PUH 3O5: REPRODUCTIVE HEALTH

Harmful traditional practices (HTPs) are deeply rooted customs and beliefs that negatively

impact individuals, particularly women and children. These practices often violate human rights

and pose serious health risks. Or HTPs are customs or rituals that are rooted in cultural beliefs

but end up putting a pregnant woman’s health or the babies at risk. They are usually passed down

through generations and are seen as “normal” in the community, even though they violet basic

human rights. Examples are Female Genital Mutilation (FGM), Nutritional taboos, Herbal

cleansing, or strengthening concoctions, Restrictive abdominal binding and traditional birth

practices

Harmful traditional practices are typically characterized by several factors:

 Long-standing cultural or social norms

 Perpetuation through generations

 Resistance to change due to cultural significance

 Disproportionate impact on vulnerable groups

HARMFUL TRADITIONAL PRACTICES DURING PREGNACY: These are rooted customs

or rituals that ends up putting pregnant women and the feotus at risk. Below are some of the

examples of harmful traditional practices during pregnancy.

1. Female genital cutting/mutilation (FGC/FGM): This is a traditional practice in which part or

all of a girl’s or women external genitalia are removed or injured for non-medical reasons. It’s

also called female genital mutilation is widely recognized as a violation of the rights of girls and
 women. Many countries have laws banning it and international bodies e.g WHO, and UN call for

its elimination.

Types of FGM

FGM includes a range of procedures, classified by the World Health Organization into four main

types:

 Type I (Clitoridectomy): Partial or total removal of the clitoris.

 Type II (Excision): Removal of the clitoris and labia minora, with or without excision of the

labia majora.

 Type III (Infibulation): Narrowing of the vaginal opening by cutting and repositioning the labia,

sometimes with removal of the clitoris.

 Type IV: All other harmful procedures to the female genitalia for non-medical purposes (e.g.,

pricking, piercing, incising, scraping or introducing substances)

Health consequences of FGM

1. Severe Pain

2. Bleeding

3. Infections

4. Shock

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6. Urinary and menstrual problems

7. Complication during child birth

8. Psychological trauma
2. NUTRITIONAL TABOOS

Nutritional taboos are culturally or religiously prescribed prohibitions against consuming certain

foods, especially during significant life events like pregnancy. These taboos are widespread

globally and can significantly impact the health of pregnant women and their babies or

Nutritional taboos are restrictions on specific foods or food groups based on cultural, religious,

or social beliefs, rather than scientific evidence. During pregnancy, these taboos are often

intended to protect the mother and feotus but may lack scientific basis and can lead to negative

health outcomes. Nutritional taboos during pregnancy are widespread and often lead to the

avoidance of essential foods, increasing the risk of malnutrition and adverse pregnancy

outcomes. Some taboos discourage alcohol, excess sugar, or very spicy/toxic foods, others are

snail and egg with reason that the child will drool and steal respectively. Some religious bodies

forbids the eating of crayfish.

TYPES OF FOOD AND COMMON REASONS FOR AVOIDANCE

S/N Tabooed Foods Common Reasons for Avoidance

1. Eggs, milk, and dairy Fear of causing a "fat baby" or difficult delivery

2. Meat (including offal, chicken, fish) Belief it causes fetal abnormalities, miscarriage, or convulsions

3. Fruits (banana, mango, orange, papaya) Fear of "plastering" on fetal head, miscarriage, or fetal

discoloration

4 Vegetables (cabbage, pumpkin, green leafy) Belief they cause abdominal cramps or coat the fetus

5 Honey, sugarcane, nuts, legumes Various cultural beliefs, including making the baby "sticky" or

causing illness

6 Snail When the child is born, he/she will be drooling

EFFECTS OF NUTRITIONAL TABOOS ON PREGNANT WOMEN

Maternal and Fetal Health Risks: Examples include: Increased risk of maternal anemia, low
birth weight, preterm birth, fetal growth restriction, and poor cognitive development in the child.

Intergenerational Malnutrition: Chronic under nutrition during pregnancy can perpetuate

cycles of stunting and poor health across generations.

Social and Psychological Impact: Taboos are often enforced by family and community elders,
making it difficult for women to break these practices without support

3. HERBAL CLEANSING OR STRENGTHENING CONCOCTIONS

Many cultures use mixed herbal drinks or decoctions in pregnancy to “cleanse the womb,”

“strengthen” the mother, or “prepare the body” for labor. This poses a great risk to the feotus and

the mother. Potential effects include uterine contractions, miscarriage preterm birth,

teratogenicity, and herb–drug interactions when combined with conventional medicines

Examples of risks from traditional mixtures

Concoction / use Reported problems

Isihlambezo (Southern Africa, Direct uterotonic effect; low birth weight, fetal distress,

labor prep) uterine rupture at high doses

Mwanamphepo (Malawi, labor ↑ maternal morbidity; ↑ neonatal death/morbidity

induction)

Various mixed teas/decoctions Links with preterm birth, C-section, fetal growth issues

(global) in some cohorts

Agbo Toxicity interactions, uterine contractions (miscarriage

 Concoction / use Reported problems

risks).

4. RESTRICTIVE ABDOMINAL BINDING

 Restrictive abdominal binding (belts, corsets, bengkung/stagen) is mainly studied after birth, not

during pregnancy. Evidence focuses on pain, function, and diastasis recti abdominis (DRA),

( DRA is when the abdominal muscle like the six -pack muscles) separate along the midline,

often due to strain or pressure and can result to bulge or pooch). Very tight or prolonged binding

during pregnancy could theoretically worsen intra-abdominal pressure, venous return, or fetal

perfusion. Postpartum moderately tight abdominal binders appear useful and generally safe for

short-term pain relief and support. Strong restrictive binding should be avoided, and any support

garments should be comfortable, allow normal breathing, and be discussed with a clinician.

5. TRADITIONAL BIRTH PRACTICES

Traditional birth practices are cultural beliefs, rituals, positions, and caregiving customs used

during pregnancy, labor, birth, and the postpartum period, usually outside or alongside

biomedical care, often led by family members or traditional birth attendants.

Core elements of traditional birth practices

 1. Place, attendants, and birth positions

 Preference for home birth with relatives and traditional healers or birth attendants, often seen as

courageous, intimate, cheaper, and more supportive than facilities.

 Use of traditional midwives/TBAs, whose skills are learned through apprenticeship, dreams, or

family lineage, sometimes linked to spiritual gifts

 Non-supine positions (squatting, standing, kneeling, vertical birth) are commonly preferred but

can clash with hospital routines

2. Rituals, beliefs, and spiritual practices

 Rituals to protect mother and baby: singing, dancing, prayers, holy water, spiritual ceremonies,

and offerings to spirits or deities

 Use of herbs and traditional medicines to induce or ease labor, manage pain, or “widen the birth

canal” e.g Raspberry leaf, red clove and cinnamon

 Strong symbolism around the placenta and umbilical cord, with specific rules for cutting and

burial to safeguard the child’s future

3. Postpartum customs

 Confinement/seclusion periods, sometimes in dark or restricted spaces, to protect a “weak”

mother from illness or pollution

 Rest and community care (e.g., omugwo in parts of Africa), where mothers are excused from

chores to recover and bond with the baby

 4. Health implications and integration

 Practices can be protective (rest, social support, some hygiene and delayed cord clamping)

or harmful (unsafe herbal induction, delaying care, applying substances to the birth canal)

 Supporting traditional midwives and integrating respectful cultural elements into health services

can increase cultural safety without worsening outcomes, and may reduce complications

HARMFUL TRADITIONAL PRACTICES ON CHILDREN

Harmful traditional practices on newborns are common worldwide and contribute to infections,

sepsis, developmental problems, and sometimes death. Health education that respects culture but

clearly replaces these practices with evidence-based newborn care is consistently recommended

combined with effective safe motherhood reduction strategies is consistently recommended.

Combine with skilled and respectful care at birth.

1. Feeding and breastfeeding

 Discarding colostrum, delayed breastfeeding, prelacteal feeds (honey, sugar water, animal milk,

water) increase infection risk and undermine exclusive breastfeeding (colostrum is like liquid

gold newborns, it’s the first milk, packed with antibodies and nutrients that boosts babys

immunity, helps in gut development and provide vital nutrients.

 Early supplementation and bottle feeding are linked with higher neonatal sepsis

2. Umbilical cord and skin care

 Applying ashes, cow dung, toothpaste, heeng/asafoetida, powders, cow dung, or herbal pastes to

the cord or umbilicus increases infection and sepsis risk

 Rubbing dough or harsh substances on the skin to remove hair can cause skin damage and

infection

3. Eye, ear, and respiratory practices

 Kajal/kohl to eyes and face is very common and can carry heavy metals like lead and cause eye

infection or poisoning

 Pouring oil into ears or nose is widely practiced and may lead to ear/nasal infections or

aspiration

4. Burning, branding, and toxic substances

 In some states in Nigeria, newborns may be burned, branded, pierced, or have toxic mixtures

(e.g., Sagwa with herbs, animal parts, lead) applied to the shaved scalp, potentially causing

poisoning, severe complications, and death

5. Bathing, swaddling, smoke, and isolation

 Immediate or early bathing can cause hypothermia and is linked to higher neonatal risk

 Restrictive swaddling increases risk of overheating, SIDS (sudden infant death syndrome), and

hip problems

 Exposing newborns to herbal or incense smoke for healing or protection may harm lungs

 Prolonged seclusion in dark rooms and isolation can delay care-seeking

 SAFE MOTHERHOOD MORTALITY REDUCTION STRATEGIES

Safe motherhood focuses on preventing women from dying or being disabled during pregnancy,

childbirth, and postpartum. Research shows maternal deaths fall most where countries combine

strong health systems, rights-based policies, and community interventions rather than single,

isolated actions. Examples of safe motherhood mortality reduction strategies include, Core

Clinical Health-System Strategies, Community, Demand-Side strategies and Rights-Based

Strategies

Core Clinical Health-System Strategies: These include :

 Having a Skilled birth attendance and emergency obstetric care: Having a provider with

midwifery skills at birth plus rapid referral and surgery

 Functioning referral system: Linked primary-level facilities (health centres) with referral

hospitals (Secondary facilities) are prioritized as the most effective intrapartum strategy. When a

condition cannot be managed at the primary level, there should be a functioning referral system

for referral to be made.

 Community, Demand-Side Strategies

These address the “three delays” (deciding to seek care, reaching care, receiving quality care)

through birth preparedness, transport schemes, and community health workers Community

interventions (health education, CHWs, emergency transport, clean delivery kits) significantly

improve care-seeking and reduce mortality in low-resource areas

Rights-Based Strategies

 Respectful maternity care & reducing obstetric violence improve women’s experiences and

increase facility use.

 Social and policy measures: Safe Motherhood policies, free delivery schemes and incentives

have been central to Nepal’s mortality decline, though weak implementation limits impact

SAFE CHILD MORTALITY REDUCTION STRATEGIES

Reducing deaths in children under 5 requires a mix of clinical, public-health, and social

interventions, especially in the neonatal period and in low-resource settings.

High-impact clinical and preventive interventions

 These involve six clearly effective interventions such as antenatal corticosteroids for threatened

preterm birth, early initiation of breastfeeding, hygienic cord care, kangaroo mother care (A

kangaroo mother care (KMC) is a skin-to-skin contact where a baby is held against the chest in

other to regulates baby’s heartbeat, breathing, boosts bonding and helps in breastfeeding).

Insecticide-treated bed nets for children, and vitamin A from 6 months

 Measures such as quality antenatal care, maternal tetanus vaccination, and prophylactic

antimalarials in pregnancy, case management of neonatal sepsis/pneumonia, and surfactant for

preterm babies, and effective treatment of childhood malaria and pneumonia.

 Essential child-health interventions with strong mortality impact: exclusive breastfeeding,

complementary feeding, routine Immunisation (EPI), vitamin A and zinc, oral rehydration salts,

antibiotics for pneumonia, ITNs, and community case management of common infections

Health-system and community strategies

 Antenatal/intrapartum care and improved clinical management and quality of paediatric care,

plus health education and care-seeking support prevents under-5 deaths

 Health-system strengthening (primary care, referral systems, community health workers)

 Social determinants improve income value, improve maternal education, access to primary care,

multisectoral action on education, WASH, environment, and nutrition is essential to reduce child

mortality.