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complications. In 2005 (WHO), there were an estimated 536 000 maternal deaths
worldwide. Most of these deaths occurred in developing countries, and most were
quarters between 1990 and 2015. However, between 1990 and 2005 the maternal
The high incidence of maternal death is one of the signs of major inequity
spread throughout the world, reflecting the gap between rich and poor.
disparities within countries between people of different cultures, with high and
pregnant status and some because pregnancy aggravated an existing disease. The
four major killers are: severe bleeding (mostly bleeding postpartum), infections
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and obstructed labor. Complications after unsafe abortion cause 13% of maternal
deaths (UNICEF 2004). Globally, about 80% of maternal deaths are due to these
causes. Among the indirect causes (20%) of maternal death are diseases that
and HIV. Women also die because of poor health at conception and a lack of
adequate care needed for the healthy outcome of the pregnancy for themselves
and their babies. The first step for avoiding maternal deaths is to ensure that
women have access to family planning and safe abortion. This will reduce
The women who continue pregnancies need care during this critical period
for their health and for the health of the babies they are bearing. Most maternal
deaths are avoidable, as the health care solutions to prevent or manage the
complications are well known (Basavanthapa, 2008). Since complications are not
predictable, all women need care from skilled health professionals, especially at
birth, when rapid treatment can make the difference between life and death. For
instance, severe bleeding after birth can kill even a healthy woman within two
childbirth reduces the risk of bleeding very effectively (Wilson, 2006). Sepsis – a
very severe infection – is the second most frequent cause of maternal death. It can
be eliminated if aseptic techniques are respected and if early signs of infection are
recognized and treated in a timely manner. The third cause, eclampsia, emerges as
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cause of maternal death is obstructed labor, which occurs when the fetus’ head is
too big compared with the mother’s pelvis or if the baby is abnormally positioned
(WHO, 2007). For women to benefit from those cost-effective interventions they
must have antenatal care in pregnancy and in childbirth they must be attended by
skilled health providers and they need support in the weeks after the delivery.
and Health Survey (2003), data show that less than two thirds (62%) of women in
developing countries receive assistance from a skilled health worker when giving
birth. This means that 45 million home deliveries each year are not assisted by
care visits, are attended by a midwife and/or a doctor for childbirth and receive
postnatal care. In low- and middle-income countries, just above two thirds of
women get at least one antenatal care visit, but in some countries less than one
There are many reasons why women do not receive the care they need
before, during and after childbirth. Many pregnant women do not get it because
there are no services where they live, they cannot afford the services because they
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are too expensive or reaching them is too costly. Some women do not use services
because they do not like how care is provided or because the health services are
pregnancy and childbirth each year (UNICEF, 2000). Over 99 percent of those
deaths occur in developing countries such as the Philippines. But maternal deaths
only tell part of the story. The Philippines’ maternal mortality rate continues at an
unacceptably high level. While maternal mortality figures vary widely by source
and are highly controversial, the best estimates for the Philippines suggest that
approximately 4,100 to 4,900 women and girls die each year due to pregnancy-
Filipino women and girls will suffer from disabilities caused by complications
to ensure that 80 percent of mothers are provided with essential health care
packages. The package includes: (a) tetanus toxoid immunization, (b) nutrition,
complications before, during and after pregnancy, (e) clean and safe delivery, (f)
planning, (h) STD/HIV prevention, and (i) dental care. The package is very
comprehensive and most of these are provided during prenatal care of mothers
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(DOH, 2007). Meanwhile, the basic premise of the Safe Motherhood Initiative is
that childbirth must not carry with the risk of death or disability for the woman
and her infant. Deaths due to pregnancy and childbirth are both too high in
developing countries like the Philippines. To address this concern, the DOH
least four times of prenatal visits, the first of which is on the first trimester; and
(2) postnatal care should be given within two days after delivery, at most one
week after. More recently, the DOH provided for seven visits for prenatal services
The 2003 National Demographic and Health Survey (2003 NDHS) data
show that seven in ten women made at least four antenatal care visit, while five in
ten women made the first visit in the first trimester of pregnancy. Furthermore,
women avail of prenatal services for curative rather than preventive reason
terms of delivery care, only 38 percent of live births were delivered in a health
facility, and only 60 percent of all births were attended by a health professional.
maternal and infant morbidity and mortality in the country by checking whether
there are complications arising from the delivery and providing the mother with
information on how to care for herself and her child. In the 2003 NDHS, only one
in three women who delivered outside a health facility followed the DOH
and disability will depend on identifying and improving those services that are
critical to the health of Filipino women and girls, including antenatal care,
emergency obstetric care, and adequate postpartum care for mothers and babies,
and family planning services (UNFPA, 2003). Health care programs to improve
care providers and logistical services that facilitate the provision of those
programs. Once maternal and neonatal programs and policies are in place, all
women and girls must be ensured equal access to the full range of services (DOH,
2003).
health practices and beliefs and modern health science and technology are of
resistances retard even the simplest activities. Perhaps the greatest value of this
Although essentially nothing new is recorded, the volume does provide a valuable
synthesis of information from many sources. Even the almost excessive use of
quotations is handled with sufficient care so that ideas are built rather than
There are naturally minor points on which this health worker disagreed
with the author's strongly anthropological orientation. For instance, in spite of the
few instances cited, it is somewhat naive to really expect much cooperation from
indigenous practitioners (Davidson, 2003). Many people have tried with great
dedication and enthusiasm and failed, but results are never reported. As pointed
extent a pregnant woman from getting the care she needs. To improve maternal
health, gaps in the capacity and quality of health systems and barriers to accessing
health services must be identified and tackled at all levels, down to the
Both health and illness are concepts that are defined by an individual’s
another. Kaufert (1996) emphasizes the need to examine the universal process of
a certain illness or disease within a social and cultural context instead of imposing
Cordillera, people are bounded by their own culture which includes their beliefs
and practices. Many mothers stick to what they believe is good for them and
practice cultural approaches that would seem fit to cure her illness. On the other
hand, rural women often have difficulty accessing health care services. In today’s
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world of managed care, community hospitals and rural health units may be of
more concern is the multiple roles and role strain women experience in rural
anyone to turn to themselves. Self esteem may decrease as they are unable to
fulfill the expectations of family and community, with depression as the end
result. Bushy (1993) advises health care providers to help indigenous mothers
recognize their strengths and incorporate their definitions of health and illness
express them. The culture of a society denotes “traits which are shared by a
generation within that society by teaching and learning.” This, however, does not
take into account the possible biological variations of people within any society
and how these may change its culture as a result of harmful influence or the
in any society, habits fostered by the prevailing culture, or to a lesser extent by the
limited to traditional habits and customs, particularly in relation to health and the
farming cycle, because the very survival of the people depends on their fitness for
work on the land. Some may also think that culture in an industrial country can be
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equated with taste in the fine arts. Both ideas are quite erroneous. Culture is
confined within narrower limits. Where culture is concerned, the health worker
has, in fact, to come to grips with a subject much wider than a few traditional
In the simplest societies, habits are developed for self preservation and the
childbirth, and weaning, the aim being to ensure successful reproduction and to
protect the life of mother and infant. Looked at from a modern, scientific point of
disease and its remedies. Whether people will choose the new or old will
demonstrate their basic belief and hopes (Lucas, 2003). They will soon learn
producing results. They will make of the new system only for limited range of
for everything else, chiefly because the traditional methods and remedies closely
respond to the basic ideas of their society. Thus, this study will identify the
cultural beliefs on maternal and newborn health care that are still being used at
present. Moreover, the extent of practice of the cultural beliefs on maternal and
Conceptual Framework
(1991, 1995a, 1995b, 1997). Leininger (1991, 1995a) underlines the meaning and
and her Culture Care Theory is the only nursing theory that focuses on culture.
(Rosenbaum 1997.) The roots of the theory are in clinical nursing practice:
Leininger discovered that patients from diverse cultures valued care more than the
nurses did. Gradually, Leininger became convinced about the need for a
In her Culture Care Theory, Leininger states that caring is the essence of
nursing and unique to nursing. (Leininger 1978, 1981, 1984, 1988, 1991, 1995a,b,
1989.) First, Leininger considers nursing a discipline and a profession, and the
term ‘nursing’ thus cannot explain the phenomenon of nursing. Instead, care has
Leininger (1995a) views ‘caring’ as the verb counterpart to the noun ‘care’ and
1970, Morse et al. 1990, Reynolds 1995, McCance et al. 1997). When Leininger’s
appears that her view of care is wider than, for example, that of Orque et al.
(1983), who describe care as goal-oriented nursing activities, in which the nurses
recognize the patients’ ethnic and cultural features and integrate them into the
nursing process. Second, the term ‘person’ is too limited and culture-bound to
explain nursing, as the concept of ‘person’ does not exist in every culture.
Leininger (1997) argues that nurses sometimes use ‘person’ to refer to families,
in meaning from the term ‘person’. Third, the concept of ‘health’ is not distinct to
nursing as many disciplines use the term. (Leininger 1997.) Fourth, instead of
1995a,b, 1997.)
people use to solve human problems. (Orque et al. 1983, Leininger 1991.) In that
1997) refers culture to the specific pattern of behaviour which distinguishes any
aspects as an explicit form of it. Leininger (1997, 38) states that culture refers to
patterns, and practices” and agrees that culture is learnt by group members and
1995a) distinguishes between emic and ethic perspectives of culture. Emic refers
to an insider’s views and knowledge of the culture, while ethic means the
outsider’s viewpoints of the culture and reflects more on the professional angles
of nursing. Apart from culture and environmental context, ethno history is also
Ethno history refers to the past events and experiences of individuals or groups,
which explain human lifeways within particular cultural contexts over short or
long periods.
culture care phenomena. The assumptions and definitions are derived from the
Theory, and they are used as guides to systematic study of the theory. Strictly
• care (caring) is essential to curing and healing, for there can be no curing
without caring
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• every human culture has lay (generic, folk or indigenous) care knowledge
and practices and usually some professional care knowledge and practices,
• culture care values, beliefs, and practices are influenced by and tend to be
with his/her beliefs, values, and caring lifeways will show signs of cultural
in the qualitative research paradigm than the rigid operational definitions typical
• cultural and social structure dimensions refer to the dynamic, holistic, and
different cultures
explain and predict health behaviors. This is done by focusing on the attitudes and
beliefs of individuals.
The HBM is based on the understanding that a person will take a health-
confidence).
The HBM was spelled out in terms of four constructs representing the
would activate that readiness and stimulate overt behavior. A recent addition to
successfully perform an action. This concept was added by Rosenstock and others
in 1988 to help the HBM better fit the challenges of changing habitual unhealthy
Culture
one’s own cultures are logical and make good sense. It follows that if other
think that the behaviors of other people who have more reserved relational
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cultures may seem strange, even inappropriate. The person might wonder why a
romantic couple would not be more open in displaying affection to one another in
public. The individual might even be tempted to conclude that the “reserved”
situations. People who are used to informal meetings of a group might think that
organization where suits are worn every day may react with cynicism and
practice. Someone from a culture that permits one man to have only one wife may
find it quite inappropriate that another culture allows one man to have multiple
wives. With regard to culture, the tendency for many people is to equate
“different” with “wrong,” even though all cultural elements come about through
Cultures change over time. In fact, cultures are ever changing—though the
change is sometimes very slow and imperceptible. Many forces influence cultural
also through communication between individuals that cultures change over time.
Each person involved in a communication encounter brings the sum of his or her
own experiences from other (past or present) culture memberships. In one sense,
encounters influence the individual and the cultures over time. Travel and
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one cultural context to another, and in small and large ways, cultures come to
as the air is invisible to those who breathe it. Language, of course, is visible, as
are greeting conventions, special symbols, places, and spaces. However, the
special and defining meanings that these symbols, greetings, places, and spaces
have for individuals in a culture are far less visible. For example, one can observe
individuals kissing when they greet, but unless one has a good deal more cultural
of a culture where the cow is sacred, that same steak would have an entirely
Health
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At the time of the creation of the World Health Organization (WHO), in 1948,
health was defined as being "a state of complete physical, mental, and social well-
In 1986, the WHO, in the Ottawa Charter for Health Promotion, said that
health is "a resource for everyday life, not the objective of living. Health is a
Health is not only physical or mental health per se – health is also situated
norms, worldview, power structures, the role of beliefs, practices (Jocano, 2007).
Nutrition
organisms, of the materials necessary (in the form of food) to support life. Many
(Marcia, 2000).
in human nutrition, meal planning, economics, and preparation. They are trained
like obesity and metabolic syndrome, and such common chronic systemic
Hygiene
Hygiene is the practice of keeping the body clean to prevent infection and
illness, and the avoidance of contact with infectious agents. Hygiene practices
include bathing, brushing and flossing teeth, washing hands especially before
eating, washing food before it is eaten, cleaning food preparation utensils and
surfaces before and after preparing meals, and many others (Eichner, 2005). This
may help prevent infection and illness. By cleaning the body, dead skin cells are
washed away with the germs, reducing their chance of entering the body.
disease (Herman, 2003). Other uses of the term appear in phrases including: body
hygiene, used in connection with public health. The term "hygiene" is derived
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from Hygeia, the Greek goddess of health, cleanliness and sanitation. Hygiene is
also the name of a branch of science that deals with the promotion and
vary widely, and what is considered acceptable in one culture might not be
acceptable in another.
Encouraging children’s personal hygiene habits is a day to day issue that parents
and careers need to reinforce and practice so they and the children in their care
can stay healthy and avoid illnesses and infections (Medibank, 2008).
attitude to personal cleanliness that will extend into adulthood and help avoid
coughing and using a tissue when sneezing can avoid spreading colds and flu
(Stabler, 2006).
many different illnesses and infections around at various times of year, the best
preventative measure you can take in looking after your own and your children’s
(Evans, 2001).
Most children enjoy taking a bath or shower and helping children develop good
personal hygiene habits can help them learn how important these habits are
(Crane, 2000). Educating young children about children’s hygiene helps them
routine of brushing teeth. Taking care with this ritual should help the
development of healthy adult teeth. Children need to brush their teeth at least
twice a day and so become aware of the importance of this aspect of hygiene for
children into the habit of washing their hands after using the toilet, and into a
regular habit of washing their hands after playing with pets, coughing or sneezing,
and before eating or handling food (Crane, 2000). Children’s personal hygiene
practices are simple and easy for young children to understand when they focus
The most important feature of child hygiene is to make sure that good
standards are met with approval. The habits formed in children’s hygiene routines
early in life should help them stay healthy in the future (Clark, 2004).
health care services which are developed to meet promotive, preventive, curative,
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rehabilitative health care of mothers and children. It includes the sub areas of
maternal health, child health, family planning, school health and health aspects of
the adolescents, handicapped children and care for children in special settings
(WHO, 2005).
following childbirth. For each woman who succumbs to maternal death, many
more will suffer injuries, infections, and disabilities brought about by pregnancy
diabetes, malaria, sexually transmitted infections (STIs), and others can also
increase a woman’s risk for complications during pregnancy and childbirth, and,
thus, are indirect causes of maternal mortality and morbidity (Rogers, 2007).
Since most maternal deaths occur during delivery and during the postpartum
period, emergency obstetric care, skilled birth attendants, postpartum care, and
These services are often particularly limited in rural areas, so special steps
reduce maternal mortality and morbidity must also address societal and cultural
factors that impact women’s health and their access to services (Swedo, 2006).
Women’s low status in society, lack of access to and control over resources,
Laws and policies, such as those that require a woman to first obtain
permission from her husband or parents, may also discourage women and girls
from seeking needed health care services – particularly if they are of a sensitive
marriage. Many women in developing countries marry before the age of 20.
Pregnancies in adolescent girls, whose bodies are still growing and developing,
put both the mothers and their babies at risk for negative health consequences
(Jones, 2001).
The consequences of maternal mortality and morbidity are felt not only by
women but also by their families and communities (Patney, 2005). Children who
lose their mothers are at an increased risk for death or other problems, such as
malnutrition. Loss of women during their most productive years also means a loss
of women and girls to lead healthy lives in which they have control over the
resources and decisions that impact their health and safety. It requires raising
Maternal Health
complete physical, mental and social wellbeing and not merely the absence of
disease or infirmity in all matters relating to the reproductive system and its
functions and processes. It implies that people are able to have a satisfying and
safe sex life, are informed about to have access to safe, effective, affordable and
for regulation of fertility which are not against the law, are able to have access to
appropriate health care services that will enable women to go safely through
pregnancy and child birth and provide couples with the best chance of having
healthy babies.
reproduce and regulate their fertility, women are able to go through pregnancy
maternal and infant survival and well being and couples are able to have sexual
(Kamalam, 2005).
Disease Prevention
diseases, (or injuries) rather than curing them or treating their symptoms. The
term contrasts in method with curative and palliative medicine, and in scope with
public health methods (which work at the level of population health rather than
• Always
• Maternal Health
• Often
Care
• Never
• Newborn Health
Care
Demographic Factors
• Age
• Religion
• Educational
Attainment
• Occupation
The paradigm of the study will comprise the independent, dependent and
intervening variables.
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cultural beliefs on maternal and newborn health care. On the other hand, the
independent variables will comprise the cultural approaches which will include
the beliefs and practices. Moreover, it will also include the respondent’s age,
1. What are the cultural beliefs on maternal and newborn health care that
maternal and newborn health care when the following variables are
a. Age
b. Religion
c. Educational attainment
d. Occupation
1. The cultural beliefs on maternal and newborn health care are still
a. Age
b. Religion
c. Educational attainment
d. Occupation