Prepared by Daniel Richard Kambey, The University of Tokyo, Japan for International Conference on Public Health and Well-being 2019, 4-5 April, Negombo, Sri Lanka Co-Authors Amandha BTR, Fitriana, Ayuningtyas SL

1. CULTURAL INFLUENCE ON MATERNAL AND
CHILD HEALTH IN SINGKIL DISTRICT, ACEH,
INDONESIA: A SHORT REPORT
Amandha BTR, Fitriana, Daniel RK, Ayuningtyas SL, Onishi H

2. BACKGROUND

3.  Everyday approximately 830 women die from
preventable causes in the maternal phase, with 99% of
maternal deaths happening in developing
countries especially in rural areas and poorer
communities (World Health Organization, 2018).
 Children’s health has also become a serious problem Children’s health has also become a serious problem
worldwide. Majority of childhood deaths caused by
preventable of treatable disease (World Health
Organization, 2018).

4. Singkil district is one of the districts in Aceh Province, Singkil district is one of the districts in Aceh Province,
Indonesia.
 Data from the Health District Office stated that Aceh province
has one of highest maternal and child mortality rates in
Indonesia (Koto, Andriani, & Ginting, 2018).
 In the last four years (2011-2014) maternal death in Singkil
District has increased with 67% dominated in post-partum.

5.  The high maternal and child
mortality rates are related to
pre-eclampsia, infection,
and hemorrhage as direct
factor.
 Additionally, delays in
decision making and
culture contribute to
decision making and
culture contribute to
maternal and child health.
 Singkil District has strong
cultural traditions related to
maternal and child health which
are involved in their family
decision making.

6.  One of the strong cultures
related to maternal and child
health is “Badapu”.
 Badapu is traditional culture
which involves food restriction
for post-partum women andthe
women also have to live in a small
room full of smoke.room full of smoke.
 Those women only eat rice
without side-dish and only
consume less water. The
women and her baby will live in
room full of smoke (Badan
Perencanaan Pembangunan
Daerah, 2016).

7.  Understanding of important issues in maternal
and child health practice, culture, beliefs, and traditions
is a important role in designing culturally appropriate
interventions (Morris et al., 2014).
 This study aims to report a cultural influence
related to “Badapu” on maternal and child healthrelated to “Badapu” on maternal and child health
in Singkil District.

8. Methods
 This was a qualitative
study with
phenomenological
approach.
 Participants were
women involved in
“Badapu” tradition
and stake-holders
“Badapu” tradition
and stake-holders
from primary healthcare
and health district
offices through
observation and in-
depth interviews.
 This study was
conducted in July 2018

9. Result
 Badapu is a hereditary
cultural tradition that believes
in food restriction, warming the
woman and the baby in a room
full of smoke.
 Mothers and their babies have Mothers and their babies have
to participate in Badapu for
40 until 60 days.

10.  “... Every woman after giving birth they only consume rice with
little water.They also cannot consume any vegetable and fruits.
We believe that chicken, meat and water make delay in
wound healing” (Participant 1, Family of woman after givingwound healing” (Participant 1, Family of woman after giving
birth).

11.  Badapu tradition also believes that the mother and her
baby have to live in a small room full of smoke and not go
anywhere.The woman should lay down in a bed with hot
stones on her feet, and should not raise their arms.This
position is supposed to make sure all of the woman’s
body will stay warm.body will stay warm.
 “We believe that woman who sweaty will make their wound
related to giving birth will healed. Every woman and her child
will stay in a small room to warm up our body.We also restrict
theirself-care such as take a bath to make sure our body still
sweaty” (Participant 2,Woman).

12.  Side effects of Badapu include discontinuation of
breastfeeding which makes malnutrition of the baby.The
newborns and infants also get impact to their respiratory
tract.The newborns and infants will be at risk for
respiratory tract infection and pneumonia that can cause
the high mortality in Singkil District.the high mortality in Singkil District.
 “Badapu is one of the contributing factors related to high
maternal and child mortality in Singkil District.Women have
high risk for anemia related to food restriction and the baby is
at risk for respiratory tract infection” (Participant 3, Local
Development Officer).

13.  Stakeholders in Singkil they make collaborative agreement
between midwives and the women who helped in child
delivery (local shaman) to change behavior.
 “Our government motivates collaboration among midwife and
local shaman to improve MCH.We make memorandum oflocal shaman to improve MCH.We make memorandum of
understanding (MoU) to increase awareness of health
behavior” (Participant 4, Midwife)

14. Discussion
 Badapu requires food restriction for post-partum women that
affects their nutritional status. Study by Deri (2009) shows that
82.2% of subjects who suffered anemia.There were 68.9% of the
post-partum women involved in Badapu who have low Body Mass
Index (BMI) under 25.
 Furthermore, lack of nutrition will delay in wound healing process.
Wound healing process needs high protein for fibrinogen formation.
Badapu restricts protein intake and post-partum women should only
consume rice with some side-dishes allowed.
Badapu restricts protein intake and post-partum women should only
consume rice with some side-dishes allowed.
 Post-partum women actually need increased nutrition for
breastfeeding process.The baby needs breast milk as an important
nutrition source. Food restriction makes decreased breast milk
production.
 The mother and baby in Badapu culture live in a room full of smoke.
Smoke contains carbon monoxide that is dangerous for humans
because it makes a bonding to Hb which decreases oxygen
levels(Badan Perencanaan Pembangunan Daerah, 2016).

15.  The factors related to the barriers to maternal health include
lack of knowledge, risky practice, delay seeking care, and
expectations of family and community (Morris, Short, Robson,
& Andriat sihosena, 2014).
 Socio-cultural development in a community can give positive
and negative effect.There is a relationship between health and
culture. Culture can affect behavior and responses relatedculture. Culture can affect behavior and responses related
health and disease.
 Health care providers have an important role in health
promotion and changing unhealthy behavior related to local
culture. Health care providers should negotiate and modify the
culture that gives negative impact to MCH(Rahayu et al., 2017).
 Collaboration between midwives and local shamans aims to
negotiate health behavior change related to local culture.

16. Conclusion
 Singkil district is one of the districts in Aceh Province,
Indonesia with high maternal and child mortality rates.
 One of factors that is contributing is the culture called
Badapu.
 Badapu is a culture which requires post-partum women
to do food restriction, minimize their movementto do food restriction, minimize their movement
and self-care, and live with their baby in a small
room that is full of smoke.
 Stake-holders can reduce negative impacts of
Badapu by making collaborative agreements among
shamans and midwivesin order tonegotiate
positivebehavioral change.

17. Thank You