3.2 Perinatal ritual
A primary focus of the qualitative discussions was to form an extensive list of the rituals and behaviors that surround pregnancy and childbirth and to get descriptions of the context that surrounds them and the reasons people give for doing them. Additional topics included perception and use of the medical system and how people reasoned about perinatal ritual. The result was a compilation of short descriptions of each ritual, behavior, or belief, and their associated reason or consequence (where reported). These were then coded by association with perinatal timeline, consistency with biomedical practice, and for the intention of the ritual (avoid risk or promote health).
Table 3.3: Searchable table of perinatal rituals from qualitative discussions
The raw data for the compiled set of rituals, beliefs, and practices are in 3.3. The Project RISE team prepared and published a synthesis of the rituals captured by the FGDs (Legare et al. 2020), a pdf of which can be found here.
Typing “river” in the searchable table’s column labeled ‘ritual’ yields a set of results across beneficiaries (Mothers) and influencers regarding a commonly held view that rivers should not be crossed over by pregnant women. The reason behind this belief is fairly similar across mothers, mothers-in-law, and Dais. For another example, typing “miscarriage” in the reason column shows what a common concern this is across groups of participants (mothers, mothers-in-law, ASHAs, AWWs, Dais, Pandits, Mulanas). This is one of the few salient concerns that carry across all of the spheres of influence.
The beliefs, rituals, and practices documented in the FGDs were also coded for consistency with biomedical recommendations (consistent, inconsistent, neutral). Examples of behaviors for each category are as follows:
| Consistent | Neutral | Inconsistent |
|---|---|---|
| avoiding hard labor | applying warm water and carom seed compresses to the body | bathing the mother and child within 24 hours of birth |
| side sleeping during pregnancy | placing iron objects in doorway of room to protect from evil eye | applying mustard oil to cord stump |
| immediate skin-to-skin contact | tying a string around the infant’s wrist | not feeding colostrum |
| timely initiation of breast feeding | shaving the infant’s head to help rid impurities |
We found that many rituals were intended to avoid risks and that very few contradicted biomedical recommendations:
| Pregnancy | Postpartum | |||
|---|---|---|---|---|
| Descriptor | Mothers | MILs | Mothers | MILs |
| Count of practices | 152 | 204 | 152 | 212 |
| Health promoting | 19 (13%) | 27 (13%) | 59 (39%) | 102 (48%) |
| Risk averting | 131 (86%) | 175 (86%) | 85 (56%) | 94 (44%) |
| Neutral re biomedical | 123 (81%) | 174 (85%) | 100 (66%) | 128 (60%) |
| Consistent with biomedical | 26 (17%) | 28 (14%) | 18 (12%) | 31 (15%) |
| Contra biomedical | 3 (2%) | 2 (1%) | 30 (20%) | 36 (17%) |
The following is a synopsis of the main findings of the analysis (Legare et al. 2020):
Nearly every belief or practice that participants articulated was directly associated with a health-related outcome or concern
These concerns included a wide range of physical and supernatural risks to both mother and child
- Miscarriage, birth complications, and premature delivery were among the most frequently-named worries
The Jiloi bird: a bird that is probably supernatural that can bring harm if it flies over the head of pregnant woman at night or in the early morning. The harmful effect of exposure to the Jiloi bird could be that the child will be born weak, thin or with a foul odor. Participants say that it is not a bat or an owl. It presents an example of a supernatural cause or agent relevant to perinatal health concerns
Many rituals are associated with preventing the socio-religious notion of the “impurity” of childbirth from spreading to others
- new mothers should refrain from worship, avoid touching water or food sources, and avoid temples, handpumps, and kitchens
Many rituals are associated with protection during solar and lunar eclipses
Some mothers reported that pregnant woman should avoid cutting things during an eclipse because this could cause the newborn to have cuts on their bodies or some physical deformity
Some mothers reported that pregnant women should not eat or sleep during an eclipse, which is also to prevent physical deformities
Some mothers referred to placing amulets in the home during an eclipse. One variety of this was to hang a piece of thread or wood equivalent to the height of the pregnant woman on the wall during the eclipse
Many perinatal taboos and superstitions were associated with avoiding evil eye. Evil eye is a supernatural curse that is believed to be transmitted through a malicious gaze and is usually motivated by envy, jealousy, or lack of reciprocity that may cause illness or even death (Dundes 1981). Taboos and beliefs associated with avoiding or mitigating evil eye included:
- not walking outside, not looking at or crossing rivers, and not reporting pregnancy to others
- rivers are open or barren areas which are more prone to threats from spirits or demons
- many mothers tie a locket around the neck or arm of the mother and infant for protection
- many mothers bring an iron item to the hospital for protection from evil eye
- post-delivery some mothers burned wood at the entrance of the home or kept iron objects outside the room where the mother and infant slept
- sometimes substances are applied to the body like asafoetida (‘devil’s dung,’ dried gummy excretion from the tap root of ferula)
This brief summary covers some of the main descriptive findings of rituals but of course a truly exhaustive set of all Bihari rituals will take additional research (but see Chapter 5 for an extensive ritual narrative in the Synthesis part of the report).
We now turn to a widely known specific ritual directly related to maternal and child health.
3.2.1 Chhati
Chhati is a special ritual involving several components and precise formulaic instructions (as many rituals do) as well as many unique variations. Chhati comes on the sixth day after childbirth, but certain elements of it apply to the full six-day period between birth and the special ceremony on the sixth day.
While there are many variations, some common features of Chhathi in Bihar, as described by FGD participants, include:
- Appeals to supernatural agents for protection and blessings
- Blessings or behaviors concerned with the child’s future and its transition to world of the living
- The newborn should will often touch a pen and/or sheet of paper so the child will be intelligent and have a bright future
- A ritual bath of both mother and child
- The mother receives new clothing and the child is wrapped in a cloth and rolled on the floor
- Mothers receive special and diverse foods during Chhathi, but some variations place food restrictions on the mother between birth and the sixth day after birth8
- The child is kept in the mother’s lap so that she is able to touch her lips to the child’s mouth after she has eaten so the baby tastes the food. The idea behind this is that the child will never experience hungry in life
- Black thread is worn by the baby around the waist or wrist to help strengthen and increase the lifespan of the child9
- Kohl is applied around the eyes of the baby to increase beauty, intelligence, and to protect the child from evil eye
Overall, Chhathi contains actions that are meant to keep the child safe, avoid dangers, and ensure a successful future. It also has some implications for the mother’s early postpartum diet.
The content of Chhathi and its timing immediately make it highly relevant to Project RISE both as an example of perinatal ritual and as an opportunity space to consider in the design phase of the project.