By Sandra Michie.
When we move into a difficult cultural situation and begin to understand people’s beliefs in health or other areas, we often face difficulties in teaching new ideas.
Perhaps one of the first principles to remember is that there is much good in every culture, and simply because something is different from our ways it is not necessarily wrong. We need to understand people’s beliefs thoroughly and then to build upon them to bring meaningful change.
Cultural beliefs can be divided into…
- helpful
- harmful
- neither helpful or harmful
Take time to assess each belief with these criteria. This can be very helpful in working out our response to that belief and the actions resulting from it. We need to work from where the people are – from the very basis of their beliefs and traditions. It may take many months, even years, to understand what lies behind some beliefs, but without this understanding it may be impossible to improve the whole situation.
Sit and take time to talk with people of all ages and understand the basis of their beliefs.
CASE STUDY
In the area of Zambia in which I worked, there was the belief that if a mother became pregnant again before the previous baby was actually walking, then the breastmilk turned bad and the first baby would die. This resulted in a cultural taboo on sex for the mother before that child was walking, and also a speedy weaning of such a child if the mother should become pregnant. Then the child would weaken and often die, usually due to malnutrition and infection, as a result of poor weaning foods and complete lack of milk intake – so the belief was carried on.
The older women (“grandmothers”) encouraged the belief, both because they believed it to be fact, and because they wanted to encourage traditional practices in the younger generation – a weaned child would often go to live with grandmother (which pleased her).
The younger women longed for another view that would “liberate” them – the belief created stress in monogamous marriages and often resulted in infidelity, or the resort to polygamy to fill the gap.
Helpful aspects
- A 21 month gap (or longer) between births was good for the mother’s health.
- The baby received the mother’s full attention for at least 21 months.
- Breast feeding for over 18 months was very good for the baby.
Harmful aspects
- The mothers fear that her breastmilk would poison the baby.
- The fantastic attitude that the child would die and it would be her fault.
- The “justified” infidelity and polygamy.
In this situation, the positive aspects needed to be encouraged without strengthening all that the “grandmothers” said. They were the key people. But the role of the men was important. The younger men were used to recognising the truths learned through education and could have an active role in change. The younger couples were often moving out of the cultural society of their parents (by urbanisation, education, etc). If the men would accept changes, they strongly influenced their wives.
Appropriate responses
1. Support of those few mothers who became pregnant before the older child was walking, encouraging them to continue breast feeding as long as possible.
2. Providing a viable alternative method of family planning.
3. Health teaching – on the use of locally available weaning foods and the value of breast milk even if a mother became pregnant again – was given:
- on an individual basis to the distressed mother
- to all mothers at antenatal clinics and visits
- in the home environment and in ways and language acceptable for the older women.
- to the husband and other men of the community
- to school children, who often care for their younger siblings and will soon be parents themselves.
If traditional beliefs are…
Helpful: Encourage them
Harmful: Identify the root of the problem. Seek some non-offensive means of change. Start from where they are now.
Neither: Ignore them.
Sandra Michie spent 25 years in rural Zambia with mission medical work, mainly involved in preventative health care.
