A newborn baby should not be bathed until 24 hours after birth. Bathing babies early can increase the risk of hypothermia, and if the baby is of low birth weight the risk is even greater. Hypothermia is one of the major causes of mortality among newborns. A study conducted in a hospital in India shows that 9.6% of the total neonatal deaths were due to hypothermia (Kaushik et al, 1998). Compared to safe cord cutting and good breastfeeding, good bathing was demonstrated by the smallest proportion of the women. Only 16.6% of the women whose data were analysed bathed their babies after 24 hours of birth. Nationally, only 9.3% of the babies were bathed after 24 hours of birth; therefore, delayed newborn bathing is not a common practice throughout Nepal (MoHP, New ERA, Macro International Inc., 2007).
There are cultural beliefs associated with newborn bathing. In Nepal, bathing a baby soon after birth is widely prevalent because the baby’s body is coated with vernix, which is considered dirty. Therefore, bathing a baby soon is a custom followed to purify the baby (Gurung, 2008). People also fear that if the baby’s skin is not cleaned soon, the baby will get skin infections. In rural Nepal, usually the TBAs assist deliveries and some of them believe that immediate newborn bathing is also required to protect the baby from cold. Usually, babies are bathed with lukewarm water after cord cutting and cleaning the spot within half to one hour of duration. Breastfeeding is also not initiated until the baby is bathed (Gurung, 2008).
It has been reported that in Southern Nepal, babies require year-roundthermal care because mild or moderate hypothermia is nearly universal,with a substantially higher risk in the cold season (Mullany, et al, 2010). One of the important approaches to reduce the risk of hypothermia and improve thermal care for newborn babies is to delay their first bath. Research on community, household, and caretaker practices associated with hypothermia can guide behavioural interventions to reduce risk.
The descriptive analysis showed that good newborn bathing was greatest (63%) among the disadvantaged indigenous caste/ethnicity group women compared to other caste/ethnicity groups which is primarily because the proportion of disadvantaged indigenous caste/ethnicity women was very high in the sample population. Within the different caste groups, a greater proportion of women from the upper caste group (29.6%) practised delayed newborn bathing compared to other caste groups. Out of all dalit caste/ethnicity group women, only 6.1% adopted delayed newborn bathing. The multivariate analysis confirmed that women belonging to dalit caste/ethnicity group were less likely to bathe their babies after 24 hours of birth compared to the upper caste/ethnicity group women. This finding is not quite unexpected because in Nepalese society caste/ethnicity is often associated with greater levels of knowledge and purity. Compared to other caste groups, people belonging to the upper caste/ethnicity group are more educated, and hence might be more knowledgeable. Thus, they might have understood the benefits of bathing babies a day after birth whereas dalit women are mostly uneducated, therefore, are less aware of the importance of delaying newborn bathing. Therefore, they bathed babies within 24 hours of birth. The cultural beliefs associated with birth and newborn bathing might have been more frequent among the dalit caste/ethnicity group women, therefore, they bathed their babies within 24 hours of birth.
Maternal education has a strong influence on the utilisation of maternal health services and child survival. Educated women are more likely to break away from tradition to utilize the modern means of safeguarding their own health and that of their children, are better able to utilize the available services in their community to their advantage and seek quality health services (Caldwell & Caldwell, 1988; Magadi et al, 2000 & Barrera, 1990). Therefore, it could be expected that the women who attained secondary or higher education level are more inclined towards using modern health facilities and services and thus become more aware of the importance of delayed newborn bathing and demonstrate good newborn bathing. However, Nepal’s national data for newborn bathing and level of education shows that the proportion of babies bathed after 24 hours of birth is greatest among uneducated women and lowest among
the higher level educated women. In this study, among all the women who demonstrated good newborn bathing, the greatest proportion was uneducated. The descriptive statistics also showed that nearly half of the higher level educated women bathed their babies after 24 hours of birth while between only 12 to 23% of women who were uneducated, or primary or secondary level educated bathed their babies after 24 hours of birth indicating that there might be a positive relationship between higher education and good bathing practice. Nevertheless, in the multivariate analysis, the higher education level did not emerge as a positive predictor of good bathing, possibly because of the low proportion of higher level educated women in the sample population (5.5%) and therefore a lack of statistical power to determine the association. Surprisingly, the secondary education level emerged as a negative predictor of good bathing practice in the analysis. The results thus indicate that beliefs associated with early newborn bathing might be prevalent among the educated people too. A study conducted by Baqui et al (2006) in rural Uttar Pradesh of India also found a negative impact of secondary and higher level education on thermal care practice for newborns.
Delayed newborn bathing was also related to the SES of the women. Women who were in the fourth and the highest wealth quintiles were more likely to bathe their baby after 24 hours of birth. The explanation for this relationship is the same as that for the relationships between SES and safe cord cutting and early breastfeeding practices. The richer women might be more inclined towards using modern health services where they learn about the importance of delaying bathing. Thus, they are more inclined towards bathing baby after 24 hours of birth.
Mothers’ knowledge of ‘delivery cleans’ and newborn bathing was also related to good newborn bathing practice. As might be expected, if women had knowledge of correct newborn bathing time, they were more likely to bath their newborns after 24 hours of birth. Women were also more likely to demonstrate good newborn bathing if they had knowledge of things that needed to be kept clean during delivery. This association indicates that there might be a positive relationship between knowledge of ‘delivery cleans’ and knowledge of correct bathing time. Thus, if women had knowledge of ‘delivery cleans’ they were also likely to demonstrate good newborn bathing.
In rural areas of Nepal, FCHVs play a vital role in providing information related to family planning, safe motherhood, and child health, particularly in the places where access to health workers and facilities are limited or difficult. In this study good bathing practice was also associated with advice provided by FCHVs on newborn bathing during pregnancy. This
relationship is direct. In the villages, FCHVs organise meetings with pregnant women and new mothers on a monthly basis where they discuss issues related to safe motherhood and newborn care. FCHVs also make home visits to pregnant women and new mothers. Therefore, those women who are visited by FCHVs and are advised by them on newborn bathing become more aware of the importance of bathing the newborn at least 24 hours after birth. Thus, they are more inclined towards bathing the baby after a day of birth.
Though the use of ANC services was not associated with delayed newborn bathing in the full regression model, it was found to be positively associated with good newborn bathing practice when socio-demographic, SES and use of ANC service variables were regressed. However, it could not retain its significance when variables related to knowledge; counselling and advice, and exposure to media was introduced. Good bathing practice was also not related to birth preparedness and exposure to media.
It has been documented that bathing newborns soon after birth increases the risk of hypothermia. Neonatal hypothermia is recognized as one of the contributing factors to neonatal mortality and morbidity, but data are largely lacking from developing countries where the majority of high-risk neonates are born. Nepal is one of the countries which have a high neonatal mortality rate by world standards and currently the neonatal mortality rate of Nepal is 33 per 1,000 live births. In urban areas the rate is 25 per 1,000 live births and in the rural areas it is 40 per 1,000 live births (MoHP, New ERA, Macro International Inc., 2007). Therefore, this study by identifying the determinants of good newborn bathing practice will help the safe motherhood and neonatal health programmers to design programs and strategies to minimize or remove the barriers and promote the enhancing factors associated with good newborn bathing practice. The cultural beliefs associated with the need to bathe baby soon after birth are difficult to modify as they have been practiced for a long time and are deeply rooted in the minds of rural Nepalese families. For instance the result of this study has already showed the high prevalence of bathing newborn soon after birth among the educated women too, which might be because of the belief and desire to remove vernix completely to keep the baby clean and pure. However, other factors that determine delayed bathing could be changed with less effort. Therefore, improving SES and increasing the knowledge of women and their family members of newborn bathing time and the possible risk of hypothermia might be more effective approaches to modify newborn bathing behaviours.