title: Cultural theories of postpartum bleeding in Matlab, Bangladesh: implications for community health intervention.
abstract: Early recognition can reduce maternal disability and deaths due to postpartum haemorrhage. This study identified cultural theories of postpartum bleeding that may lead to inappropriate recognition and delayed care-seeking. Qualitative and quantitative data obtained through structured interviews with 149 participants living in Matlab, Bangladesh, including women aged 18-49 years, women aged 50+ years, traditional birth attendants (TBAs), and skilled birth attendants (SBAs), were subjected to cultural domain. General consensus existed among the TBAs and lay women regarding signs, causes, and treatments of postpartum bleeding (eigenvalue ratio 5.9, mean competence 0.59, and standard deviation 0.15). Excessive bleeding appeared to be distinguished by flow characteristics, not colour or quantity. Yet, the TBAs and lay women differed significantly from the SBAs in beliefs about normalcy of blood loss, causal role of the retained placenta and malevolent spirits, and care practices critical to survival. Cultural domain analysis captures variation in theories with specificity and representativeness necessary to inform community health intervention.
authors.affiliation: Center for Research on Maternal and Newborn Survival, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia 30322, USA. lsibley@emory.edu
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Sibley
authors.forename: Daniel
authors.initials: D
authors.lastname: Hruschka
authors.forename: Nahid
authors.initials: N
authors.lastname: Kalim
authors.forename: Jasmin
authors.initials: J
authors.lastname: Khan
authors.forename: Moni
authors.initials: M
authors.lastname: Paul
authors.forename: Joyce K
authors.initials: JK
authors.lastname: Edmonds
authors.forename: Marjorie A
authors.initials: MA
authors.lastname: Koblinsky
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh; D003153:Community Health Services / Q000379:methods*; D003469:Culture; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006700:Home Childbirth; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D008880:Midwifery; D006473:Postpartum Hemorrhage / Q000628:therapy*; D012424:Rural Population; D055815:Young Adult