Religio-cultural factors contributing to perinatal mortality and morbidity in mountain villages of Nepal: Implications for future healthcare provision.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Culture* ; Health Status Disparities* ; Perinatal Death* ; Religion*; Perinatal Mortality/*ethnology ; Rural Health/*ethnology; Adolescent ; Adult ; Female ; Health Knowledge, Attitudes, Practice/ethnology ; Humans ; Infant, Newborn ; Morbidity ; Mothers/psychology ; Mothers/statistics & numerical data ; Nepal/epidemiology ; Policy Making ; Pregnancy ; Qualitative Research ; Rural Health/statistics & numerical data ; Rural Health Services/legislation & jurisprudence ; Rural Health Services/organization & administration ; Young Adult

Objective and the Context: This paper examines the beliefs and experiences of women and their families in remote mountain villages of Nepal about perinatal sickness and death and considers the implications of these beliefs for future healthcare provision.
Methods: Two mountain villages were chosen for this qualitative study to provide diversity of context within a highly disadvantaged region. Individual in-depth interviews were conducted with 42 women of childbearing age and their family members, 15 health service providers, and 5 stakeholders. The data were analysed using a thematic analysis technique with a comprehensive coding process.
Findings: Three key themes emerged from the study: (1) 'Everyone has gone through it': perinatal death as a natural occurrence; (2) Dewata (God) as a factor in health and sickness: a cause and means to overcome sickness in mother and baby; and (3) Karma (Past deeds), Bhagya (Fate) or Lekhanta (Destiny): ways of rationalising perinatal deaths.
Conclusion: Religio-cultural interpretations underlie a fatalistic view among villagers in Nepal's mountain communities about any possibility of preventing perinatal deaths. This perpetuates a silence around the issue, and results in severe under-reporting of ongoing high perinatal death rates and almost no reporting of stillbirths. The study identified a strong belief in religio-cultural determinants of perinatal death, which demonstrates that medical interventions alone are not sufficient to prevent these deaths and that broader social determinants which are highly significant in local life must be considered in policy making and programming.

J Obstet Gynecol Neonatal Nurs. 1995 May;24(4):327-31. (PMID: 7643264)
J Health Popul Nutr. 2011 Jun;29(3):255-64. (PMID: 21766561)
Kathmandu Univ Med J (KUMJ). 2006 Apr-Jun;4(2):176-81. (PMID: 18603894)
Sociol Health Illn. 2003;25:23-40. (PMID: 14498928)
JAMA. 2006 Apr 19;295(15):1809-23. (PMID: 16622143)
Med J Aust. 2007 May 21;186(10 Suppl):S47-50. (PMID: 17516883)
BMC Int Health Hum Rights. 2014 May 19;14:17. (PMID: 24885760)
Soc Sci Med. 2010 Nov;71(10):1764-72. (PMID: 20541305)
J Nepal Health Res Counc. 2015 Jan-Apr;13(29):78-83. (PMID: 26411718)
Bull World Health Organ. 2012 Jun 1;90(6):403-403A. (PMID: 22690025)
BMC Pregnancy Childbirth. 2004 May 22;4(1):8. (PMID: 15154970)
Soc Sci Med. 2006 Jun;62(12):2930-44. (PMID: 16406206)
Women Health. 1999;30(1):85-103. (PMID: 10813269)
BMC Pregnancy Childbirth. 2015 Feb 13;15:27. (PMID: 25884164)
BMC Int Health Hum Rights. 2008 Mar 28;8:4. (PMID: 18373839)
BMC Pregnancy Childbirth. 2015 ;15 Suppl 2:S6. (PMID: 26391217)
Soc Sci Med. 1996 Mar;42(5):759-68. (PMID: 8685744)
Natl Vital Stat Rep. 2015 Jul 23;64(8):1-24. (PMID: 26222771)
Soc Sci Med. 2010 Aug;71(3):608-615. (PMID: 20605304)
Soc Sci Med. 1983;17(3):147-61. (PMID: 6836349)
BMC Public Health. 2013 Dec 28;13:1239. (PMID: 24373558)
Midwifery. 2005 Jun;21(2):139-53. (PMID: 15878429)
Reprod Health. 2012 Oct 10;9:25. (PMID: 23050689)
JNMA J Nepal Med Assoc. 2011 Jan-Mar;51(181):21-7. (PMID: 22335091)
J Nepal Health Res Counc. 2015 Jan-Apr;13(29):73-7. (PMID: 26411717)
Lancet. 2016 Feb 6;387(10018):587-603. (PMID: 26794078)
Front Public Health. 2015 Aug 14;3:197. (PMID: 26322302)
Lancet. 2005 Mar 12-18;365(9463):977-88. (PMID: 15767001)
Lancet. 2011 Apr 23;377(9775):1448-63. (PMID: 21496911)
BMC Public Health. 2017 Jan 26;17 (1):124. (PMID: 28122606)
Stud Fam Plann. 2012 Jun;43(2):93-114. (PMID: 23175949)
J Health Popul Nutr. 2011 Aug;29(4):371-8. (PMID: 21957676)
Lancet. 2005 Jan 29-Feb 4;365(9457):383; author reply 383-4. (PMID: 15680448)
Kathmandu Univ Med J (KUMJ). 2010 Jan-Mar;8(29):62-72. (PMID: 21209510)
Cien Saude Colet. 2010 Jul;15(4):2105-11. (PMID: 20694332)
Lancet. 2005 Mar 5-11;365(9462):891-900. (PMID: 15752534)
ISRN Psychiatry. 2012 Dec 16;2012:278730. (PMID: 23762764)
Lancet. 2014 Jul 12;384(9938):174-88. (PMID: 24853603)
BMC Pregnancy Childbirth. 2015 ;15 Suppl 2:S7. (PMID: 26391335)
Midwifery. 2013 Oct;29(10):1173-81. (PMID: 23845450)
Glob Health Action. 2015 Mar 31;8:24011. (PMID: 25843493)
Lancet. 2014 Jul 12;384(9938):189-205. (PMID: 24853593)
Lancet Glob Health. 2016 Feb;4(2):e98-e108. (PMID: 26795602)
BMC Public Health. 2011 Jan 31;11:67. (PMID: 21281478)
Lancet. 2011 Apr 30;377(9776):1523-38. (PMID: 21496906)
Lancet. 2014 Jul 26;384(9940):347-70. (PMID: 24853604)
J Midwifery Womens Health. 2014 Jan;59 Suppl 1:S110-7. (PMID: 24588912)
Lancet. 2011 Apr 16;377(9774):1353-66. (PMID: 21496915)
Ethiop Med J. 2010 Apr;48(2):105-15. (PMID: 20608014)

Date Created: 20180316 Date Completed: 20180705 Latest Revision: 20181114

20240104

PMC5854484

10.1371/journal.pone.0194328

29544226