‘My Mother…My Sisters… and My Friends’: Sources of maternal support in the perinatal period in urban India
Introduction
The perinatal period is the largest contributor to disease burden in low and middle-income countries (Lopez et al., 2006). India contributes to the greatest number of child deaths and malnourished children in the world, with infant mortality rates still at 57 per 1000 live births and almost half the child population being underweight (DHS, 2007). India is not on track to achieve the 2015 health-related Millennium Development Goals (MDGs) and more focused attention on the perinatal continuum is warranted (Bhutta et al., 2010). The challenge of delivering appropriate maternal and child health care in urban India is now a major issue for the government (Bhaumik, 2012, UNICEF, 2012). While social determinants such as poverty, illiteracy, poor status of women, as well as dysfunctional health systems are critical underlying factors that adversely affect maternal and child health in India, these factors are relatively difficult to change in the short term (Bhutta et al., 2005).
A critical gap in our knowledge on how to improve perinatal outcomes, is how family and community practices influence maternal and child health and support seeking behaviours (Bhutta et al., 2005). There is considerable evidence mainly from western countries to suggest that intervention programmes aimed at improving the ‘social’ milieu in pregnancy and childbirth have positive practice implications, given that childbearing so strongly bridges the biological and the social (Oakley, 1985, Oakley et al., 1990). Research has demonstrated the positive association between social support and maternal mental health and breast feeding (Bhopal, 1998, Balaji et al., 2007, Barona-Vilar et al., 2009). While the importance of social support in the perinatal period in developing countries is acknowledged (Maimbolwa et al., 2003), much of the research literature about this period, focuses on antenatal and delivery practices (Goodburn et al., 1995), with an emphasis on care-seeking of maternal and infant ‘illness’ (Mesko et al., 2003, Ronsmans et al., 2010), or specifically around maternal depression (Rahman et al., 2003, Andajani-Suthahjo et al., 2007), and intimate partner violence (Daruwalla et al., 2009).
An emerging literature from Africa and South Asia is documenting the importance of social support for mothers in the postpartum period (Mbekenga et al., 2011a, Mbekenga et al., 2011c) as well as documenting particular concerns of fathers (Mbekenga et al., 2011b, Sapkota et al., 2012) and specific roles for midwives (Lugina et al., 2001). There have been some excellent anthropological explorations of pregnancy and childbirth in South Asia, particularly focusing on the rural setting (Gideon, 1962, Blanchet, 1984, Ram, 1994, Rozario, 1998, Pinto, 2008); however, there is a paucity of research exploring the perinatal psychosocial milieu in urban settings, with particular reference to sources of support throughout the perinatal continuum.
In 2003 a prospective birth cohort study was commenced at St. John's Medical College (SJMC) Hospital, Bangalore, India, to explore the association of maternal health and nutrition with pregnancy and child health outcomes. Several salient reports and results have already emerged out of this cohort study (Muthayya et al., 2006); the single most important factor in determining birth weight and hence child outcomes in this cohort was maternal education level. We situated our research study within this cohort to elicit psychosocial and cultural factors that influence perinatal outcomes, for mother and infant dyads in urban India. In particular we wanted to determine where and how women got their support, advice and emotional sustenance through pregnancy, childbirth and early child rearing, broadly conceptualised as the perinatal period.
Section snippets
Methods
We used an ethnographic approach with in-depth qualitative interviews as we were looking to generate new theories and hypotheses (Fitzgerald, 1997), as well as achieve a deep understanding of the socio-cultural context of the perinatal period in urban India.
Findings
The results of the analysis and interpretation of the qualitative data are presented as key themes identified with respect to the research question: ‘what is the nature of support—emotional, practical and health related, available to the mother–infant dyad in the perinatal period’? The following themes emerged:
- •
Importance of women's own mothers
- •
My place (ooru)
- •
Female support network
- •
Role of husband
- •
The ambivalent role of the family
Discussion
This paper highlights the range of sources of support, psychological, socio-cultural and practical, that women and their infants need through the perinatal period in urban India. The realm of the ‘social’ in the perinatal period has been explored in the last two decades as an avenue for positive intervention in the west, particularly in the form of home visiting and structured social support (Oakley, 1985, Oakley et al., 1990). Social support as conceptualised or provided in developing
Conclusions and policy implications
The urban milieu is soon going to be the major challenge for health services delivery; by 2050 it is estimated that 70% of all people will live in urban areas with major implications for women and children who are the most vulnerable (Trudy, 2009, UNICEF, 2012). Apart from dealing with the obvious challenges of burgeoning populations, increasing inequity and poor access to basic services, for many urban dwellers particularly in South Asia their social and cultural reference points are back in
Conflicts of Interest
We declare there is no conflict of interest of any members of this research group to this piece of research.
Acknowledgements
We gratefully acknowledge the invaluable support and help provided by Dr. Sumithra Mutthayya and members of the Nutrition Research team from St. John's Research Institute, St John's Medical College, Bangalore. The first author is particularly grateful to all the women and families who so freely gave their time to this research.
References (50)
- et al.
A qualitative approach to social support and breast-feeding decisions
Midwifery
(2009) India outlines plans for National Urban Health Mission
The Lancet
(2012)South Asian women in east London: motherhood and social support
Women's Studies International Forum
(1998)- et al.
Countdown to 2015 decade report (2000–10): taking stock of maternal, newborn, and child survival
Lancet
(2010) - et al.
‘Alone, I wouldn't have known what to do’: a qualitative study on social support during labor and delivery in Mexico
Social Science & Medicine
(1998) Husbands and maternal health matters in rural Guatemala: wives' reports on their spouses' involvement in pregnancy and birth
Social Science & Medicine
(2002)- et al.
The role of the extended family in women's risk of intimate partner violence in Jordan
Social Science & Medicine
(2010) - et al.
Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data
The Lancet
(2006) - et al.
Tanzanian midwives' views on becoming a good resource and support person for postpartum women
Midwifery
(2001) - et al.
Joy, struggle and support: postpartum experiences of first-time mothers in a Tanzanian suburb
Women and Birth
(2011)
Postpartum experiences of first-time fathers in a Tanzanian suburb: a qualitative interview study
Midwifery
Barriers to and attitudes towards promoting husbands' involvement in maternal health in Katmandu, Nepal
Social Science & Medicine
Can women's autonomy impede male involvement in pregnancy health in Katmandu, Nepal?
Social Science & Medicine
Understanding gendered influences on women's reproductive health in Pakistan: moving beyond the autonomy paradigm
Social Science & Medicine
Social support in pregnancy: the ‘soft’ way to increase birthweight?
Social Science & Medicine
Medical management and giving birth: responses of coastal women in Tamil Nadu
Reproductive Health Matters
Listening to mothers: qualitative studies on motherhood and depression from Goa, India
Social Science & Medicine
Husbands' experiences of supporting their wives during childbirth in Nepal
Midwifery
Complex emotions, complex problems: understanding the experiences of perinatal depression among new mothers in urban Indonesia
Culture, Medicine and Psychiatry
Social support networks and maternal mental health and well-being
Journal of Women's Health
Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: a review of the evidence
Pediatrics
Women, pollution and marginality: meanings and rituals of birth in rural Bangladesh
Using thematic analysis in psychology
Qualitative Research in Psychology
Conflict, crisis, and abuse in Dharavi, Mumbai: experiences from six years at a centre for vulnerable women and children
PLoS Med
National Fact Sheet. National Family Health Survey, India 2005–6
Cited by (30)
“Tension” and distress in South Asia: A systematic literature review
2022, SSM - Mental HealthWomen’s experiences of social support during pregnancy: a qualitative systematic review
2023, BMC Pregnancy and ChildbirthBonding and Infants’ Development and Quality of Life: A Study Among Mothers with Severe Mental Illnesses in Remission
2023, Indian Journal of Psychological MedicineDevelopment of indicators to measure quality of life for pregnant women (QOL-PW)
2023, Journal of Preventive Medicine and Hygiene