Indigenous postpartem maternal and child health care practices among the Igbo of Nigeria

Dan S. Obikeze

Noting the apparent neglect of postnatal maternal care in the modern health care system, the author describes the indigenous postpartum maternal and child health care rites and observances among the Igbo of Southeastern Nigeria. Next, he examines these practices against the background of the Igbo conception of health, and recommends that Igbo health practices be adapted and incorporated into the primary health care programme.

The reproductive process comprises three closely interrelated vital events: pregnancy, parturition (delivery) and the puerperium. In recognition of the importance of these events for the survival of human society, all health systems--both traditional and modern--provide some form of specialized maternal and child care. But there are considerable differences with respect to the attention to, and emphasis on, each of the three components. To cite Edouard and Foo-Gregory: "each culture has its own birthing system, reflecting the inherited values of that society." (1985:3). In general, the modern health care system emphasizes pregnancy and delivery, while somewhat neglecting the puerperium (Bender and Ewbank 1994:67,72; WHO 1996:2). And yet a large proportion of maternal and neonatal mortality and morbidity occurs during the postpartum period (WHO 1993:7). Many of the traditional health systems of Asia, Africa, the Middle East and Latin America, by contrast, have developed elaborate and effective postpartum health care practices, rites and observances based on their local experience (Gideon 1962; Longo 1964; Chen 1973; Pillsbury 1978; Greenberg 1982; Finerman 1984). This article documents and highlights the indigenous postpartum maternal and child health care rites found among the Igbo of Southeastern Nigeria. The author believes that modifying and incorporating some of these health practices into the modern health care system would represent a significant improvement.

The Omugwo postpartum rites
Among the Igbo of Nigeria, the puerperium or 'Omugwo' lasts for one lunar month (28 days) after child delivery. The period is normally calculated as seven 'market weeks' of four market days each. In the case of health centre or hospital deliveries, the Omugwo observances commence when the mother is discharged and returns home. Usually, the mother and the baby are taken into her hut or appartment, where a fire has been made for them. The mother has the infant in bed with her, so that it can nurse whenever it wants to. As Uchendu observes, "to put a baby in a separate place is regarded as showing want of love for the baby and little respect for one's duty as a mother" (1965:59).
During Omugwo, the mother is confined to the house, is relieved of all chores, is given special food, and is nursed by her own mother (the baby's grandmother) or an elder sister. The grandmother takes over her daughter's household, supervising the preparation of regular meals for her son-in-law and other household members. She instructs her daughter on the appropriate Omugwo rites and ensures that she observes the various prescriptions and proscriptions related to day-to-day activities during the puerperium. There are considerable local variations in the number and content of Omugwo observances and practices, but the following are common in most Igbo communities in Nigeria:

Rest and exercise
During the first 'izu' (market week) the woman is confined to her room, and spends most of her time in bed. She is not allowed to go into the kitchen, to enter the yam barn, or to touch raw food. The end of the first izu is marked by certain ceremonies; the mother is then allowed outside her house, but may not leave the family compound until after the third izu. However, if the need arises, these restrictions may be temporarily waived in order to enable the mother--escorted by her own mother--to keep doctor's appointments for postnatal check-ups or baby inoculation dates.

Dietary practices
Soon after delivery, the new mother is given a stimulating hot soup made with dried fish, meat, yams, plenty of pepper and a special herbal seasoning called 'udah', which makes the uterus contract and thus helps in expelling getting rid of blood clots (Iweze 1983). From then on, she is encouraged to eat anytime she feels like, just as the baby nurses at will, day or night. The grandmother or the Omugwo nurse sees to it that the mother follows a special diet. According to the older women I talked to in Orumba during focus-group discussions, the function of the diet is fourfold:

· to restore blood lost during childbirth (highly nutritious);
· to restore energy (invigorating);
· to facilitate the healing of wounds and restore normal bodily functions (therapeutic and medicinal);
· to promote milk flow (lactative).

The dishes are meaty and peppery with a little palm oil, and are always eaten hot.
The husband is expected to provide his wife with regular supplies of fresh palm wine during Omugwo, as well as other energy-giving drinks and beverages. Palm wine contains a high level of yeast which is good for the milk flow.

Bathing practices
Sponge bathing the new mother and the baby is the responsibility of the grandmother. During this daily ritual, the mother sits on a low kitchen stool before a bowl of hot water containing medicinal herbs. As she receives a general sponge bath, the abdomen and hips are given a vigorous massage with bath towels, herbs and hot water. One of the older women interviewed in the Nsukka area described the sponge bath as a most soothing experience. To complement the massage, and to help the abdominal muscles to regain good tone, bands of cloth are tie tightly around the abdomen.
Baby care
Each day the grandmother gently washes the baby with warm water. She then massages its body, stretches the limbs, and rubs oil all over its body. She cuddles the baby before giving it back to its mother who, as noted above, keeps it with her and allows it to feed on demand.
Until the milk flow is established (or if the mother is ill), the baby is wet nursed by the grandmother or some other lactating kinswoman.
The grandmother also regularly cleans the umbilical cord stump and applies medicated oil. Occasionally, the baby is given boiled and filtered water to drink.
If the infant or its mother falls ill, the grandmother first tries home remedies that have proved helpful in the past; only when these fail is hospital treatment sought.

Housekeeping lessons
The grandmother shows her daughter how to change the baby's nappy, and allows her to practice doing it. This is only one of the many things the young mother learns by doing during the Omugwo period. It offers a unique opportunity for her to ask questions about managing her home. Housekeeping, child care, conflict management, knitting, and sewing were the most common skills learnt by the women I talked to during focus-group discussions. In addition, the close and intimate interaction with the mother or elder sister brings with it many added and unexpected benefits. The following examples may serve to illustrate this.

When asked if they had learnt anything especially valuable during Omugwo, Mrs Nwama said:
'As a young girl, I did not bother to learn how to prepare the traditional dish called 'nri oka' and the special soup that goes with it. So some months after the wedding I was embarrassed when my husband asked me if I would prepare this dish for our guests. When my mother came for my first Omugwo, I asked her to teach me how to prepare this meal. Since then I have become a local nri oka specialist!'

And Mrs Oyiboka said:
'Two remarkable things happened during my first Omugwo. My mother helped settle a long-standing misunderstanding between me and my husband's brother's wife. Since then she and I have become the closest of friends.
Secondly, my mother took time to teach me the traditional herbal remedies for common childhood ailments such as convulsions, heat rash, coughs, fever, etc. I am still grateful to her for that.'

Sexuality and contraceptive practices
The Igbo have a tradition of postpartum sexual abstinence which lasts for several months after the delivery, and ideally until the child is weaned. It is considered an abomination to have sexual relations with a woman in Omugwo. The presence of the grandmother in the nuclear family during Omugwo helps to enforce the practice of abstinence, thereby promoting the proper spacing of pregnancies.

Theoretical implications
All of these practices have to be seen against the background of the Igbo conception of health. As in most African societies, that conception is a holistic one, in other words, health encompasses the total well-being of the individual, the family, and the society. It implies a state of physical, social, psychological and spiritual well-being. Seen in this light, Omugwo postpartum rites and observances among the Igbo can be conceptualized as follows.
First, the traditional African practice of having the mother share her bed with the baby, together with breast-feeding on demand, encourages early psychological bonding between the mother and her child. This has far-reaching consequences for the emotional development of the child.
Second, the Omugwo rites and observances emphasize equal care and attention for mother and child during the puerperium, instead of concentrating on the child to the neglect of the mother, as modern health systems tends to do.
Third, Omugwo rites and practices promote cross-generational maternal health. They provide a unique opportunity for young, inexperienced mothers to learn about baby care, family and home management right in their own home. This promotes child and family health both directly and indirectly.
Fourth, Omugwo rites provide older women with a new and highly valued role within the family and society. This contributes greatly to their self-esteem, reputation, and general well-being. The fact that during Omugwo the grandmother is a figure of authority within the family teaches children to cherish, respect and trust these women. In this way, Omugwo observance creates a bond between the woman's nuptial and natal families, and thus enhances family life and social integration.
On the societal level, Omugwo rites clearly underscore the crucial importance of the neonatal period for the survival of human beings and society, as has been shown by demographic and medical research. What is currently needed is a modification of the modern maternal and child health care programmes to fully address the problem of neonatal mortality and morbidity, both of which are acute in the developing world.

Future prospects for Omugwo observance
Let us now consider the prospects for the survival of Omugwo postpartum rites under modern socioeconomic conditions. The three greatest obstacles in modern Igbo society are female employment in the formal sector, urbanization, and migration out of the villages. There are, however, ways to surmount these obstacles. All working mothers in Nigeria get paid maternity leave of at least six weeks, which covers the Omugwo period. If the grandmother is also employed, she can take her annual leave around the time of her daughter's delivery.
As regards the issues of migration and urbanization, the indications are that many grandmothers are delighted at the prospect of visiting an important urban centre or traveling abroad for their daughter's Omugwo rites. To quote two examples which came up during the focus-group discussions conducted for this study:

· In Orumba, Anambra State, one of the women recounted with enthusiasm her first "aeroplane trip" to the city of Lagos to attend her daughter's Omugwo.

· At Nsukka, another woman spoke with pride about travelling to the United Sates of America for her daughter's Omugwo. In her words: 'What on earth would have taken me to the United States if it had not been for the birth of my granddaughter, who has also been named after me!'

For their part, educated working mothers see the observance of Omugwo as a welcome opportunity to have a complete rest themselves and also 'to give Mom a treat'. Omugwo rites are readily adaptable to Westernized lifestyles, and the modern health care system stands to be greatly enriched by incorporating Omugwo health practices into its primary health care programmes.

Dr Dan S. Obikeze
Professor of Sociology and Director of CIKPREM
University of Nigeria
Nsukka
Nigeria

References
Bender, D.E. and D. Ewbank (1994) 'The focus group as a tool for health research', Health Transition Review Vol.4, No.1.

Chen, P.C.Y. (1973) 'An analysis of customs related to childbirth in rural Malay culture', Tropical and Geographical Medicine Vol.25.

Edouard, L. and C. Foo-Gregory (1985) Traditional birth practices: an annotated bibliography. Geneva: WHO/MCH/85.11.

Finerman, R.D. (1984) 'A matter of life and death: health care change in an Andean community', Social Science and Medicine 18:329-334.

Gideon, H.A. (1962) 'A baby is born in the Punjab', American Anthropologist 64:1220-34.

Greenberg, L. (1982) 'Midwife training programmes in highland Guatamala', Social Science and Medicine 16:1599-1609.

Iweze, F.A. (1983) 'Taboos of childbearing and child-rearing in Bendel state of Nigeria', Journal of Nurse-Midwifery 28.

Longo, L.D. (1964) 'Sociocultural practices relating to obstetrics and gynecology in a West African community', American Journal of Obstetrics and Gynecology 89, No.4.

Pillsbury, B.L.K. (1978) 'Doing the month: confinement and convalescence of Chinese women after childbirth', Social Science and Medicine 12:11-22.

Uchendu, V.C. (1965) The Igbo of Southeast Nigeria. New York: Holt, Rinehart and Winston.

WHO, (1993) Coverage of maternity care: a tabulation of available information. Geneva: WHO/FHE/MSM/93.7.

WHO, (1996) Perinatal mortality: a listing of available information. Geneva: WHO/FRH/MSM/96.7.

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