Religio-cultural factors contributing to perinatal mortality and morbidity in mountain villages of Nepal: Implications for future healthcare provision.

PLoS One. 2018 Mar 15;13(3):e0194328. doi: 10.1371/journal.pone.0194328. eCollection 2018. Paudel M1, Javanparast S1, Dasvarma G2, Newman L3. Author information 1 Southgate Institute of Health, Society and Equity, Flinders University, Adelaide, Australia. 2 College of Humanity, Arts and Social Sciences, Flinders University, Adelaide, Australia. 3 Education Arts and Social Sciences Divisional Office, University of South Australia, Adelaide, Australia. Abstract OBJECTIVE AND THE CONTEXT: This paper examines the beliefs and experiences of women and their families in remote mountain villages of Nepal about perinatal sickness and death and considers the implications of these beliefs for future healthcare provision. METHODS: Two mountain villages were chosen for this qualitative study to provide diversity of context within a highly disadvantaged region. Individual in-depth interviews were conducted with 42 women of childbearing age and their family members, 15 health service providers, and 5 stakeholders. The data were analysed using a thematic analysis technique with a comprehensive coding process. FINDINGS: Three key themes emerged from the study: (1) 'Everyone has gone through it': perinatal death as a natural occurrence; (2) Dewata (God) as a factor in health and sickness: a cause and means to overcome sickness in mother and baby; and (3) Karma (Past deeds), Bhagya (Fate) or Lekhanta (Destiny): ways of rationalising perinatal deaths. CONCLUSION: Religio-cultural interpretations underlie a fatalistic view among villagers in Nepal's mountain communities about any possibility of preventing perinatal deaths. This perpetuates a silence around the issue, and results in severe under-reporting of ongoing high perinatal death rates and almost no reporting of stillbirths. The study identified a strong belief in religio-cultural determinants of perinatal death, which demonstrates that medical interventions alone are not sufficient to prevent these deaths and that broader social determinants which are highly significant in local life must be considered in policy making and programming. PMID: 29544226 PMCID: PMC5854484 DOI: 10.1371/journal.pone.0194328 Free PMC Article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5854484/