by Sahara Dhakal Kafle

Have you ever witnessed a newborn or a toddler with sunburned skin, oiled enough to remind you of your visit to the mustard mill, thickly painted kohl eyes and a touch of collyrium on the forehead to ward off evil eyes? I am sure every Nepali newborn household can relate to the above description as this is a common practice in newborn care in South Asia, including Nepal. These practices are cultural rather than traditional because traditions can differ in each family, but culture usually is observed in mass. 

I do not deny the benefits of massage and sun-basking for babies. However, I am against the rigidity and cultural malpractices in rearing and raising infants in today’s information age, and practices that continue despite knowing that it does more harm than good to maternal and child health.

Every society has cultural practices, beliefs, superstitions or taboos concerning pregnancy and childbirth. Each year, many research papers published from countries in Asia and Africa mention that maternal and infant mortality are related to cultural and traditional belief systems. Unfortunately, out of many nations, most deaths before the age of five globally occur in South Asia, including Nepal, and the poorest countries in Africa. 

Having worked as a nurse for many years in the department of Obstetrics and Gynecology, I have witnessed malpractices in baby care right after the baby’s handed to the parents. From my perspective, hospitals in Nepal aren’t known for proper counselling of newborn parents and their families. The pediatrician develops no handouts on ‘dos and don’ts’ after the delivery nor on maternal care before the delivery. The hospitals mostly leave teaching parents about infant care entirely to nurse-educators. I can assure you that underpaid, overworked nurses both in private or government hospitals aren’t motivated enough to sit and counsel every new parent regarding the good and bad practices before discharging a mother and her newborn from the hospital. 

After completion of post-delivery checkups, parents take their baby home, but with qualms as they won’t have the hospital support in taking care of their child anymore. A lack of instructional guidance or understanding about what parents need to know before bringing their newborn home makes them insecure, nervous and helpless, prompting them to seek help from the family matriarch, who with their previous experience in raising children, steps right in. Generally, it’s the matriarchal head of the family who takes responsibility of the mother and the newborn. Middle and upper-class families typically can afford hired nannies with years of practice in traditional handling of baby and mother care. 

If you are wondering about the role of the father, ironically in a patriarchal culture, male involvement is seen as postpartum taboo. Hence, it’s a female affair alone. Nowadays, in many metropolitan cities, it’s common for fathers to be involved in baby care showing equal involvement in child care. However, in previous years and still commonly practiced in rural parts of Nepal, a father of half a dozen children never has had the experience of washing their offspring’s bottom.

Every house has its traditional practice related to raising infants: some little, some many, some helpful, some detrimental. As soon as the baby enters the home, it becomes part of the family’s cultural traditions. These traditional practices can be traced to centuries of passed-on continuum baby care techniques deeply rooted in culture. The most common baby care practice implied in infant and toddler care across all Nepali communities are the indoor use of coal, oil-based vigorous massage, squeezing baby breasts and the use of collyrium in the eyes. These practices have been condoned by medical doctors and pediatricians repeatedly but to no avail. Surprisingly, even educated men and women are influenced by these poor cultural practices of infant care. I have even witnessed well educated people, influencers, and celebrities performing such practices and even endorsing it on social media.  

The journey of motherhood is challenging for many mothers and for about to be mothers. Tradition or cultural practices involved in postpartum care may restrict what new mothers can do. Many mothers have maternal instinct on how to take care of their baby. They are innately adept at recognising their infant’s woes and throes, except for some mothers experiencing postpartum “baby blues” after childbirth. Nonetheless, many mothers don’t have a voice or courage to object to the traditions that seemingly do more harm than good to their baby. I call this emotion a “postpartum dilemma”. Many mothers know that the practice is harmful to their baby, but she does it for convenience, under family pressure, and to please the elders. 
It’s time to intervene in practices associated with bad maternal and infant childcare and follow procedures and ways that have medical claim based on systemic observation and development made in medicine.

Hospitals and the government should effectively intervene to discourage poor practices in antenatal and postnatal care by creating stronger awareness. For example, a pediatrician could prepare questionnaires or brochures based on the baby’s developmental stages to keep parents aware of regular developmental changes which will help boost their confidence while caring for their baby. In many countries, the “pregnant mother conference” is viewed as one of the needed interventions to reduce infant and maternal mortality rates and promote family support. The Ministry of Health alongside hospitals and healthcare facilities must organise and encourage women to participate in pregnant mother conferences, foster antenatal care service utilisation and counsel on dangers and complications associated with traditional malpractices involved in infant and mother’s care. 

I am aware that the roads to behavioural change in newborn care need more than creating interventions and awareness. The mothers have to be bold enough to object and ditch the customs and say NO to the pressure put on her by the elders in her family. Our innate understanding of culture and traditions is to respect them, no matter how awful and ill-advised. Undaunted mothers of today have to be the voice for mothers of tomorrow and disregard any bad traditional practice that does not support the betterment of their children. Women of today can make motherhood easier for women of tomorrow. For now, we have to find an intersection where both medical and cultural faculties meet with logic and wellbeing.

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