Isolation of mother and child after childbirth
The main reason for immediately isolating the mother and the newborn from the rest of the household after childbirth is because of the 'impurity and polluting effects of childbirth', which is believed to be dirty, defiling and contaminating. The following account illustrates the extent of belief in the concept of impurity and pollution after childbirth.
"Someone was sent to fetch the dai [traditional birth attendant] during my labour pains, but in the meantime I had given birth. No-one attended to me or attempted to clean me or my baby. I was lying on the mud floor in a pool of blood and placenta with the baby still attached to the umbilical cord. When the dai arrived after an hour she cut the cord and cleaned me and my baby."
But some women believed that segregation was practiced to ensure that the mother and the baby were kept away from infections, and that it gave mothers time to recuperate after childbirth.
"Although we do believe in ritual pollution after childbirth, but in our household we practice isolation and segregation of the newborn and the mother primarily to keep them away from infections. As you know, as per our tradition, after birth we have too many visitors coming to 'see the baby'. At this stage, if the infant and the mother are exposed to all the visitors, they would get tired very easily and also may be exposed to certain infections like the cold and the 'flu germs, and as they are vulnerable at this stage it is best to keep them away from interacting with anybody for at least 21 days after birth."
Women in Motipur and Kapgari villages believed in the concept of pollution and contamination after childbirth, which is dirty and defiling (postpartum blood); whilst women in Santoshpur considered the placental blood to be polluting, whereas in Sultanpur women practised segregation as a 'cultural tradition'. Although belief in pollution and impurity after childbirth exists in the study villages, the length of seclusion and the type and place chosen for confinement and amenities and facilities made available to women and the newborn vary significantly from one place to the other and also between communities and caste groups (this has been discussed in detail elsewhere [
25]).
Food avoidance during lactation and breastfeeding
One thing that was common across the study population was the observance of strict food taboos after childbirth. Women in the study villages avoided certain kinds of food, which – according to them – were harmful for the infant. They avoided food believed to have laxative properties, food considered to be cold, food that caused skin rash, and acidic food. (Foods that are generally avoided are: certain varieties of green leafy vegetables, fibrous vegetables, melons, gourds, pumpkin, papaya, eggplant, shell fish, eggs amongst certain caste and communities, certain varieties of fish, lemons, limes, oranges, grapes, chillies, bell peppers, spices, bananas, yoghurt, and oily food).
Women consumed special food (milk, ghee, butter, and certain types of fish) believed to increase the quantity of breast milk and to improve their health. During this period mothers are encouraged and allowed to eat lots of garlic, which is believed to enhance the process of "drying of the womb" (contraction of the uterus). In the study villages, women strictly followed the cultural taboos related to food avoidance and restriction:
"After delivery for the first three days I was on a diet of dry food, such as rice crisps, garlic, and ghee (clarified butter), and was allowed to eat only once a day, as this diet helps to contract the uterus quickly."
In the villages of Motipur and Kapgari mothers were on a diet of rice crisps/puffed rice, tea and hot water for the first three days after childbirth. On the fourth day when the mother completed the purificatory ritual (involving a ritual bath and clipping of nails) she is allowed a mid-day meal of rice and boiled vegetables and lentils (depending on the economic status of the household, meat and fish, may be included). In the night, rice crisps/puffed rice, tea and hot water are allowed until the last day of confinement. Restrictions related to food intake and food avoidance these days – according to the women in Motipur – is dependent on the family's caste and socioeconomic status and standing in the community. Women avoided 'cold' foods to prevent illness after childbirth. Few women from Motipur and Kapgari villages did not follow the practice of food avoidance and diet restriction of eating once a day.
Whilst in Santoshpur village mothers were allowed to eat only those foods considered to be good for her and her child's health. Most women had rice, boiled vegetables, meat, fish, or eggs once a day. In the evenings they had rice crisps/puffed rice, tea, and hot water. This kind of diet continued until the last day of the seclusion period, which is 40 days in the Muslim community. In Sultanpur village the majority of the women ate everything (did not avoid any food) once a day for the entire period of seclusion, and few women had only rice crisps/puffed rice, tea, and hot water for the specified length of confinement and avoided certain foods; this varied between 21 and 30 days. Women from this village who practiced food avoidance and restriction said that they did so because of 'acidity' and 'heartburn'. Women were allowed two meals a day after the completion of their confinement period, but depending on the health of their infant, their diet was constantly altered to protect their infant's health.
Women who had any special food during the initial stages of lactation were from the upper socioeconomic group and women who had delivered at their natal homes. Special foods included were: milk, fruit, various types of pulses and lentils, meat, fish, etc. The women in Sultanpur were provided with an additional supplementary diet from their Anganwadi Centre (Integrated Child Development Scheme – a UNICEF initiative now run by the Ministry of Health and Welfare, Government of India). Women consumed special foods to increase the quantity of breast milk.
Initiation of breastfeeding
"The first feed my son received was hot water a few hours after birth. I put my son to breast after two days, as the milk 'comes' only after 48 hours. Before I put him to breast I squeezed the yellowish liquid and threw it, as it is harmful for his health because he would not be able to digest this thick yellow liquid".
Breastfeeding initiation was delayed in the study villages. The infants were given prelacteal feeds before breastfeeding. Prelacteal feeds (hot water, sugar-water, honey, mustard oil, tea, or goat/cow milk) were given to the infant to cleanse their system; there was a belief in the study villages that the child swallows waste and impurities in the womb. Only 16.5% initiated breastfeeding within an hour of giving birth (Table
1). About half did not start breastfeeding until at least 24 hours after the birth (47.9%). Women gave a number of reasons for delaying breastfeeding, but the universal reason was that 'it was harmful for the baby' and that there was 'insufficient milk'; colostrum was expressed and discarded before breastfeeding was initiated.
Table 1
How long after birth infant was put to breast
< 1 hour | 1 | 1 | 17 | 17 | 21 | 23 | 24 | 26 | 63 | 16.5 |
1 hour – 24 hours | 41 | 42 | 26 | 27 | 26 | 28 | 43 | 46 | 136 | 35.6 |
> 24 hours | 56 | 57 | 55 | 56 | 45 | 49 | 27 | 29 | 183 | 47.9 |
Introduction of supplementary foods
Supplementary food was given to a majority of infants within the first six months (Table
3). No gender discrimination was found in the study population with regards to breastfeeding, or in the introduction of supplementary food.
Table 3
Supplementary food given besides breast milk within the first six months
Yes | 89 | 91 | 89 | 91 | 79 | 86 | 86 | 92 | 343 | 89.8 |
No | 9 | 9 | 9 | 9 | 12 | 13 | 5 | 5 | 35 | 9.2 |
Infant died | 0 | 0 | 0 | 0 | 1 | 1 | 3 | 3 | 4 | 1.0 |
"We had an annaprasan [receiving food grains, especially rice] ceremony for our son in the ninth month according to our tradition [for daughters this ceremony is held in the sixth month]. As per our custom, my brother fed the first morsel of rice, fish and sweets to my son. Before the annaprasan I was not allowed to give solid food (rice, fish, and vegetables) to my son. Besides breastfeeding, I normally gave him water, animal milk, and fruit juice.
The discrepancy in holding the annaprasan ceremony is because of the belief and view of the study sample that male infants are 'weaker' than female infants, and also that male infants are more susceptible to die before completing the first six months of their lives. If they survive past the six months period, then the annaprasan ceremony is observed. Some communities observe this in the seventh month and some in the ninth month.
In all the study villages with the exception of Sultanpur, babies were first introduced to supplementary food between the fourth and the sixth months and were given plain water, animal milk, and infant formula. The women in Sultanpur introduced supplementary food for the first time between the first and the third month in the form of plain water, animal milk, and infant formula. Most women in the sample introduced soft mushy foods between the ages of seven and ten months.
Introduction of early supplementary foods for the present study was classified as anytime between one and six months. Exclusive breastfeeding included prelacteal feeds as prelacteal feeds were almost universal in the study population. Only three women in the study sample did not give any prelacteal feed to their newborn; and 35 women exclusively breastfed their babies until six months.
Termination of breastfeeding amongst the study sample was mostly due to insufficient milk, conception and refusal of the child to be breastfed.