Slide 1

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References
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Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.

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Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.

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Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.

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Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.
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disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
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microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
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July 2000.
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 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
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


Slide 2

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 3

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 4

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 5

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 6

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 7

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 8

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 9

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 10

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 11

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 12

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 13

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 14

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 15

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 16

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 17

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 18

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

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 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 19

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.








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

Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 20

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 21

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 22

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 23

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 24

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 25

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 26

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 27

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 28

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 29

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 30

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 31

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 32

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 33

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 34

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 35

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 36

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

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Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.


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Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.


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Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
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DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
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Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
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Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 37

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.


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
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Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.
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 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.
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 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 38

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 39

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 40

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 41

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 42

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 43

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 44

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 45

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 46

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 47

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 48

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 49

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 50

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 51

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 52

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 53

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
supplements, American Journal of Clinical Nutrition, Vol. 72, No. 1, 280S-290s,
July 2000.
 UNDP (2004) Common Country Assessment (CCA) Ghana, Accra Combert
Impression.
 UNDP (2002) Ghana: Accra the Millenumm Development Goal, UNDP.
 UNPFA (2002) UNPFA Fast Fact Maternal Mortality and Reproduction
Health, http://www.unpfa.org/mothers/fact.htm

 United Nations Population Fund (UNFPA). 2005.

Country Profiles for Population and Reproductive
Health, Policy Developments and Indicators, 2005.
UNFPA and Population Reference Bureau.
 UNICEF. State of the world's children. Oxford, United

Kingdom: Oxford University Press, 1998.
 World Health Organization. The WHO reproductive

health library. No 2. Geneva: WHO, 1999 (CD-ROM).
(WHO/RHR/RHL/2/99)




Slide 54

Poster Presentation 261- By Dr. Francess Dufie
Azumah
Department of Sociology and Social Work KNUST –GH
@ Penn –ICOWH 18th Congress: Cities and Women’s
Health : Global Perspective in Philadelphia, USA
7th -10th April 2010.

Post –natal care

Introduction
 Maternal and reproductive health care has gained much

global attention over the last two decades. International
bodies Organisation and national governments have put in
place policies, programmes such as MDG, as a mechanism
to curb incidence of high maternal mortality and morbidity
rates especially in developing countries.
 In Africa maternal and child mortality rates are on the
increase even though fertility rates are decreasing. For
example in Ghana, in 2003, fertility rate fell to 4.4% from
1998 levels of 6.4 children per woman. Notwithstanding
the decrease rate in fertility, maternal mortality has been
on the increase, at 214 per 100, 000 live births, with regional
variations as high as 453 per 100, 000 live birth (UNPD,
2004, GSS 2002; GDHS 2004; 2003 GPRS Report, 2004).

 In Ghana, the government in its quest to meet the MDG

goals 4 and 5 had put in place strategies such as providing
free maternal care for pregnant women. Irrespective of the
Government of Ghana and international bodies to curb
increasing maternal mortality rates in Ghana still remains
high, 540 death per 100 000 live birth in 2005 with fertility
rate at 4.4% (GHS, 2005, UNFPA, 2005; WHO, 2007 ). The
question is whether food and nutritional taboos have any
effect on women’s reproductive health status? Does these
have any effect on women’s reproductive health status?
What is the nature and extent of these practices? What are
the reasons that underpin their performance? Whether
women as ‘victims’ of such practices are aware of the health
implications ? These and many other questions is what the
research had sought to unearth in this study.

OBJECTIVE OF THE STUDY
The study examines the effects of food and
nutritional taboos and tradition on women’s
reproductive health in Ghana. Specifically it seeks
to
 Examine the nature and extend of food taboos.
 Examine the reasons that underpins the
performance of these practices by women.
 Find out whether the practicing of these have any
health implication on women
 Find out whether women as ‘victims’ of such
practices are aware of the health implications,
 Make some recommendations

METHODOLOGY

The study combined empirically both
quantitative and qualitative research
methods as a mechanism for
verification and validation.
Quantitatively it employed survey
conducted in Kumasi using the KNUST
Hospital Maternal Care center as the
area of study .Qualitatively, the use of
structured interviews, and focused
group discussion were adopted.

Sample Design and techniques
 The study dealt with a more homogenous group made up

of single sex – women. Nonetheless to have a representative
sample of all different age groups, and maternal
experience, selection was based on two distinct categorieson issues relating to food taboos and their effects on the
reproductive health of women.
 With an undefined population, the sample size of 65
respondents constituted those used for the effect of food
taboos on the reproductive health of women.
 Data was collected through the use of structured interview
guide, focused –group discussion (3 groups of 9 members),
and 8 health officials. Respondents were randomly
selected. The research instruments were pre-tested
through piloting among student- mothers.

In Ghana the two main causes for poor maternal
health outcome have been associated with
inadequate antenatal care coverage and
unsupervised deliveries (2003 GRPS Report 2004).
Some factors that impede the use of health facilities
by women during delivery are: traditional beliefs,
taboos, religion and poor attitudes by staff (ibid)
 Generally throughout the developing world, the
average food intake of pregnant and lactating
mothers is far below that of the average male.

 In Ghana, maternal care issues have been of great
concern to the government. This had led to
programmes such as the Safe Motherhood
Initiative, and recently the assistance from the

British Government (Loan) to provide free
maternal care services for all expectant mother’s.
 However, these efforts could be impeded when
there is an interplay of cultural beliefs and
practices such as nutritional taboos associated
with pregnancy and postpartum periods .

In Ghana , like most developing

countries there are traditional/
local beliefs and practices in
relation to pregnancy and child
delivery, such as precautions
against evil spirits, food taboos
etc. These cultural beliefs
influence the orientations of
women and their ways of life.

POSITIVE TRADITIONAL PRACTICES
Some traditional Practices which are regarded as
positive includes: Healthy postpartum practices
based on spiritual framework, including rest,
cleanliness, love, good nutrition and long period of
breast feeding practiced in many parts of Africa,
and other developing countries such as Latin
America, and Asia (UNFPA, 2005)

Breast- feeding

 Long-term breastfeeding provides optimal
nutrients for infants growth and development,
enhances infants immuno-logical defenses and

facilitates both mother’s recovery from childbirth
and mother-infant attachment. Women were
mostly to breastfeed their infant between two to
three years maximum or minimum 6 months
postpartum

 Breastfed children were less likely to have otitis
media, allergies, diarrhea, lower respiratory

infections and bacterial meningitis (Duncan, et
al,1993; Lucas et al,1990)

Early Pregnancy and Postpartum Nutritional taboos
 Cultural practices, such nutritional taboos, ensure
that pregnant women are deprived of essential
nutrients, and as a result they tend to suffer from
iron and protein deficiencies.
Most communities throughout Africa have food
taboos specially for pregnant women. Often these
taboos exclude the consumption of nutrients
essential for the expectant mother and foetus.

Social Profile of Respondents
Age of Respondents (years % )

3
12

29
A
ge
()

23
25

8
40+

35-39

30 -34

25- 29

20-24

15-19

No. Of Children Respondents
Have %
10 - 12 chn

7- 9 chn

4 - 6chn

1 - 3 chn

3
6

37
54

Field data on Nutritional taboos

 On Issues of relating to maternal care ( pre-and post natal

stages) and culture, respondents were asked whether
there any rules that governed their health status, and if
yes what they were. From a medical perspective expectant
mothers and women postpartum could eat anything but
this should be balanced.
 However, all respondents emphasised on the traditions
pertaining to their eating habits. It was revealed that
although they were admonished by health officials to eat
healthy foods- fruits, vegetables, soups and a balanced
diet, there were equally some foods that from a more
cultural perspective were forbidden, if they were
anticipating to have healthy babes, successful delivery and
good health especially before and after birth.
 This they learnt especially from their mother’s, and other
older female relatives and friends.

Early Pregnancy and Nutritional taboos

 Respondents indicated that traditionally some of the foods

that they were forbidden to eat as especially expectant
mothers were, salt foods (including fish- ‘koobi’, ‘mononi’),
meat and eggs, oily (fatty) foods, banana, ripe plantain
okro, garden eggs and snail.
 With the proteins (meat and eggs), they indicated that this
would facilitate having big babies hence cause
complications during delivery, which could led to the loss
of life of both mother and baby. These it was believed could
also affect the child causing him/her to steal in life.
 The ripe plantain and bananas were believed to cause pre
matured contractions and subsequently miscarriage. Okro
and snail, were said to cause slime in babies or
dripping/watery mouth.

Reasons underpinning
food taboos

Ripe Plantain Waist pains,
miscarriage, early
push (forced
labour), delays
removal of umbilical
cord
Salted Fish/ dried
fish- The baby may
not be brilliant in
the future. These
result in swollen feet
(odema)

Snail and
okro caused
the baby to
slime or have
dripping /
watery
mouth

Protein foods
Eggs and fresh
beef (meat)
Provide protein for
the woman and the
baby which
engenders the
physiological
development of
the baby.
Beef dries milk of
lactating mother.
Makes baby grow
to become a thief.
Duck eggs causes
asthma in baby

Food taboos and
Reasons
Beans- Provides

protein for the woman
and the baby which
engenders the
physiological
development of the
baby. It also causes
tummy upset or
complications. It
causes delays in
delivery for women
above 30 years.
Green leaves -

(kontomire) caused
Stomach/tummy upset or
complications

Oils and Fatty Foods
– causes jaundice

Animal Hyde - It
delays the removal
of the umbilical
cord . It also causes
miscarriage for
women in the first
term of pregnancy.

 Pineapple
Pineapple
and coconut
this causes
miscarriage
and abortion
Coconut causes
‘white eyes’/
blindness in
baby

Mangoes and
Guava is
associated with
appendicitis

 Although specific prescribed and proscribed foods differ

considerably from region to region, one item of general
agreement is that "hot" foods should be avoided during
pregnancy and encouraged in the early postpartum
period (Khan, 1981; Thompson,1983; Rea, 1981).
 Food taboos during pregnancy to the origins of a
specific condition; for example, pineapples were said to
cause abortion, and coconuts were believed to make a
baby blind, a condition described as "white eye."
 Another belief was that duck eggs may cause asthma in
the baby. Other restricted foods mentioned were milk,
other fish, and cucumber.

 Some women are not allowed to eat any meat or
fish for one month, while Muslim women are
restricted from doing so for seven days only. Other

forbidden foods after childbirth are bananas , eggs,
and leafy vegetables, especially pumpkin leaves.
Beef and hilsha fish are thought to dry up the milk
of a lactating mother and may also cause
postpartum diarrhea.
 Among Muslims during the period of seclusion,
women may be restricted to one rice meal a day,
though they are permitted to eat other cereals and
milk during the rest of the day.

Food taboos cont.
 A ground up mixture of cumin, chili, and garlic (a
"hot" food) is commonly eaten in the immediate
postpartum period, because it is thought to help
heal the birth passage.
 It is evident that women were not been allowed to

take any food for the first few days, after delivery
only water. However for most women, their water
intake had also been restricted at this time (Khan,
1981; Goodburn et al, 1995).

Nutritional Value of Some Forbidden Foods

Snails

Okro
Ripe
Plantain

This food is low in Saturated Fat. It is also a good
source of Protein and Potassium, and a very good
source of Vitamin E (Alpha Tocopherol), Iron,
Magnesium, Phosphorus,
Copper and Selenium.
High in Dietary Fiber, Vitamin A, Vitamin C,
Vitamin K, Thiamin, Vitamin B6, Folate,
Calcium, Magnesium, Phosphorus, Potassium,
Manganese, Protein, Riboflavin, Niacin, Iron,
Zinc and Copper
The fruit is extremely low in fat, high in dietary fiber and
starch. It is very low in cholesterol and salt too. It is a good
source of vitamins A, B6, and C which helps maintain vision,
good skin, and build immunity against diseases. It is also rich
in potassium, magnesium and phosphate.

mangoes

Is a good source of minerals such as copper and potassium.
It contains traces of magnesium, manganese, selenium,
calcium, iron, and phosphorus.

Oranges

Orange is a good source of minerals such as calcium, iron,
sodium, copper, phosphorus, potassium, magnesium, and
sulfur. It also contains traces of chlorine.

Eggs
Dried Fish

Coconut

It is rich in minerals, proteins, and vitamins, all
of which are easily absorbed by the body. Eggs
are a good source of essential minerals such as
calcium, iron, phosphorus, zinc and iodine.
Dried fish is rich in high quality protein (80%),
Vitamin B, Iron and Calcium.
Is rich in dietary fiber, it works great to improve digestive
health by preventing constipation. Fresh coconut milk is
slightly higher in the B vitamins, zinc, and potassium, but
slightly lower in calcium, iron, and magnesium.

 Pregnant women’s nutrition is a significant component for

the development of fetus. Her daily food intake needs to
fulfill her body’s needs and her fetus.
 The developing fetus demands certain minerals and trace
elements, throughout the 9 months gestation.
Consequently, some groups of nutrients must be
supplemented through her diet. First of all, most of foods
have high energetic value and is rich in nutrients. Eggs and
meat, rich in proteins helps to build up and regenerate
tissues. Ginger vinegar soup helps to restore calcium and
iron reserves.
 The meat, pigs liver contain large amounts of iron and
lipid-soluble vitamins, especially vitamin A, the deficiency
of which often prevails during gestation and postpartum
period.

 The biological state of women’s organism is crucial for

the pregnancy outcome and child’s further nutrient
situation

Other traditional practices during pregnancy and
postpartum
 Generally for pregnant women enema was allowed, using

prepared herbs. Women are also allowed to visit
spiritualist/ herbalists for protection and the preservation
of the pregnancy. However, there are regional variations.
 In the Northern region kalogotin( a seed like cola nut) was
boiled and given to women to drink when in full term. This
served as local cintocinum to facilitate delivery – rupturing
of uterus.
 In the volta region, the expectant woman during delivery
is made to sit in the sand, covers herself, till she delivers
and the TBA cuts the cord that links the baby and mother.

Postpartum traditions
 After birth generally various traditional herbs, are used in

the preparation of meals such as soups for mothers. This it
is believed to facilitate quick recovery from internal
wounds created as a result of the delivery process.
 A concoction known as ‘Kokroloso’ is prepared from
different branches of trees is boiled for the mother to
drink. This is believed to melt all clots of blood retained
in the uterus and also facilitate the appetite to eat
 Enema is encouraged with the use of pepper, ginger and
other spices (including ashes) to allow all by products
associated with deliver to come out. Most often among
some ethnic groups such as the Nzema’s, hot pepper is
inserted into the vagina to facilitate the healing process.

 Women for the first month are made to sit on
boiled water for this purpose, while among the
Kessena Nankana’s a pot of hot water is placed on

the woman’s belly by her in-laws .
 Due to heavy blood flow and discharge after birth,
most women use old cloth as sanitary towels, to
prevent soiling themselves.
 Again, in the absence of corsets, they are made to
tire the tummy with cloth. This is believed to
quicken the return of uterus to it normal position
 Among the people of the Northern sector, the
placenta after delivery is sent home for rituals.

Some Effects of Food /Nutritional Taboos and Traditions
on women’s Reproductive health
 Adequate nutrition is vital both to the health and

reproductive outcomes of women and to the health,
survival, and development of their children. Nutrition
deficiencies diminish not only the individual woman’s
quality of life but also that of her children.
 When respondents were asked if these proscribed practices
had any effects on their health, there was an overwhelming
affirmation. The majority had stated they believed it had
facilitated their safe and sound delivery process.
 However, when asked if they experienced any medical
symptoms during pregnancy and postpartum periods, the
results revealed that majority stated anaemia, dizziness,
fatigue, malaria, loss of appetite and weight, swollen feet
among others. Less than 10% of the respondent stated
they had had more than one miscarriage. These they
interestingly did not associate with the eaten patterns.

 Responses from key informants (the medical point of

view) rather indicated that such practices had rather a
detrimental effect on their health which could be fatal
leading to maternal death. The health center since
2009 although had not recorded any maternal deaths,
recorded some appreciable percentage of anemia cases
pregnant women and lactating mothers.

 Key Informant and FG’s indicated that some of the effects

of the food and nutritional taboos lead to poor nutritional
status of women resulting in outcomes such as : anaemia,
hypertensive disorders, immune system disorders, increase
risk of infection, malnutrition, pregnancy complications,
night blindness, fetal loss, still birth, miscarriage, premature birth and consequently maternal death.
 This does not only affect the mother but the product
(unborn / or born child) as there is a possibility of causing
potential fetal anomaly, low birth weight, adverse infant
neurobehavioural development etc. This is because the
unborn heavily relies on the mother for its nutritional
supplements to survive.

 Calories intake are every essential during postpartum

periods as lactation demands 500 – 600 additional daily
calories for the first six months postpartum, which is a
substantial increase over the latter part of pregnancy,
which only requires an additional 300 calories a day.
 A severe reduction or insufficient calories intake can be
harmful as: - it reduce the amount of lean tissue in the
body and lower basal metabolic rate, thereby inhibiting
weight loss; Cause or exacerbate fatigue; Contribute to risks
for depression or make existing depression worse and
reduce energy needed for a postpartum reconditioning
program and taking care of a new baby, perpetuating
sedentary lifestyle habits. Fatigue it is evident that
undercuts the motivation to be physically active.


Dietary allowances for selected nutrients in
pregnant women and the results of its deficiency.
Pregnant
woman’s daily
allowance
%

Deficiency Results

Energy

14

Malnutrition

Fatty acids
(unsaturated)

30(10)

Hormonal disorders, foetus congenial
brain and retina abnormalities

Protein

60

Intrauterine growth retardation,

Calcium

140-150

Hypertensive disorders

Iron

182-454

Zinc

43

Iodine

33

Anaemia, increased maternal mortality,
increased risk of infection
Foetus congenital abnormalities, abortions,
intrauterine growth retardation, premature
birth, preeclampsia, reduction of T-cells
development
Fetal loss, stillbirth, cretinism, mental

Nutrient

Vitamins

Pregnant
woman ‘s daily
allowance %

Deficiency

Vitamin A

20

Night blindness, increased maternal mortality,
premature birth, intrauterine growth
retardation, low birth weight, ante partum
haemorrhage, immune system disorders

Vitamin D

300

Neonatal tetany, fetal rickets, abnormal teeth
development

Vitamin C

67

Abruption placenta

Vitamin B 12

40

Megaloblastic anaemia, intrauterine death,
adverse infant neurobehavioral development,
immune system disorders

Fessolate

118-176

Megaloblastic anaemia, low birth weight,
potential fetal anomaly

Selenium

26

Keshan disease

Permissible compositional range for dietary
supplements for pregnancy and lactation: Vitamins
MANDATORY

REQUIREMENTS

Vitamin A IV
Vitamin D IV
Vitamin E IV

5000
400
30

Vitamin C mg
Folacin mg
Thiamine mg
Riboflavin mg

60
0.4
1.50
1.7

Niacin mg
Vitamin B12 mg
Vitamin B12

20.0
2.00
60

Permissible
compositional
range
for
dietary
supplements for pregnancy and lactation: Minerals
MANDATORY

REQUIREMENTS

Calcium gram
Iodine mg
Iron mg
Magnesium mg
Phosphorous
Copper mg
Zinc mg

0.125
1.50
18-100
0.125
1.0
2.5

Summary of Major Findings
 From a health perspective women during the pre and

post natal periods are not restricted to their intake of
foods (having balanced meal/diet). However, there are
some traditional dietary practices that debar women
from the foods and nutrients essential for their
protection and healthy growth and development of
themselves and foetus. These nutritional foods
includes a range of energy and protein foods such as
ripe plantain, meat, eggs, snails, fish; vegetables and
fruits such as green leafs, okro, pineapples , banana,
oranges , and grains including beans.

Summary
 The traditional explanations underpinning the

prohibition are that ; for instance protein foods such
as Beef and hilsha fish may dry up the milk of a
lactating mother and may also cause postpartum
diarrhea. Even though meat will provide protein for
the woman and the baby which endangers the
physiological development of the baby making the
child have craven for meat and thus becoming a thief.
Again snails and okro would cause the baby to slime,
while ripe plantain and pineapple are said to cause
waist pain, early labour, or abortion; and coconuts
were believed to make a baby blind, a condition
described as "white eye."

 Dietary taboos had consequential effects that were both non-

fatal and fatal . These resulted in poor nutritional status of
mothers , impairments of their physical and mental health,
pregnancy related complications, miscarriage, hemorrhage,
infertility, still birth and the fatal outcome of maternal
mortality .
 WHO (2000b) has defined anemia as mild, moderate, or severe
based on the following cutoff values (g/dl) for hemoglobin level:
Mild Moderate Severe, with Pregnant 10-10.9 7.0-9.9 <7.0
respectively whiles Non-Pregnant 11-11.9 8.0-10.9 <8.0. In short,
pregnant women with a hemoglobin level less than 11g/dl and
non-pregnant women with a level less than 12g/dl are considered
anemic.
 Again the abstinence affects the fetus and lactating child who

depends on the mother for these foods and nutritional
supplements.

conclusion
 Women’s nutrition during pregnancy and postpartum

periods is an important element for the development of
fetus. Her daily food intake needs to fulfill her organismic
needs and needs of developing child.
 There is a clear evidence of conflict between puerperal
woman health needs and the cultural ideology governing
maternal health issues. These practices as it is evident
have both short and long term physical and psychological
effects on its victims which are marked by chronic
infections, Gynecological disorders, which eventually
contributes to the increased rate of maternal mortality and
morbidity, which are variables of a country’s social
development indicator.

 Society’s culture needs to be preserved but harmful

ones that do affect the individual, violating their
human rights and dignity of families and society as a
whole slowing down the economic growth and
development of a country, need to be eradicated, if not
modified. Women’s rights are human rights; and they
have equal rights to health and reproductive health.
To enjoy these rights the state has to protect them by
enforcing the laws as enshrined in its constitution
and other international mandates ensuring the
eradication of these belief systems working in
collaboration with all stakeholders.

RECOMMENDATIONS
Health and religious institutions, NGOs, as well as CBOs
should provide counseling services for women to deal with
pre-pregnancy and postpartum food taboos and traditions
on women’s reproductive health.
 There is the need for sensitization and attitudinal change
towards pre-pregnancy and postpartum food taboos on
women’s reproductive health issues through education and
awareness creation.
 Traditional leaders need to take up their constitutional and
legal obligations to ensure that these traditional practices
which affect the reproductive health status of women are
modernised and given a human face if not eradicated
completely.

Carry out community based assessment to collect
baseline information on attitudes and beliefs about
the effects of pre-pregnancy and postpartum food
taboos and traditions on women’s reproductive health.
 Raise awareness on food /nutritional taboos and
traditions and its negative consequences on women’s
reproductive health with the community at large and
among traditional and religious leaders, key
professional sectors and the health services.
 Increase women’s knowledge on the effects of food
prohibitions on their health.

References


Ewa Chmielowska, Fu-sheng Shih (2007) Folk Customs in Modern Society: ‘Tradition of Zuoyuezi’ in Taiwan: An
Physical Anthropology Perspective EATS IV ,Stockholm.





Ghana Demographic Health Survey (GDHS)(2004) 2003 Ghana Demographic and Health Survey, Accra.



Human Vitamin and Mineral Requirements, Report of a joint FAO/WHO expert consultation, Food and Nutrition
Division FAO Rome, 2001.











Goodburn E. A; Rukhsana Gazi; Mushtaque Chowdhury (1995) Beliefs and Practices Regarding Delivery and
Postpartum Maternal Morbidity in Rural Bangladesh Studies in Family Planning, Vol. 26, No. 1. (Jan. - Feb., 1995), pp.
22-32.

DiGirolamo, A.M ; Grummer-Strawn, L.M and Fein .S(2001) Maternity Care Practices: Implication for Breastfeeding.
BRITH, 28:June 2001
Duncan, B, Ey J, Holberg CJ et al (1993) Exclusive Breastfeeding for at least 4 months protects against Otitis media.
Pediatrics 91:867-872.
Lucas A, Brooke OG, Morley R et al (1990) Early diet of preterm infants and development of allergic or atopic disease:
Randomised prospectives study. BMJ,1990: 300: 837-840
Ladipo O. A., Nutrition in pregnancy: mineral and vitamin supplements in American Journal of Clinical Nutrition, Vol.
72, No. 1, Pp. 280-90, July 2000
Khan, A.R. 1981. "Indigenous birth practices and the role of traditional birth attendants in rural Bangladesh." In
Traditional Birth Practices: An Annotated Bibliography. World Health Organization/ MCH/85.11.

 Thompson C.S. (1983.) "The social construction of a birth. Ritual states in the
life cycle of Hindu women in a village in central India." . In Traditional Birth
Practices: An Annotated Bibliography .World Health Organization/MCH/85.11.

 van de Wijgert, J.H.H.M. et al.(2000) Intravaginal practices, vaginal flora
disturbances, and acquisition of sexually transmitted diseases in Zimbabwean
women. Journal of Infectious Diseases 181:587–94.

 Van de Wijgert, J. et al. Men's attitudes toward vaginal microbicides and
microbicide trials in Zimbabwe. Family Planning Perspectives 25(1): 115–120.
(March 1999). www.guttmacher.org/pubs/journals/2501599.html
 Oladapo A Ladipo (2000) Nutrition in pregnancy: mineral and vitamin
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