Qualitative research on knowledge, attitudes, and practices related to women"s reproductive health, Cochamba, Bolivia

The study focused on eight stages in the reproductive cycle: pregnancy, labor and delivery of the infant, delivery of the placenta, the immediate postpartum period, the newborn period, breastfeeding, family planning, and abortion. It also explored the cultural, social, and economic factors that affect reproductive health and the utilization of formal health services. The study found that the ethnophysiology of the Quechua-Aymara woman is based largely on her concern with ups and downs and entrances and exits inside and outside of the body. A woman is believed to be healthy when her important body parts are located and moving correctly, and these movements are thought to be determined by the presence of warm or hot elements (which cause body parts to fall) or fresh or cold elements (which cause the entrance and rise of foreign elements and body parts). For these reasons, a pregnant woman seeks a cool environment and cool food; a women in labor seeks heat. Other important findings reveal that in a home birth the newborn usually receives little attention during the first few critical postpartum hours. Instead, focus is on the delivery and care of the placenta and the woman"s well-being. Breastfeeding is delayed for 2 or 3 days, based on a folk classification of the types of breast milk. Traditional birth attendants (TBA"s) are called in for some deliveries. Some TBA practices are beneficial, but others, such as the use of oxytocic drugs to speed labor, are dangerous. Family planning, while little used, is apparently of concern to the women for there are strong social and economic reasons for limiting family size. Many multiparous women reported feeling great sadness and despair on learning they were pregnant again. Interestingly, the population distinguishes clearly between spontaneous abortion, a characteristic of weak women who are unable to fulfill their social role, and induced abortion, which is seen as method of family planning and carries no stigma of weakness. An important finding is that nonusers of formal reproductive health services are not necessarily ignorant of these services. Rather, barriers to use include perceived mistreatment of women, practices that conflict with women"s modesty and ethnophysiology, lack of information provided to women during visits, and costs in time and money. Recommendations are included. (Author abstract, modified)