Juna has not travelled outside her district in her entire life and she doesn’t know her actual age. She referred to the year of a big earthquake to get a sense of her age. She gave herself the approximate age of 42 and she looked significantly older than her made up age. Juna was not even 10 when she got married and she would have been around 16 to experience her first pregnancy. The current pregnancy was her seventh pregnancy, and she lives about three hours walks from the district hospital. She gave birth to her previous six children at Goth (cow sheds) and followed 30 days birth pollution practice for spiritual reasons. She was glad that everything went well, and she did not have any bad fortune. This time she went to hospital for one check-up, a first-time experience. Juna did not feel right about going to hospital. She returned home and decided to give birth in the same Goth and continued the tradition in the same way she did for the past six births.
Childbirth as a social and cultural event has hardly been discussed in mainstream medical literature. Obstetricians, midwives, and other healthcare providers were pushed to work within the set frameworks, protocols and routine procedures, mostly in an institutional setting. Only after 1970 sociologists started to write in mainstream literature highlighting the cross-cultural significance of childbirth [1–6]. Oakley’s publications “Becoming a Mother” and “Women Confined: Towards a Sociology of Childbirth” provided strong critiques of a medical and institutional model of interventions and offered a social framework of childbirth. The notion of risks, choice and safety in childbirth has been defined differently in medical and sociological literature, which is putting women in a complex space while making decisions around where to give birth, from whom to seek support and how they would like that experience to be. The medicalisation and use of technology in childbirth made women’s experiences more mechanical which threatened their emotional safety. Nevertheless, it is important to acknowledge the efforts of both the medical and social models of childbirth in preventing related deaths, illness and problems [7].
Globally, approximately 295,000 women died due to pregnancy and childbirth-related causes in 2017, of which 94% of deaths occurred in low-resource settings. Nearly one-fifth of these deaths were in South Asia [8]. Similarly, 2.5 million children died in the first month of life in 2018 and about the same number of babies were stillborn in 2015 [8]. Despite the effort made under the Millennium Development Goals (MDG) and Sustainable Development Goals (SDG), disparities in maternal, newborn and child health outcomes between developed and developing countries remain wide. While looking at these numbers and inequities, it is critical to examine why mothers are dying during childbirth and what could be done to prevent these deaths, especially in low resource settings.
There has been ongoing advocacy on utilising the social support for women during childbirth to minimise risks of dying [9–11]. Sadly, it has not yet been translated to change in the way maternity care is provided to women, which remains mostly medically driven. It still raises a serious question about the healthcare systems in most of the developing countries which have failed to ensure the survival of mothers and babies. This clearly signifies the role that social, cultural, economic and political factors play in designing and delivering care to women during pregnancy and childbirth.
Childbirth is a powerful personal event as well as a significant social experience for women of any society [12–14]. Despite the similar physiological process, women in different cultures and societies experience childbirth differently [15–27]. Therefore, understanding the childbirth experiences of women must entail understanding their culture, tradition, belief system and social values [28]. It has been argued consistently that the degree and type of women’s choice and control depend on the construct of society where they experience childbirth [29–37]. Factors such as gender, power, social status, geography and the economy further impact women’s choice and control about their childbirth. The influence of these factors, which are known as social determinants has been critical to reduce maternal and newborn mortality in developing countries.
In most parts of South Asia, childbirth is considered as a socially and culturally rich event with special traditions and rituals. Many women continue their traditional practices during pregnancy, childbirth and the postnatal period even when they migrate to other countries. Some strong belief and traditional practice restrict women from seeking medical care when needed, and this increases the risk of illness and deaths [38]. Common factors such as the concept of purity and pollution during and after childbirth, the use of traditional healers, construct of health and illness being related to deities, beliefs related to food, myths around what is accepted and now influence pregnancy and childbirth found to be critical to shape childbirth experiences [39]. In these societies, childbirth is considered as a natural process and the tendency to seek medical help only occurs when there are serious problems – which is normally the last option.
Although there is not enough evidence to confirm the correlation of the socio-cultural factors to birth outcomes, limited research shows that South Asian born women are two times more likely to experience late pregnancy stillbirths than locally born women accessing the same public maternity services [40–42]. Nevertheless, consistent emphasis has been given to examine the influence of wider determinants to childbirth experiences of women to improve birth outcomes [43–45]. This book provides both social and cultural insights focusing on the wider determinants and practices related to childbirth in the context of South Asia. Drawing childbirth stories of women from the remote mountain villages of Nepal, I argue for a collaborative model of childbirth to promote maternal and newborn survival in cross-cultural settings.
Childbirth: medical or socio-cultural event
Public health research focuses on reducing inequalities of health outcomes related to childbirth within and between nations to prevent adverse results including the unnecessary deaths of mothers and babies in community settings [46–49]. In developing countries, there is significantly higher prevalence of childbirth-related complications leading to the deaths of mothers and newborn babies [50–54]. The South Asia region still has unacceptably high mortality and morbidity rates [55–60]. Childbirth is medically defined as a physiological phenomenon which denies the significance of maintaining social, cultural, spiritual and emotional safety for women. As a result, medical literature has heavy focus on physical risks and use of clinical measures and technologies to avert risks [26, 61–64].
Many sociologists challenged the way childbirth is viewed and managed medically as failing to acknowledge the influences of socio-cultural dimensions of women [64–68]. Me...
