not even know about the right dosage, what may happen if it is too much… For example, she may tell the woman to boil a handful of the plant but the problem is that a handful for the matrone might be different from the handful of the woman. So, there might be a risk of overdose and I am sure that it provokes [retained placenta] (Nadie, Doctor).
During labor, the matrone does everything to help the woman in delivery. She gives her a tea, she asks her to push, she tries everything according to her knowledge. So when she gives the uterotonic tea to the woman, the treatment varies from two to six hours. So, when it is still difficult, the matrone sends the woman to the hospital, and she arrives there at the fourth hour. We, midwives too, have to try everything to help the woman in her delivery so we have to use a medicine, which is also a uterotonic. The plant plus the medicine then provoke hypertonia and brings about more complications (Hanitra, Midwife).