by Chloe Roach & Lauren Hodgson

The pregnancy and childbirth journey for Malagasy women is deeply rooted in unique cultural traditions passed down through generations. These traditions honour the strength and resilience of Malagasy women and are dedicated to nurturing the well-being of both mother and child. In a context where financial and geographical constraints can limit access to maternal and child healthcare services,(1) these cultural traditions offer essential support, guidance, and care to expectant mothers.

Central to this care is the assistance provided by traditional midwives, known as Reninjaza , who play an important role in supporting Malagasy women throughout their pregnancy and childbirth. These caregivers are trusted and respected for their accessibility, personalised care, and deep understanding of local customs.(4) This support is especially critical for women in rural regions, where the Reninjaza often serve as the primary source of medical care.(5)

Cultural Traditions Surrounding Pregnancy and Postpartum Care

Cultural traditions surrounding pregnancy and childbirth reflect a deep respect for the strength of Malagasy women. Many continue daily activities, such as processing rice and trekking mountains, right up to delivery, guided by the belief that staying active ensures an easier birth.(3) This tradition also aligns with medical advice, with healthcare professionals encouraging women to remain physically active until delivery to prepare their bodies for childbirth.

“Even in the final hour before birth, midwives encourage women to keep moving and walk around to help make the delivery easier” Gerard Andriatsiory, SEED’s Project Votsira Coordinator

These cultural beliefs extend into the postpartum period, where Malagasy women observe a period of rest lasting from one to three months, known as Mifana. This practice is considered essential for recovery and is often spent at the woman’s family home, away from her partner, to encourage birth spacing. During this period, women from rural regions typically wrap themselves in multiple layers of clothing, believing that retaining heat supports breast milk production and protects against sovoky, an illness associated with exposure to cold air. This tradition is deeply respected across Madagascar, with Malagasy law granting mothers three months of maternity leave to fully engage in this important tradition of rest, warmth, and recovery.

Regional Beliefs and Maternal Health Traditions in Anosy

In the Anosy Region, distinctive traditions shaped by local beliefs play a crucial role in supporting the well-being of mothers and babies. During pregnancy, many women avoid wearing jewellery, believing that it helps prevent complications with the umbilical cord during childbirth. Similarly, dietary customs such as avoiding peanuts and bananas are followed based on the understanding that peanuts may pose a risk to the baby’s respiratory health and bananas could cause the baby to grow too large for safe delivery.(3) These beliefs extend into childbirth, where female relatives provide essential support while men traditionally remain outside, respecting the belief that their presence could cause complications.

Alongside these customs, deep-rooted fears of jealousy, cursing, and poisoning are a significant part of the cultural landscape in Anosy.(3) Such fears encourage women to hide their pregnancies for the first five months, only revealing the news after they are visibly pregnant, which can lead to missed antenatal care appointments crucial for monitoring maternal and child health. To protect themselves from perceived curses, some women also turn to traditional healers for herbal remedies. While believed to ward off harm, these herbs can sometimes pose risks to the mother and child, highlighting the delicate balance between cultural beliefs and healthcare practices.

Project Votsira: Supporting Maternal and Child Health Outcomes

In Fort Dauphin, the regional capital of Anosy, SEED's Project Votsira works to integrate traditional practices with improved maternal and child healthcare. Through community-based education sessions and household visits, community health workers provide vital knowledge on breastfeeding, nutrition, antenatal care, and safe childbirth practices. These efforts are gradually shifting cultural norms, such as the belief that colostrum harms the mother and child, as well as misconceptions surrounding specific foods that pregnant women should avoid.

There has been a big change in how colostrum is perceived. Previously, it was discarded because people believed it wasn’t good. Now, because of Votsira, mothers are giving colostrum directly to their babies. Gerard Andriatsiory, Project Votsira Coordinator

By delivering context-specific education, Project Votsira is effectively bridging traditional practices with evidenced-based healthcare to create a future where all women have access to safe and healthy pregnancy and childbirth experiences. These efforts are driving sustainable improvements in maternal and child health, ensuring lasting benefits for mothers and their children in Fort Dauphin.

References

1. Kazel M. Healthcare centres in Madagascar during COVID-19. The Borgen Project [Internet]. 2020 [cited 2024 Aug 29]. Available from: https://borgenproject.org/healthcare-in-madagascar-during-covid-19/

2. Paolella V. Letters from Madagascar: The only rest for pregnant women comes after giving birth. Sun Journal [Internet]. 2024 Mar 17 [cited 2024 Aug 23]. Available from: https://www.sunjournal.com/2024/03/17/letters-from-madagascar-the-only-rest-for-pregnant-women-comes-after-giving-birth/ . Published March 2024

3. Morris J, Short S, Robson L, Andriatsihosena M, et al. Maternal health practices, beliefs and traditions in South East Madagascar. Afr J Reprod Health. 2014;18(3):101-17.

4. Quashie H, Poureyya D, Rakotomalala O, Andriamaro F, et al. Traditional therapeutics, biomedicine and maternal health in Madagascar: paradoxes and power issues around the knowledge and practices in reninjaza. Health Cult Soc. 2014;7(1):1-13.

5. Ibid.