Consideration of health seeking behaviour among the participants illustrated the complexity of the health care system in the community of uMzimkhulu. In such communities, the treatment, cause of illness and the healing system are clearly interconnected. Several common themes emerged from the data analysis and provided insight into women’s choices of health care systems during pregnancy. These themes are described in this chapter. The data reflects considerable diversity in the health seeking behaviour of the women during pregnancy.
Women’s health seeking autonomy may be influenced by many factors such as cultural beliefs, education, work status and religion. Similarly, choosing to give birth at home is influenced by
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personal preferences, family belief systems and structures, health related issues, social and cultural norms. In patriarchal societies, however, women do not have the choice or control over the type of health care system they will use during their pregnancy and childbirth. Giving birth at home is associated with risk factors that may lead to death; however, many women still prefer home deliveries over health care facilities. During pregnancy, women are faced with deciding on a health care system that will best suit both their needs and belief systems.
Behaving according to cultural beliefs during pregnancy is important and in every community and culture, there are certain rituals and practices important for the protection of the mother and foetus. With changing times, medical pluralisms have come to exist with the western hegemonic health care system retaining dominance. Women have, over the years, had to choose either one or both health care systems.
For Thandeka, Thuli, Thandiswa, Thandah and Thobeka (pseudonyms for some of the participants in this research), traditional views, practices and beliefs have prevailed. These women reside in the rural areas of uMzimkhulu. They have never left uMzimkhulu or lived in bigger cities and have worked as domestic workers for teachers and nurses in the small town.
The most educated dropped out of school in grade nine and none seemed to regard education as important. Their communities still believe strongly in the importance of TBAs and the practices that they offer to women in general, but most importantly during pregnancy. All five had been assisted by TBAs with all their pregnancies and two of the five women had given birth at home with the assistance of a TBA. For them, visiting a TBA was more important than their monthly visits to the clinic and they all believed that TBAs played a meaningful role during pregnancies. The TBA practices are interwoven with their own beliefs and practices making the women feel comfortable to communicate their concerns with the TBAs without the fear of being judged.
The worldview of this rural community involves cultural beliefs and practices during pregnancy; these practices are believed to play an important role in protecting the mother and foetus for the duration of the pregnancy, and they also play a role in the development of the foetus. During their pregnancies, the participants shared that they visited TBAs for protection against evil spirits. Thobeka explained that she visited a TBA for all three of her pregnancies for the sole purpose of protecting her foetus from abathakathi and imimoya emibi (witches and evils spirits). Her TBA gave her an intambo yasesinqeni (string with protective powers) to wear around her waist. She was also provided with amafutha enja yolwandle (seal oil) to apply to
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her belly every day especially on days when she would be going to family or community gatherings. The belief in this community is that pregnancy is a very vulnerable period for women making them susceptible to evil spirits and easy targets for witches. In this community, a pregnant woman ought to limit attending weddings, funerals or parties as it is believed that some people have evil and negative energies that may taint or even harm the foetus. This understanding of the TBAs amongst the community members is an example of the influence and impact of social identity. Believing in TBAs enabled women to collectively share their ideas and even to maintain their traditional health related identities.
Thuli shared that she too made use of the services of a TBA with her two pregnancies. The TBA provided her with isiwasho (water that has been prayed over) to drink, bath and breathe in the steam. Thandiswa explained that she did not attend the clinic during her first pregnancy because she believed that the services of the TBA were more important. To protect her foetus, she was given intambo to wear around her waist and Vaseline mixed with impepho, to apply to her belly every day. These are important practices in this community; if a woman does not follow these practices, it is believed that she may lose her foetus which is not strong enough to fight off bad spirits. The TBAs explained that during the pregnancy umfati omitsi kufuneka aqine angatsambi (meaning a pregnant woman should be strong and not weak). Being strong, according to the TBAs, depends on the use of medicine to protect against evil spirits. Some of the women in this study did seek some form of antenatal care but it seemed of little importance to them. This was a worrying trend as ANC can help with finding problems and can even save the lives of both the woman and foetus. ANC improves the survival and health of babies, reducing the number stillbirths and neonatal deaths and indirectly by providing an entry point for health contacts with the woman at a key point in the continuum of care (Kisuule et al. 2013;
Titaley et al. 2010; Lincetto et al. 2010; Raatikainen, Heiskanen and Heinonen 2007). Some women visited the clinic in the second trimester only when they were worried. They had no understanding of the importance of participating in ANC in the first trimester of pregnancy.
Some shared that they feared having blood tests and taking an HIV test; this appeared to keep many away from the clinics. They seemed to prefer TBAs as they could then avoid these tests.
This finding means that maternal education is important during pregnancy. Authors such as Elmusharaf, Byrn and O’Donovan (2015) and Bender and McCann (2000) recommended integrational learning during pregnancy as they believed it would improve appropriate selected health behaviours. Caldwell (1979) argued that higher levels of maternal education result in a reduced sense of fatalism in the face of children’s ill health. In addition, the women expressed
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that they found being assisted by male nurses and doctors very worrying and this made them uncomfortable. In the African culture, it is taboo for a man who is not your husband or boyfriend to touch or see your private parts. The body is a sacred and personal possession; only those trusted are allowed to see and touch one’s body or this can feel like a violation. Generally, the genital and pelvic examination leads to the greatest sense of vulnerability.
“Kunzima ukuba nqunu ngisho phambi kwabomama laba ababelethisayo, ngiye ngibone kunzima kakhulu uma sekuzomele ngikhulule ngibuye ngithintwe umuntu wesilisa engingamazi. Umzimba awukhululeki kanti kwamina ke angikhululeki, ikona engiye ngibone ukuthi kuyangixosha emtholampilo loku.
“I find it extremely uncomfortable undressing and being touched in my private parts by a TBA, it becomes an even greater challenge being assisted by a male nurse or doctor because it feels like a violation of my body.” – Ammy
5.2.1 Concoctions during pregnancy
Few studies have focused on the specific ingredients and preparation of isihlambezo.
Concoctions during pregnancy are believed to play a vital role as a preventative health tonic providing the foetus with important vitamins and calcium. The research participants all believed that women who do not ingest isihlambezo during pregnancy become prone to complications during the birthing process. The participants also believed that the foetus does not develop well without isihlambezo. One of the participants shared that her cousin who had not taken isihlambezo during pregnancy experienced a very long and strenuous labour process and gave birth to a weak infant. Studies carried out by Adams et al. (2009) and Band et al.
(2007) found that women use complementary and alternative medicine for relief of stress and pregnancy related complications, as prevention of labour and for the general health benefits during pregnancy. Makoae (2000, 36) added that “herbal medicines serve different purposes such as treating abdominal pain, preventing abortions, ensuring safe pregnancy, keeping the foetus slim, making the pregnant women strong, enlarging the birth canal and enhancing stronger contractions during labour”.
“Kumele ngisisebenzise isihlambezo uma ngikhulelwe, sibalulekile ngoba sisiza mina kanye nengane. Ngiye ngizwe umehluko umangisebenzisa isihlambezo emzimbeni wami angibi naso isibhocobhoco nokukhathala kanti futhi nesisu ngiye ngizwe silula singangesindi nengane ngiye ngizwe idlala ngaphakathi esiswini.
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“I have to use isihlambezo during pregnancy because I find it to be most helpful to me and the baby growing inside me. I always feel a difference when I start using isihlambezo as my whole body feels different, I do not get tired as often and the foetus moves around making me aware that they are well and healthy.” – Thanda
“Isihlambezo sixebula umtwana anganamatheli esiswini. Ukunamathela kwengane esiswini kwenza ukuthi kube nzima uma usuyoteta. Mina ngibona kubalulekile ukuthi ngisebenzise Isihlambezo ukuze ngingabi nazo izinkinga umasengiyozala.
“Isihlambezo prevents the foetus from sticking to the womb of the pregnant woman. If the foetus is stuck onto the womb it makes the birthing process difficult for the woman. I use it so that I do not encounter problems during the birthing process.” – Thobeka
“Isihlambezo siyikhambi, senziwa ngamakhambi wesintu, mina ngiye ngibone kungcono uma ngisebenzisa imithi yemvelo kunamaphilisi wasemtholampilo engingazi ukuthi akhandwa kanjani. Angazi kungani emitholampilo bengasisebenzisi isihlambezo ngoba phela thina abantu abasisebenzisayo siyawuzwa umehluko owenzekayo kithi. Mina sangisiza Isihlambezo ingane yami ingadlali, kodwa ngathi sengiqala ukusebenzisa Isihlambezo ngezwa isidlala.
“Isihlambezo is a natural concoction prepared using natural traditional medicines. I find that I prefer the use of isihlambezo as opposed to the pills that I get from the clinic because I have no idea how they have been made. I do not understand why the staff at the clinic have a problem with isihlambezo because as an individual who uses it, I find that it makes a big difference.
Isihlambezo helped me when my foetus was not moving, but it started moving as soon as I started on isihlambezo.” – Thandiswa
A study carried out by Adams et al. (2009) found that most users of alternative and traditional medicine regarded these medicines as more natural, safe, or having at least of equal efficacy when compared with medical prescriptions for pregnancy. The respondents in this study voiced the same opinion, sharing that it is in fact the pills from the clinic that they do not trust as they do not know how they have been prepared. It emerged that the participants feared the idea of going to hospital. Thandeka, Thuli and Thandiswa specifically expressed their fear of being taken to theatre for a caesarean section. They expressed that all the practices that the TBAs offer are natural including the birthing process; hence they are the preference.
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