Dear Judith,

Congratulations on tackling this subject.

I am currently working as a MW Advisor in Afghanistan and, having thought
much on this subject, I recognise the tensions. There are a few studies
that have been published in-country here by NGOs over the last few years
which might help -  I will try to get the references and organisations for
you.

I have a few initial thoughts that may be relevant:

The culture in Afghanistan is seen in the West as one entity (burkhas and
supporession of women mostly). However, there may be as much cultural
variation between the woman from a village and the middle-class female
government employee, as there is between myself and the latter.
Withholding infant colostrum is cultural, traditional, but it is not
universal. It is not done for a religious reason but because it has always
been believed and been practiced that way(ie for the same reason all of us
do many things!). We cannot box people into being of a particular culture
(ie. don't assume that all South Asian women believe in this practice or
that they would be offended if such a practice was challenged), but we can
still give them an informed choice, persuading while ensuring that they
know THEY will make the choice, to change their practice or not. The
persuasion however, might sometimes be best used in another direction.

The decision-makers here, and probably still once people move to the west,
are commonly the husband and the mother-in-law (perhaps the mother if the
mother-in-law is not around). Various recent studies have shown this - I
will try to find the references. This has implications for any changes in
practice being advised.

In Afghanistan, everything appears to be negotiable; Staff are not trained
by being taught, they are trained by long discussions; Strikes are not
resolved by penalties, but by taking the time to persuade and come to some
form of agreement; One does not get through a military checkpoint by
having the right papers (necessarily) but by politeness and timely
negotiation; A husband does not give permission for his wife(required
here) to have a manual removal of placenta (as opposed to hysterotomy) by
someone telling him he has to allow her, but by someone taking the time to
explain, to talk to other respected individuals, to listen and eventually,
to persuade.

In Afghanistan there are many practises which one would assume would be
against the culture but which have caught on like wildfire eg. the
practice of giving oxytocin to speed up the birth...so now you get women
in the villages going to the pharmacy in the bazaar for the "injection to
speed up labour". It is dangerous and likely to end in a negative outcome
but the point is that culture can and is changing, and changing rapidly.
Sometimes it is perhaps the diaspora in the West who are much slower to
change than those who remain in their home country!

I hope I can provoke some helpful thought.

Warm Regards
Kathy Carter-Lee
RM MSc MCH
MW Technical Advisor
AKHS-Afghanistan.

> Dear Colleagues,
>
> In Lothian we recently completed a study of the experiences of
> maternity services staff in attempting to meet the needs of minority
> ethnic women during pregnancy, intrapartum and in the immediate
> postnatal period.  We are complementing up with a focus group-based
> study with 5 groups of Lothian minority ethnic women.  Lothian's
> minority ethnic population is relatively small in comparison with many
> other cities, which means both that women can be particularly isolated,
> and that - unless they have worked elsewhere - few midwives have
> substantial experience of working routinely with an ethnically diverse
> population.
>
> One major theme arising from interviews with hospital-based midwives
> and obstetricians was confusion over advising South Asian women on
> feeding their babies colostrum.  Many staff assumed that South Asian
> women were reluctant to feed their babies colostrum, that this was
> culturally-embedded practice, and didn't attempt to engage with them on
> this (in an effort 'not to offend').  Others were troubled by this
> approach, feeling that it perpetuated inequalities, but were uncertain
> how to go about broaching it sensitively with women, and were also
> worried about how it sat with baby-friendly status.
>
> We plan to explore this further through our focus group research with
> South Asian women later this year, and to try and incorporate
> reflections on culture and its mutability and stereotyping into any
> training we are able to do with midwives.  However, it would be very
> helpful to know if any colleagues have come across similar situations,
> and whether anyone working in areas with substantial South Asian
> populations have produced specific materials on breastfeeding for South
> Asian women, guidance for midwives and others working with them, or
> breastfeeding policies which recognise cultural variability in bresat
> feeding practices.
>
> Best wishes,
>
> Judith Sim
> Senior Health Policy Officer
> Lothian NHS Board
> Deaconess House
> 148 Pleasance
> Edinburgh EH8 9RS
>
> 0131 536 9449
> [log in to unmask]
>
>
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