ETAPA DEL
8.2.2.3 Subprograma de seguimiento a la actividad reproductiva de las especies migratorias en la cuenca baja del río Cauca
Within the literature, different cultures have their own dietary practices that are
followed by postpartum women and they were mainly done to restore their health and
to protect them from ill health conditions in the future. Although there were variations
in these practices and beliefs, they could often be traced back to the theory of cold and
hot balance for health in traditional Chinese medicine. There is an extensive literature
on the range of dietary practices that are observed, which is reviewed here.
4.8.2.1 Roles of food
Literature about cultural health practices of postpartum diet revealed different
purposes the food plays in women’s health; findings from studies in Far East countries
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often be categorized into two main roles; compensating the blood loss and cleansing the
body from dirty and harmful blood. For example, the women reported that certain types
of food were eaten to regenerate the blood, and this belief was common among women
from Korea (Sich 1981), Vietnam (Thi et al. 2002), and China (Cheung 1997). Also,
foods that improve the wound healing were reported among the women from Myanmar
(Sein 2013), and the participants from Loa (Barennes et al. 2009) believed that grilled
food (but not vegetable or fruits) repair internal organs, while herbal tea was used to
heal tissues injured by childbirth. Other related roles of food were to improve the
circulation (Thi et al. 2002), flush out the dirty blood (Pillsburry 1978), get rid of
placenta remaining in the uterus (Brathwaite and Williams 2004), and dissolve blood
clots (Thi et al. 2002). Not only did they believe that food improves the postpartum
women’s health, but that it also protects them from illnesses, for example the Vietnamese
women (Lundberg et al. 2011) prevented types of food during the postpartum period to
prevent illnesses in the future, while the women in Korea (Sich 1981) and in China
(Pillsburry 1978) believed that some types of food enhance production of breast milk.
Meanwhile, Khmer women (White 2004) indicated another purpose of food, such as
using salty food to increase the women’s thirst so they would be able to drink more
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The women in East Asian countries such as Bangladeshi women (Goodburn et
al. 1995) described their belief of using food to improve their healing process,
particularly the birth passage, which was similarly reported from the women in
Myanmar (Sein 2013) and Loa (Barennes et al. 2009), by eating a mixture of grounded
cumin, chilli, and garlic during the immediate postpartum period.
Studies of African countries such as Nigeria (Iliyasu et al. 2006) indicated that
82.7% of the postpartum participants consumed a large quantity of gruel mixed with
local salt due to their belief that it increases postpartum women’s strength and flow of
breast milk. Although they consume different types of food, the purposes are common
among the women from different cultures.
The Negev Bedouin women in Palestine Hundt et al. (2000) believed the mixture
of date and olive oil taken by the women in the past for the 40 days postpartum was
beneficial for breastfeeding, strengthening the postpartum woman, and helped in
stopping the postpartum bleeding. However, that old traditional meal has now been
replaced with eating meat, which they also believe is good for the postpartum health.
The women believed in the necessity of eating well at this period, which they defined as
eating high-protein food including poultry and meat as well as soups. In that study, the
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similar to that of humoral medicine; hot and cold body balance is important for health,
even if they do not acknowledge such beliefs and theories.
The most popular dietary practice for postpartum women in Turkey was found
to be the eating of a sweet meal called 'Bulamac', consisting of flour, fat, and sugar (82.8%), while drinking a mixture of grape molasses and butter was the second most
frequent nutritional practice (69.6%) (Geckil et al. 2009). Postpartum women were
encouraged to consume such sweet drinks and meals because they believed that this
food provided energy, and improved the production of breast milk.
In order to increase the amount of breast milk, a Turkish group of women
followed traditional practices included those related to diet such as eating onions, sweet
black eyed peas, potatoes and tarhana (a kind of soup); they also reported drinking linden tea, and wearing ornaments called milk beads, which look like drops of milk. The
Iranian participants followed traditional practices including eating kuymak, wheat, and water melon in addition to praying (O’zsay & Katabi 2008).
On the other hand, the women also reported that certain types of food were
harmful to their health, for example, a survey study’s findings (Wang et al. 2008)
showed that more than 90% of the participated Chinese women did not eat cold, hard,
or sour food in the postpartum month; these foods included mainly fruits and vegetables
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major concern of dental health was also reported among the Korean women (Sich
1981), as the participants avoided hard food. The participants from Myanmar (Sein
2013) classified food that should be avoided by postpartum women according to their
beliefs about the food being hot, cold (e.g. duck and cucumber), wind (e.g. pork) or
acidity inducing, and food they believed cause hypertension and drowsiness (e.g.
seafood). Therefore, they avoided sour, spicy, some types of meat, seafood, and some
vegetables and fruits. Noticeably, the types of food avoided were much more than those
which were allowed during this period. The participants (White 2004) reported their fear of toas and the different foods that could cause toas (i.e. ill health postpartum condition), and these were commonly all the types of food that women did not eat during
this time. It is believed that roasting provides protection from toas and women can eat as many roasted foods as they could during this period. Also, there were foods believed
to be poisonous such as water buffalo meat, pig’s head, and many types of fish (White
2004). Dietary restrictions have also been reported, but this time for the new-born
child’s health rather than for the postpartum women; the Vientiane women in Loa
(Barennes et al. 2009) avoided certain types of food especially in the first two weeks
after childbirth because they believed it caused negative health consequences for the
new-born. They called their restricted postpartum diet phitkam, in which they rarely ate vegetables and fruits during the postpartum month. For a period extended to two
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lapmou (i.e. pork with vegetables). In addition, they had restrictions in eating white- skinned animals because they believed it caused weakness, along with sugars, spices,
and liquid food including sauces.
Studies of South Asian countries have also examined postpartum food practices
and beliefs. It was found (Mahbub & Ahmed 1997) that cold food such as sour-tasting
foods are prohibited from the new Bangladeshi mother because it is believed that this
could make the uterus rotten and leads to shutika (i.e. one of the traditionally known postpartum illnesses). Milk, fish, cucumber and hilsha (i.e. a popular river fish) were avoided during this period because they believed it could dry the milk of lactating
mother and cause shutika (i.e. postpartum diarrhoea).
The main difference in restricted meat and fish between Hindu and Muslims
among Bangladeshi women was the duration of restriction; Hindu women had to avoid
it for the whole month, while Muslim women were restricted for only seven days
(Goodburn et al. 1995). Some were not allowed to eat any food for the first few days;
only a limited amount of water was permitted. Moreover, there are other forbidden
foods for postpartum women including bananas with seeds, eggs, and leafy vegetables
(Goodburn et al. 1995). Also, they believed (Mahbub & Ahmed 1997) another
postpartum condition they called shutika could be a consequence of nari paka. They also believed postpartum women should avoid eating vegetables and certain type of fish
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and sweet pumpkin due to their belief violating food taboos leads to suffering from
shutika. The women described two types of shutika; gorvo shutika (occurs before child birth) and hukna shutika (occurs after child birth), however their signs and symptoms were similar. They believed affected women experienced vertigo, painful limbs, poor
appetite, pain and fever, and then women gradually became weaker and thinner.
Women of African descent in the USA (Phillips 2005) reported avoiding bitter,
excessive sweet and salty food because they believed these types of food could harm the
organs involved in childbirth according to traditional Hausa medicine in Nigeria.
The women in Turkey (Geckil et al. 2009) believed that cold water and uncooked
vegetables should be avoided and were considered dangerous. Around 25% of the
participants in that study avoided certain foods, such as uncooked vegetables and fruits
during the postpartum period, while 18.3% were extremely restricted in drinking water
for the first 2-3 days postpartum.
4.8.2.2 Cold and hot food
The hot and cold theory based diet practices dominated findings generated from
the Far East studies. This theory (Helman 2014) is based on a concept that bodies of
postpartum women are extremely imbalanced toward ‘cold’ due to the blood and energy
loss during childbirth. Therefore, efforts made to restore the hot and cold balance aim
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in the postpartum diet. For example, the postpartum women in Vietnam were
encouraged to have warm food to provide warmth and to restore women’s energy (Thi
et al. 2002). Postpartum women (Pillsbury 1978) following the hot and cold balance
approach avoided eating raw and cold foods such as those growing in watery or dark
places, and they only consumed what is considered to be hot food. It was also expected
that they consumed large amounts of chicken prepared with a lot of sesame oil, as it is
considered hot food (Pillsbury 1978). The hot food was usually high in protein, fat,
calories and vitamins such as chicken, egg, pork, gluten rice wine and ginger. All the
food had to be very soft and well cooked (Cheung 1997). The Vietnamese women
(Lundberg et al. 2011) believed postpartum women are in a cold state and should eat
only hot food such as meat and eggs, and avoid cold ones such as fruits; they also could
make food warmer by adding ginger and wine to it. These women described that their
most commonly consumed food during the postpartum period was pig’s trotters cooked
with papaya or red beans and potato and eaten with rice. Khmer postpartum women
believed hot foods restored heat to their body, which could be related to the humoral
medicine principles (White 2004). The Khmer women (White 2004) were discouraged
from eating cold food because this was classified in the humoral system and included
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Postpartum experience was examined from the perspective of different
populations; the postpartum experience of six professionals and highly educated
Chinese women living in Canada (healthcare professionals, journalist and computer
programmer) (Brathwaite & Williams 2004). They reported eating special Chinese
soups, which they believed were important to restore heat and cold balance. Other
participants avoided cold food during this period and described a special diet for the
postpartum women, which consisted of pork trotters and ginger. They believed that
such type of food helps the women to bring back their bodies’ heat and cold balance,
and it help them to get rid of the remaining parts of the placenta in the uterus. Despite
high levels of education and living in Western countries, these traditional practices were
adhered to by women.
Women of African descent in the USA described avoiding cold food and drinks
during postpartum as they believed women in this period were in a cold state and they
therefore said that only hot soups and foods should be consumed (Phillips 2005).
Rural Bangladeshi women (Goodburn et al. 1995) shared the Chinese beliefs that
hot foods should be encouraged during the postpartum period. Bangladeshi women
(Mahbub & Ahmed 1997) also believed that the violations of the postpartum cultural
rules could cause illness to postpartum women; for example, the participants reported
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They believed this condition occurs when a woman eats cold food during the
postpartum period and they described its association with foul-smelling uterine
discharge mixed with the lochia that could last for three to four months, together with
fever and body ache.
4.8.2.3 Postpartum food characteristics
The women described some key characteristics of the postpartum diet, for
example, there was a common belief in the importance to have soft and easily chewed
food among Chinese and Korean. The Korean postpartum women (Sich 1981) described
exclusively eating soft food in the form of seaweed soup and rice because they believed
their teeth as well their bones are loose during this period, while the Chinese women
(Cheung 1997) believed all of their food should be very soft and well cooked. Kaewsarn
(2003) surveyed Thai postpartum women using a descriptive questionnaire and found
that food restrictions were found to be the fourth most popular Thai postpartum activity
that lasted between 2 days to 24 months. The foods consumed during this period were
sources rich in protein, vegetables, fruit, and herbal drinks and medicines. Soft, hot, and
sweet foods such as rice soup, eggs, sweet water and noodles were encouraged to be
consumed during this month (Wang et al. 2008). The Myanmar women (Sein 2013)
were encouraged to eat chicken because they believed it had the power of wound
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2004) were encouraged to eat Khaw, which is a traditional recipe that contains beef, pork, or fish pouched with salt, pepper, and palm sugar, based on affordability. For
others who cannot afford it, they can replace that meal with eating rice porridge called
borboror rice with salt and pepper.
Shakya (2006) explored postpartum cultural practices among women in a
village in Nepal, and the findings indicated that the participants believed alcohol is good
for postpartum women’s health. They served the best quality of alcohol called aerakor fermented liquor called chhyang to the women after childbirth, and if they were wealthy, they served a warm alcohol mixed with one teaspoon of ghee to the postpartum
women. They believed alcohol restores energy and reduces exhaustion as the women
became intoxicated. Also, they believed millet alcohol reduces the pain of uterine
contraction during the postpartum period. The Nepali Women could have one rice meal
a day during the seclusion period, and they could have cereals with milk for the rest of
the day (Goodburn et al. 1995).
In African countries such as Sudan, the study findings (Elneim 2014) showed
that the postpartum diet was focused on eating meat, eggs, fish and chicken, and not
eating fruits and vegetables, or high-energy snacks like porridge ring, date milk
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soup tea ring with milk, hargl grass (i.e. type of plant) with milk, and hot milk with butter.
4.8.2.4 Quantity of postpartum food
In China it was believed that women doing the month should increase their
number of meals to about five or six (Pillsbury 1978). In another study of Vietnamese
women in postpartum (Landberg 2011), women described believing they should
increase the amount of food they consumed during postpartum due to their weakness,
as food enhanced their recovery and strengthened their bodies. The women believed
eating plenty of food after delivery could prevent Dubolota which was traditionally perceived as a postpartum pathological condition characterised by weakness and which
could lead to white vaginal discharge (Mahbub & Ahmed 1997).
4.8.2.5 Drink and water restrictions
In contrast to other Far East cultures such as China, Hmong (i.e. Asian ethnic
groups from the mountains of China, Vietnam, Laos and Thailand) and Thai, hot drinks
such as wine, coffee and tea were prohibited for Vietnamese postpartum mothers
because it was believed that they could affect the quality of their milk. Only limited
amounts of hot water and herbal tea were allowed because they believed that water is
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was believed to tighten the intestine and to prevent urine ailments in old age (Thi et al.
2002).
A descriptive quantitative study using a questionnaire to investigate and identify
the 10 most observed postpartum behaviours among women from rural and urban
communities was conducted in Jordan (Jarrah & Bond 2007). It found that 67.5% of
the participants disagreed with the belief of 'restricting postpartum fluid intake to
prevent stretching the stomach', however 25% believed that it is a correct belief. The
authors concluded that this was a concern due to the postpartum women’s need for
proper hydration to replace the fluid loss during childbirth.
In the above section, postpartum dietary practices for different cultures have
been described and reasons for following these were explained. Although practices
varied, many originated from the hot and cold theory, which considers that postpartum
women are in a cold state and need to avoid cold food to restore their balance within
their bodies. Many dietary practices are also focused on providing high-energy
nourishing foods to replenish energy following birth, support healing and
breastfeeding, and nourish the mother. It was notable that women’s mothers and
mothers in law were holders of authoritative knowledge in relation to diet, and that
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to a more westernized one. Other common traditional postpartum practice was
confinement within the home, which will be described in the following section.