Cultural Practices and Their Impact on Healthcare
28-01-2025
Abstract
Culture is a pivotal factor that shapes perspectives and individual behaviours. In African and South Asian contexts, traditional practices have fostered both positive and negative impacts on women's health. While collectivistic traditions demonstrate the benefits of community support and generational knowledge transfer, patriarchal norms have sustained harmful practices and taboos. These negative cultural influences worsen gender discrimination, hinder healthcare access, and contribute to higher rates of maternal and child mortality.
Understanding and addressing these challenges requires culturally sensitive, community-driven interventions. Emphasising the positive aspects of traditional practices while addressing their harmful facets could foster acceptance of modern healthcare solutions. Empowering local health workers, integrating traditional medicine, engaging men in discussions on women’s health, and incorporating reproductive health education into school curricula can help dismantle stigmas and improve outcomes. A nuanced approach that respects cultural diversity while advocating for gender equity is key to ensuring healthier and more equitable futures for women in these regions.
Introduction
Culture is a silent force that shapes societal outlooks and individual actions. Revolving around togetherness and community support yet entrenched in patriarchy, African and South Asian traditions and generationally passed down practices have perpetuated aspects such as healthcare as well. An understanding of the attitudes and mindsets that shape these cultural practices is key to fostering meaningful strides toward change.
Collectivistic Communities
With communal well-being and family centricity, the female community offers immense support to one another, significantly improving maternity and menstrual experiences. Whether the Nigerian Onugwu tradition or Indian Sutak, these women-centric traditions allow for rest and recovery while ensuring the availability of appropriate diet, physical care and mental support.
Omugwo is a Nigerian practice where the mother and grandmother tend to the new mother, assisting with household chores and care of the newborn. They help ease the transition into motherhood by showing the ropes of tending to a baby, helping with soothing massages and providing dietary guidance for food that assists with postpartum recovery and breastmilk production. With the added benefit of comfort and familiarity helping the mothers overcome postpartum mental health issues, home remedies such as the consumption of spicy food and Sitz baths help remove internal clots and heal reproductive organs. Similar practises in South Asia, such as China (Zuo Yuezi) and India (Sutak), emphasise oil massages, belly binding and diet, ensuring rest and recovery while fostering community support.
Female community health workers, such as dais in India and Shasthya Shebikas in Bangladesh, are older women from within the local communities who offer specialised care and expertise while adhering to cultural norms. This significantly improves maternal and child welfare. Similarly, in Ethiopia, women health workers deliver services while respecting local customs and traditions.
Misogyny and Patriarchy
Prevalence of the dowry systems, such as dahej in India or serotwana in Africa, is a major contributor to the gender preference leaning toward boys in African and South Asian communities. What began as a practice of providing for their daughters and ensuring their financial security, the dowry has evolved into a payment to the groom as a means of reflecting the bride's worth. The financial strains of this practice, especially in rural areas, have led to female infanticide, suicides and severe mental health issues among women (Freda, 2024).
A cultural preference for a boy child has led to neglecting the girl children through disregard of preventive care, immunisation, and poor nutrition. 6% more girls than boys are severely stunted, and 13% more girls than boys are unvaccinated. Owing to this, Indian and Pakistani girls between the ages of 2 and 5 are almost 50% more likely to die than boys (Pande et al., 2010). Moreover, these cultures impose restrictions on female autonomy. These restrictions are true for healthcare as well. Women are most often required to be accompanied by their spouses, fathers, or other male guardians while visiting doctors. This cultural barrier delays critical medical interventions, especially during childbirth, contributing to high maternal mortality rates (Fikree & Pasha, 2004).
The male-centricity of these cultures has also played a role in the taboo around menstruation and stigmas surrounding sexual health. This holds especially true due to hesitation in speaking up in the presence of a male guardian. The stigma prevents women from seeking contraception or treatment for sexually transmitted infections. Maternal deaths, most commonly from the likes of haemorrhage, sepsis, and eclampsia, continue to take a large toll. Unsafe abortions causing haemorrhage and sepsis also contribute to female mortality rates.
Taboos around menstruation have led to unsafe practices in these nations and render women vulnerable to both mental and physical traumas. For instance, the practice of chhaupadi in Nepal forces menstruating women to stay in isolation, often in huts with minimal provisions in wild, unsafe areas. This exposes them to risks of hypothermia, snake bites, and assault. Myths of impurity of period blood and looking at menstrual cloth leading to blindness in men fuel this stigma. Further, a combination of the taboo in speaking about menstruation coupled with the need for male guardianship for women stepping out of the house often prevents women from seeking products required for menstrual hygiene. 42.5% of women in India use old cloth pieces, and 73.5% of them reuse cloth pieces, causing reproductive tract infections (Mustafa, 2019).
Child Marriage
Until the early 1900s, average life expectancy was between 25 and 35 years, and therefore, marriage at the age of 10 was common practice in the Global South. Although life expectancies began improving over time, fear of invaders and monarchs sexually assaulting unmarried women led to the continuation of this practice. Entrenched in unquestioning beliefs and superstitions, several parts of Africa and South Asia have upheld this practice of marrying children off at young ages despite enhanced life expectancies and the demise of monarchial setups.
Source: Statista, 2024
Early marriage often implies forcefully partaking in early sexual activity and childbearing. Girls between the ages of 15 and 19 are twice as likely to die of pregnancy and childbirth, as well as complications between the ages of 20 and 24. Because their bodies are not yet fully developed, young adolescents are at much greater risk of suffering life-threatening or debilitating conditions as a result of childbirth, like obstetric fistula and haemorrhaging (Sinclair et al., n.d.).
Way Forward
Addressing health challenges posed by cultural practices requires culturally sensitive and community-driven interventions. Acknowledging the positive aspects of traditional methods will facilitate cross-learning across nations. Further, building on cultural beliefs and mindsets will enhance the chances of acceptance of modern notions and changes that are being advocated. Having people belonging to the same communities advocate these issues could improve acceptability and add credibility to the need for change.
Incentivising and training midwives on the necessary skills needed to tackle women's health beyond maternal care could help reduce the reliance on male guardianship in getting medical attention. In addition, this could help tackle the problems arising from neglect of the girl child. Empowering midwives with the needed tools and at-home solutions could ensure a greater degree of preventative health participation, a higher number of girls receiving immunisation vaccines, and care and guidance during menstruation, among others. Moreover, integrating traditional medical practices like Ayurveda or Unani could improve the acceptance of healthcare services, particularly amongst rural communities.
Furthermore, engaging men in discussions pertaining to women's needs and health could help break through the stigma and taboos surrounding reproductive and menstrual health. Increased familiarity with these issues could help normalise and thereby increase sensitivity toward women’s healthcare needs. On a similar note, integrating the scientific/biological aspects of phenomena like periods into school syllabi will a) raise awareness and sensitised kids, b) enable men to understand the critical need for seeking timely medical attention for women-specific ailments, c) make girls more comfortable with their bodily changes reducing the mental trauma and empower them to take a stance for themselves, d) help girls take more informed intentional preventative measures toward their health.
Finally, South Asian and African cultural practices hold a significant place in shaping women’s health in these nations. While some traditions showcase valuable support and care, others perpetuate harm and inequality. A nuanced approach that factors in cultural diversity and adheres to traditional beliefs while advocating for women’s rights and health is essential. Through education, empowerment, and culturally sensitive interventions, these nations can ensure equitable and healthy futures for their women.
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