CHAPTER I

PREFACE
1.1 Background
Maternal mortality, deaths during pregnancy, birth or the postpartum period, is a key
indicator of women's health and status (World Health Organization (WHO), 2015a). The top three
direct causes of maternal mortality worldwide are hemorrhage, postpartum infections, and pre-
eclampsia (Say et al., 2014; WHO, 2015a). One of the Sustainable Development Goal (SDG)
targets is to reduce the current global maternal mortality ratio of 216 per 100,000 live births to less
than 70 per 100,000 live births by 2030 (WHO, 2015b). Asia suffers the largest proportion of the
world's maternal deaths. Of the 302,000 global maternal deaths that occurred in 2015, more than
one-third took place in the Asian region (WHO, 2015a). In fact, the Southern Asia region,
consisting of nine countries,1 accounted for about 66,000 of these deaths, while about 4800
occurred in the four countries in Eastern Asia,2 and about 13,000 occurred in the 11 countries of
South-Eastern Asia3 (Alkema et al., 2015; WHO, 2015b). Overwhelming evidence demonstrates
that prenatal care, skilled attendance at birth, and adequate postpartum care could dramatically
reduce maternal (and infant) mortality rates (Bale et al., 2003; Oyerinde, 2013; The United Nations
Children’s Fund (UNICEF), 2015; WHO, 2016). However, the use of these services is low among
some Asian populations. For example, the United Nations (UN) estimates that only 42% of women
in South Asia receive the recommended four or more antenatal care visits and only 49% give birth
with a skilled birth attendant (WHO, 2016). Put into perspective, antenatal care coverage (four or
more visits) in Laos is only at 37%, while it is much higher for Cambodia and Indonesia, at 72%
and 84% respectively. Rates of birth with a skilled attendant is another example of inadequate care,
reaching 42% in Laos, 92% in Cambodia, 87% in Indonesia, and 73% in the Philippines (WHO,
2016). The utilization of formal maternal healthcare also varies greatly within countries. Studies
have documented the considerable disparities in use of maternal healthcare services among women
living in the Asia region, demonstrating that the lowest rates of maternal healthcare utilization
often belong to the most marginalized groups, such as ethnic minorities, women living in rural
areas, women with little formal education, and women with low economic status. In recent
decades, significant progress has been made in reducing maternal mortality primarily by
addressing supply-side barriers, such as the lack of skilled birth attendants or financial constraints.
However, evidence demonstrates that even when skilled formal healthcare is accessible, not all
women utilize these services, suggesting that demand-side barriers, including cultural beliefs,
women's preferences, and other factors which influence the demand for maternal healthcare
services, play an important role in determining the likelihood that women will use formal services.
While childbirth is a biological event, the pregnancy and birth experiences surrounding it are
mostly social constructs, shaped by cultural perceptions and practices. Scholars have argued that
the medical view of pregnancy and birth often fails to appreciate the influence that traditional
beliefs and practices have on maternal healthcare service utilization. For one, beliefs surrounding
a routine, uncomplicated pregnancy may paint a different picture than that commonly shared
within Westernized institutional medical practices. Medical risks or problems during pregnancy
may therefore go undiagnosed for longer, the different view point delaying women from seeking
care at institutional practices while favoring more familiar informal healthcare practitioners.
Considering the significant role that demand-side barriers pose to alleviating maternal mortality,
cultural competency has been garnering greater support as a means to improving the utilization
rates of maternal healthcare services. Often times, simplistic analyses have blamed women and
their family members for their poor utilization of medical services during pregnancy and
childbirth. However, studies from around the world demonstrate that when services are culturally
competent, women and their families express higher levels of satisfaction and have higher rates of
utilization. In order to achieve the SDG target, policymakers and health care providers must find
ways to encourage women from groups with traditionally low rates of maternal healthcare
utilization to access these services. By recognizing and appreciating prevailing local beliefs,
maternal healthcare providers can be better positioned to provide culturally competent care to
women and their families, thereby improving maternal and infant health outcomes when possible.
The purpose of this study is to provide a comprehensive review of the evidence regarding the most
common traditional practices in Asia relating to pregnancy, childbirth, and the postpartum period.
We provide an account of the beliefs and practices that persist in Asian cultures despite the
modernization that has occurred in the past 15 years, examining a broad range of beliefs in three
categories (pregnancy, childbirth, and the postpartum period) and by geographic concentration.

1.2 Formulation of the problem

 1. What is cultural variations influencing pregnancy outcomes?
2. How alternative lifestyles choices?
3. What is maternal role attainment?
4. How nontraditional support systems?
5. How the cultural beliefs related to activity during pregnancy?
6. What is food taboos and cravings?

1.3 The Purposes

1. To know about cultural variations influencing pregnancy outcomes
2. To know about alternative lifestyles choices
3. To know maternal role attainment
4. To know nontraditional support systems
5. To know the cultural beliefs related to activity during pregnancy
6. To know food taboos and cravings

1.4 The Benefits

To make the students collage about cultural variations influencing pregnancy outcomes.

CHAPTER II
 DISCUSION

1. Cultural variations influencing pregnancy outcomes

All cultures recognize pregnancy as a special transition period, and many have particular
customs and beliefs that dictate activity and behavior during pregnancy. Recent reports of
childbirth customs in the united states and Canada have focused on accounts of differing beliefs
and practice relative to pregnancy among various etnich and cultural groups. This section describes
some of the biologic and cultural variation that might influence the provision of nursing care during
pregnancy.

2. How alternative lifestyles choices?

Despite recent cultural changes that have made it more acceptable for women to have careers
and pursue alternative lifestyles, the dominant cultural expectation for north american women
remains motherhood within the context of the nuclear family. Changing cultural expectations have
influenced many middle-class north american women and couples to delay childbearing until their
late 20s and early 30s and to have small families. Some women are making choices regarding
childbearing that might not involve a marital relationship.\

For another group of mothers who chose not to parent, the choices are not as clear. Infant
relinquishment is in direct relinquishment is in direct conflict with western ideal cultural values,
which suggest that all parents want a child. Nurses must examine their own cultural values when
carring for women in this situation, making certain to avoid negatively stereotyping mothers who
decide to relinquish their babies for adoption. The decision to relinquish is almost always difficult,
and the birth mother doesnt forget the experience.

3. What is maternal role attainment?

 The Maternal Role Attainment Theory was developed to serve as a framework for nurses
to provide appropriate health care interventions for nontraditional mothers in order for them to
develop a strong maternal identity. This mid-range theory can be used throughout pregnancy and
postnatal care, but is also beneficial for adoptive or foster mothers, or others who find themselves
in the maternal role unexpectedly. The process used in this nursing model helps the mother develop
an attachment to the infant, which in turn helps the infant form a bond with the mother. This helps
develop the mother-child relationship as the infant grows.

The primary concept of this theory is the developmental and interactional process, which
occurs over a period of time. In the process, the mother bonds with the infant, acquires competence
in general caretaking tasks, and then comes to express joy and pleasure in her role as a mother.

The nursing process in the Maternal Role Attainment Theory follows four stages of acquisition.
They are: anticipatory, formal, informal, and personal. The anticipatory stage is the social and
psychological adaptation to the maternal role. This includes learning expectations and can involve
fantasizing about the role. The formal stage is the assumption of the maternal role at birth. In this
stage, behaviors are guided by others in the mother's social system or network, and relying on the
advice of others in making decisions. The informal stage is when the mother develops her own
methods of mothering which are not conveyed by a social system. She finds what works for her
and the child. The personal stage is the joy of motherhood. In this stage, the mother finds harmony,
confidence, and competence in the maternal role. In some cases, she may find herself ready for or
looking forward to another child.

4. Nontraditional support systems

 A cultural variation has important implications is a womans perception of the need
for formalized assistance from health care providers during the antepartum period. Western
medicine is generally percieved as having a curative rathr than a preventive focus. Indeed,
many health care providers view pregnancy as a disaster waiting to happen, a physiologic
state that at any moment will become phatologic. Because many cultural groups percieve
pregnancy as a normal physiologi process, not seeing pregnant women as ill oe in need of
the curative services of a doctor, women in these diverse groups often delay seeking, or
even neglect to seek, prenatal care.
Pregnant women and their partners are placing increased emphasis on the quality
of pregnancy and childbirth, and many childbearing women rely on nontraditional support
systems. For couples who are married, white, middle class, and infrequent users of their
extended family for advice and support in childbirth-related matters, this kind of support
might not be crucial. However, for other cultural groups, including blacks, hispanics,
filipinos, asians, and native north americans, the family and social network are of primary
importance in advising and supporting the pregnant woman.

5. cultural beliefs related to activity during pregnancy

Pregnancy care is one of the factors that need to be considered to prevent complications
and death during childbirth, as well as to maintain fetal growth and health. Understanding
pregnancy care behavior (ante natal care) is important to know the health effects of the baby
and the mother herself.
Facts in various circles of society in Indonesia, there are still many mothers who consider
pregnancy as normal and natural. They feel they do not need to check themselves regularly to
the midwife or doctor. There are still many mothers who are not aware of the importance of
prenatal care to midwives causing the detection of high risk factors that may be experienced
by them. This risk is only known at the time of delivery which is often because the case is too
late to bring fatal consequences, namely death.
This is likely due to low levels of education and lack of information. Apart from a lack of
knowledge of the importance of pregnancy care, problems in pregnancy and childbirth are also
influenced by marital factors at a young age that are still common in rural areas. In addition,
there is still a preference for child sex, especially in some tribes, which causes the wife to
experience consecutive pregnancies in a relatively short period of time, causing the mother to
have a high risk of childbirth.
For example among the people of the Nuaulu tribe (Maluku) there is a tradition of
pregnancy ceremonies which are considered as an ordinary event, especially the pregnancy
period of a woman in the first month to the eighth month. But at the age when the womb has
reached nine months, then they will hold a ceremony. The nuaulu community has the notion
that when a woman's womb has reached nine months, the woman concerned is overwhelmed
by the influence of evil spirits that can cause various magical dangers. And not only himself is
also the child who is surrounded by him, but other people around him, especially men. To
avoid the influence of these evil spirits, the pregnant woman needs to be exiled by placing her
in posuno. The nuaulu community also thinks that in the life of a child, a new human being is
created or just started in the womb which is 9 months old. So in this case (pregnancy period 1-
8 months) by them is not considered a process of starting life forms.
Another problem that has a significant effect on pregnancy is a nutritional problem. This
is because there are beliefs and restrictions on some foods. Meanwhile, their daily activities
are not reduced plus the restrictions on some foods that are really needed by pregnant women
will certainly have a negative impact on the health of the mother and fetus. No wonder that
anemia and malnutrition in pregnant women is quite high, especially in rural areas.
In Central Java, there is a belief that pregnant women abstain from eating eggs because it
will complicate labor and never eat meat because it will cause a lot of bleeding. While in one
area in West Java, a mother whose pregnancy entered 8-9 months intentionally had to reduce
her food so that the baby she conceived was small and easily born. In the Betawi community
prevents eating salted fish, sea fish, shrimp and crabs because it can cause milk to become
salty. And indeed, besides her mother's malnutrition, the weight of a baby born is also low. Of
course this greatly affects the baby's endurance and health.
6.Food taboos and cravings
Food taboos are as universal as food. It stands to reason then that they have helped us
through the years in our efforts to avoid killing ourselves. As it turns out, some of the most
fascinating food taboos dovetail with another basic human desire–reproduction.
All around the world, there are all kinds of rules about what pregnant woman can and
cannot eat. (As if it weren’t hard enough being pregnant without everyone offering their well-
intended advice.) “Declaring certain foods taboo because they are thought to make a person sick
is also the basis for the many food taboos affecting pregnant
women,” according to ethnobiologist Victor Benno Meyer-Rochow of Finland, who studies
folk wisdom.
Some of these taboos are myths and some of them have a modicum of grounding in science.
And many of them are still practiced today. When adhered to, they help make a group feel
connected, says Meyer-Rochow.
Most of us are already fairly familiar with some common religious food taboos: No meat
on Fridays during Lent for Christians, Halal and Kosher laws for Muslims and Jews, prohibitions
against consuming beef for Hindus, a taboo on all meat for Buddhists. There are other, non-
religious taboos too–horses and guinea pigs are kept as pets in the United States, but fine for food
in France and Peru. But there’s so many more, particularly aimed at protecting pregnant women.
Top of Form
Some Nigerians believe eating yams might make a baby too big to deliver, and eating fish can
cause late delivery in Tanzania. Speaking of fish, it may cause a woman to have graceful children
(in ancient Jerusalem lore), or an upside down fetus and extra long delivery (in Indonesian tales).
An Unprecedented Look at a Young Woman’s Face Transplant
In rural Laos, eating rats is verboten for a woman in the family way, but in western Malaysia, rats,
frogs, and other “small” spirits are fine to eat, so long as a husband or close relative does the killing
(the baby’s spirit is too weak for larger grub like turtles and anteaters).
Here are some other food (and drink) taboos for pregnant women:

Eggs
Eggs have long been associated with sexuality, reproduction, and new life in
general. Despite the obvious symbolism with pregnancy, eating eggs (and often chickens and
other birds that lay them) is a fairly common taboo for pregnant women. In Indonesia, chicken
eggs are off limits, lest the baby be “chicken” about making an appearance and thus lengthening
delivery for mom. Like peanuts, eggs are one of the top eight food allergens but also like peanuts,
studies now suggest that egg consumption during pregnancy is fine. Consuming raw eggs,
however, is discouraged in the U.S. because of concerns about salmonella contamination.
Alcohol
Many doctors advise against all alcohol consumption for pregnant women. And yet, a
recent Danish study suggests moderate drinking (about 5 glasses of wine a week) is fine for the
expecting mama. One study even suggests that actual alcohol consumption might not matter as
much as the social implications of said consumption for pregnant women–proof (excuse the pun)
that whatever side you fall on, alcohol is definitely a taboo during pregnancy.
Cold Foods… and Hot Ones
Traditional Chinese medicine dictates that qi (vital energy) must be balanced
between yin (negative) and yang (positive) forces. Since diet is an important source of qi,
avoiding certain foods is thought to be key to preventing miscarriages or problems with the
baby. And reports suggest many Chinese women still follow these “rules” today.
Pregnant women must avoid eating or even preparing cooling foods, like ice cream, watermelon,
bananas and mung beans. Such foods have too many yin qualities, and might cause a
miscarriage. But “wet-hot” foods, like shrimp, mangoes, pineapples and lychees, are also to be
avoided, because they might cause allergies or skin problems for the baby. Spicy, cold, or oily
foods can also weaken qi and cause infertility.
Food taboos offer an important window into our development as a species. It’s no mistake that
many taboos, for men and women, center around major life events–pregnancy and birth, death,
coming-of-age ceremonies and illness. According to Meyer-Rochow, “one of the aims of food
taboos is to highlight particular happenings, making them memorable.”
Pregnancy itself is pretty memorable. Trying to sort through all the rules about what you should
and shouldn’t eat with a baby on board? That’s a little harder.
 CHAPTER III
CONCLUSION
Culture as it relates to pregnancy and childbirth was discussed from many vantages points.
Biologic and cultural variations that can affect childbearing outcomes were indentified and
analyzed. Women choosing alternative childbearing lifestyles were examined. The importance of
nontraditional support systems to pregnant women, along with discussions of cultural beliefs and
preactices as they relate to pregnancy, birth, and the postpartum period, were suggestion for
nursing care.