Elsevier

Midwifery

Volume 30, Issue 1, January 2014, Pages 130-137
Midwifery

‘My Mother…My Sisters… and My Friends’: Sources of maternal support in the perinatal period in urban India

https://doi.org/10.1016/j.midw.2013.03.003Get rights and content

Abstract

Objective

to explore the wide-ranging sources of support that the maternal–infant dyad need or expect throughout the perinatal period in urban India.

Setting

homes and community settings in greater metropolitan Bangalore, South India.

Participants

using in-depth interviews of 36 mothers from different socio-cultural and socio-economic backgrounds who had given birth within the past two years in a tertiary hospital, we explored the nature of support, advice and emotional sustenance through pregnancy, childbirth and the early child rearing period available to these women.

Findings

the overwhelming importance of women's own mothers in practical and emotional terms, the connectedness to ‘native’ place or ‘ooru’, the role of the diverse, extensive female network and the more contingent role of the husband emerged as major themes. The family was a major source of support as well as distress. While the support from their own mother was a constant, women used various forms of support throughout the perinatal continuum.

Conclusions and implications for practice

we call for a more nuanced understanding of what women in urban India expect and need in terms of support throughout the perinatal period. Clinicians and policy makers need to understand the various players, their different roles at critical times through the perinatal continuum and be able to identify those who are vulnerable and in need of enhanced support. Although the health sector is not a strong player in the socio-cultural milieu in the perinatal period, their role as facilitators of this support is crucial.

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.

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