Cultural Norms and Practices of Birth Preparedness among Indigenous Maasai Women in Northern Tanzania: A Descriptive Qualitative Study

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Chanimbaga, Erick Donard Oguma, Fabiola Vincent Moshi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5804566/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Preventable maternal morbidities and mortalities due to pregnancy-related complications can arise at any stage in pregnancy, delivery, and after. Despite efforts to encourage women to give birth in healthcare facilities, improvement has remained stagnant, particularly in remote Indigenous Maasai populationsin northern Tanzania. The study aims to explore the cultural norms and birth preparedness practices among Indigenous Maasai women in Northern Tanzania. Methods : The study employed a descriptive qualitative study design, which was conducted from 11 April 2024 to 31 May 2024, among Indigenous Maasai women. In-depth interviews were conducted with 7 newly delivered Indigenous Maasai women, and three focus group discussions with 30 Indigenous Maasai elderly women. The thematic analysis with inductive approach was used to analyze the qualitative data. Results: The study findings identified five overarching themes and 16 sub-themes, shedding light on the prevalent adherence to cultural norms and traditional practices surrounding childbirth. The themes encompassed traditional preparation for childbirth, culturally rooted approaches to maternal well-being, ritualistic practices during pregnancy and delivery, the collaborative roles of husbands within the family, and cultural norms associated with newborn care. These themes highlight the intricate interplay between cultural traditions and maternal health practices in the study context. Conclusion : The study's findings reveal that Indigenous Maasai women in Tanzania adhere to traditional birth practices, which include the utilization of herbal medications and dietary modifications during pregnancy, labor, and postpartum. Their husbands play a crucial role in determining the birth location and providing assistance during labor and delivery, with a preference for traditional birth assistants (TBAs). This preference for TBAs during care and delivery increases the risk of complications for both mothers and newborns. Therefore, the study's findings emphasize an urgent need for community health educational programs focused on creating awareness of the effects of traditional practices such as restriction of food intake during pregnancy and inadequate use of skilled birth attendants among the study population to enhance maternal well-being. Figures Figure 1 Figure 2 Introduction Maternal mortality is a major public health issue worldwide; in 2020, problems associated to pregnancy and delivery claimed the lives of approximately 287,000 women. About 87% (253,000) of these maternal deaths occur in developing countries; out of this percentage, 70% (202,000 deaths) occur in Sub-Saharan Africa, including Tanzania (1). However, from 2000 to 2020, the maternal mortality rate (MMR) declined from 342 to 223 per 100,000 live births (1). Despite the Sustainable Development Goal (SDG) 3.1 of reducing the maternal mortality rate (MMR) to less than 70 per 100,000 live births by 2030, the trend of MMR remains high, particularly in developing countries. Most maternal deaths are preventable and could be avoided by implementing proven interventions to prevent and manage complications during pregnancy, childbirth, and the postnatal period (2,3). The birth preparedness (BP) approach is a global key aspect of the safe motherhood strategy that can meet SDG 3.1 (4). It encompasses both preparing for a typical childbirth experience and being ready to handle unexpected complications that require emergency obstetric intervention (5). Hence, it encourages pregnant women to seek timely skilled birth attendants when labor begins and in case of obstetric complications. World Health Organization estimates that 300 million women in low-income nations experience either temporary or permanent complications associated with pregnancy and childbirth (6). This is due to delayed health-seeking, reaching, and obtaining necessary healthcare services during the period of pregnancy, delivery, and post-partum (7). In addition, the delay in seeking care is accountable for 75% of maternal mortality (8). Furthermore, about 15% of all pregnant women experience potentially fatal conditions that necessitate medical attention, and some will need a significant obstetric intervention to survive (9). Moreover, obstetric complications can arise at any stage in the pregnancy, delivery process, and after (CDC, 2020). Thus, BP practices continue to be the most important way to reduce the risk of complications such as severe bleeding, obstructed labor, pre-eclampsia, eclampsia, sepsis, and unsafe abortion (10). In addition, these are the primary complications that cause 80% of maternal deaths (1). However, the BP package at the individual level includes identification of the preferred skilled birth attendants, identification of the nearest healthcare facility for acceptable obstetrical services, saving funds for delivery and related emergency obstetric expenses, arranging transportation to a health facility for normal birth and, in case of emergencies, identification of appropriate blood donor, preparing materials for both the mother and newborn and being aware of the obstetric danger signs (11,12). Maasai community, being an Indigenous pastoralist group living in East Africa, has distinct cultural norms, beliefs, and practices that may have an impact on how they seek maternal healthcare services, potentially resulting in unfavorable outcomes for mothers and newborns (13). One of the significant challenges that the Maasai community faces is accessing and utilizing maternal and newborn health services, with many women delivering at home where there is no running water, sterilization, and without the assistance of skilled birth attendants who can manage obstetric complications (14). In Tanzania, the health system has significantly improved by providing free delivery services at all public health institutions and expanding health services to save the lives of pregnant women and newborns (15). Hence, it has made tremendous progress towards lowering MMR from 556/100,000 live births in 2015/16 to 104/100,000 live births in 2022 (TDHS, 2022). Still, it is out of the SDG 3.1 target of reducing MMR to less than 70/100000 live births by 2030. Moreover, Tanzania has made strategies to strengthen primary health facilities and introduced comprehensive emergency obstetric and newborn care (CEmONC) in health centers, aiming for 80% of deliveries to take place at health facilities (17). Thus, the national coverage for health facility deliveries increased from 51% in 2010 to 81% in 2022 (TDHS, 2022). Despite efforts to encourage women to give birth in healthcare facilities with the assistance of skilled birth attendants who can manage complications when they arise, improvement has been constant, particularly in remote Indigenous populations (19). However, the Maasai community, as an Indigenous pastoralist group in Tanzania, has unique cultural norms, beliefs, and practices that can influence their health-seeking behaviors for maternal health service utilization (20). Despite the numerous benefits of health facility birth preparedness practices in enhancing maternal and neonatal health outcomes, information is insufficient regarding these practices among Indigenous Maasai women in Tanzania. Therefore, the current study aims to bridge the identified gaps by understanding cultural norms and practices of BP among Indigenous Maasai women in Tanzania. This will facilitate the creation of culturally appropriate strategies to enhance health facility BP practices. Methods And Materials Study settings The study was conducted in the Arusha region, specifically in Longido district, to represent the Indigenous Maasai women in Tanzania from 11 April 2024 to 31 May 2024. The region was selected because the Maasai population inhabits it highly. Longido district is one of seven districts of the Arusha region of Tanzania, and it is among three districts where most of the Maasai population lives (Ngorongoro District, Monduli District, and Longido District). The district has a population of 175,915 residents. Among the population, males 82,887, females 93,028, and 7037 females were estimated to deliver in 2022, and it has an area of about 7,786 km2 (21,22). The annual per capita income for Longido district residents is 199.630 Tsh. Almost all districts show an alarming lack of water for both human and livestock use. The Maasai are the dominant group in the district. However, the district is comprised of 18 wads and 41 villages. It has one district hospital, three health centers, and 25 dispensaries (21,22). There are 123 health personnel available out of 292 required. In Longido DC 549 women delivered with the assistance of TBAs and 275 delivered at home, for a total of 824 deliveries that happened in the community (23). Study Design A qualitative descriptive study design was employed to explore information from stakeholders using adapted semi-structured interviews and group discussion guides to explore traditional BP practices and cultural norms considered important for traditional BP practices among indigenous Maasai women in Tanzania, respectively. Study Population Key stakeholders who were willing to share their information and experiences concerning traditional BP practices and cultural norms considered important for traditional BP practices, including Indigenous Maasai women who delivered 24 months before the study participated in IDI, and Indigenous elderly Maasai women involved in FGD after providing verbal and written consent for participation. Inclusion Criteria The study included key Indigenous Maasai women stakeholders who resided in the chosen villages, could give consent, and were eager to share their knowledge and experiences on traditional birth preparation and cultural norms crucial to traditional BP practices. Exclusion Criteria Key Indigenous Maasai stakeholders reported being sick and incapable of communicating verbally. Sample size determination Purposive selection of key stakeholders based on their ability to express their ideas and experiences, where 7 informants were interviewed and 30 informants (3 focus group discussions with 10 informants in each group) were involved in IDI and FGD, respectively. However, the sample size for IDI was determined by the saturation level where 7 participants were interviewed, and after interviewing participant number 7, there was no emerging new data. For FGD, the determination of saturation was observed in group three where no new data came up, and that is how the researcher knew the data saturation point had been reached. Sampling procedure A homogenous purposive sampling procedure was employed to select 10 key informants (Maasai women who delivered 24 months before the study to participate in IDIs to share their understanding of traditional practices of BP. Also, 30 key stakeholders (elderly Indigenous Maasai women) were selected purposefully to participate in three FGDs and share knowledge on the cultural norms considered important for traditional BP practices, as they were considered to have rich knowledge concerning the cultural norms considered important for traditional BP practices. Data Collection Method Qualitative data was collected through IDIs and FGDs, which were conducted with a sample of key informants. The principal investigator and two Maasai nurse midwives research assistants fluent in the Maasai and Swahili languages performed IDIs and FGDs in a quiet place within the community setting, mostly in the village offices and under a tree to provide privacy and confidentiality. Before starting the interview and discussion, the research assistants had two days of intensive orientation to obtain consistency. The first research assistant, acting as a translator, assisted the principal investigator in conducting the interview and guiding the IDIs and FGDs, while the second research assistant handled digital voice recording and note-taking. The local Maasai language was used for both IDIs and FGDs. Data collection tool An adapted IDI and FGD guide was used, which included semi-structured questions derived from the previous studies (Solomon & Tesfaye, 2022 & Mosley, 2019). The IDIs were based on traditional birth practices. However, cultural norms considered important for traditional BP were explored through FGDs to guarantee fruitful dialogues. Both IDIs and FGDs were conducted in a local language (Maasai) by two skilled Maasai nurse midwives who were research assistants but also translators and the principal researcher. Furthermore, an audio recorder and notebooks were used to record and to take notes from the participants’ information throughout the entire IDIs and FGDs after obtaining their verbal and written consent following the provision of an explanation for recording purposes and that the recordings were to be used for the research purposes only, ensuring their anonymity and confidentiality. The discussions were held in a quiet location within the community to ensure active participation from all participants and to ensure confidentiality and privacy. Each IDI took about 45 to 60 minutes, while each FGD lasted 1 hour and 45 minutes on average. To facilitate fruitful dialogue among participants, the groups were arranged in a semicircle and quiet environment. Data collection procedure Research assistants who were intensively orientated on data collection objectives, instruments, and techniques together with the principal investigator collected qualitative data through the use of semi-structured (open-ended) questions in a face-to-face interview for IDI and FGDs. Before starting data collection, an adequate introduction including the purpose of the research, handling of data, and reassurance of the anonymity and confidentiality of their responses were provided to create rapport, entrustment, and honesty. Additionally, the interview commenced with broad questions followed by multiple follow-ups and probing questions aimed at eliciting a more profound comprehension of the traditional BP practices from the participants. The participants’ patience and tolerance for explaining their experiences on the topic determined how long the interview could last. However, about 45 to 60 minutes was used to complete the interview. Before initiating the interview, informants were requested to provide verbal and written informed consent. Important points were summarized right away, and whenever needed to obtain clear information. Ensuring Trustworthiness Credibility To ensure credibility, multiple sources of data collection were used, such as recording and taking notes during IDIs and FGDs, to guarantee that findings are not based on a single source of data. Moreover, the tools were shared with experts in the field of research, and their suggestions for improvement were subsequently taken into consideration. Also, data saturation, extended familiarization with the transcript data, and extended interaction with key informants in IDIs were all contributed to the credibility. In addition, all interviews and discussions were transcribed from the local Maasai language into Swahili by three Maasai nurse midwives who were not part of the research assistance and then translated into English by two Bachelor degree-holder nurses who were conversant in both languages (Swahili and English) for analysis. Also, the data analysis engaged 6-degree holder nurse midwives who were fluent in English. Dependability To validate the research findings, numerous data sources were used in gathering information from various sources, including IDIs and FGDs, and various research techniques like probing during IDIs/FGDs. However, member checking was observed by presenting and discussing the preliminary research findings with the participants to verify the dependability of the results, thereby ensuring that their views and experiences on traditional BP and cultural norms considered important for BP practices have been correctly captured and that findings line up with the informants' viewpoints. Confirmability Confirmability was maintained by ensuring that data and interpretations of the findings were surely drawn from the data and not the inquirer's imagination. This was achieved by taking field notes and audio recordings during the data collection process to make sure that no important data regarding the study that respondents provided was missed. In addition, to protect data, transparency, and obligations were taken into consideration. However, reflexivity was ensured by making study results more objective, transparent, and unbiased through the use of different personnel, from the translation of the findings from the local language to Swahili, then from Swahili to English, and during analysis as six-degree-holder nurses involved in analyzing the data. Transferability In order to guarantee transferability, a diverse range of key informants were included in the study to capture a wide range of viewpoints and experiences. Whereby, Indigenous Maasai women who delivered 24 months before the study participated in IDI, and Indigenous elderly Maasai women involved in FGD. By guaranteeing that the study represents the experiences of several groups, a diverse sample increases the likelihood that the findings may be extrapolated to other populations or environments, hence improving the findings' transferability. Moreover, the study employed a well-defined, methodical strategy to data gathering, which was fully explained. This contains details regarding participant selection, data collection methods, and data collection Tools. The study supports the findings' transferability by making sure that others can duplicate the approach in comparable circumstances by providing these details. Moreover, the research findings were comparing and contrasting with other studies that have been conducted among in Indigenous Maasai women on the same research topic. Data analysis The data were analyzed using inductive thematic analysis guided by Brown and Clark's (2006). Before starting the transcription process, the voice recordings were fully listened to multiple times. The three Maasai nurse midwives fluent in both the local and Swahili languages who were not part of the research assistants transcribed and translated all voice recordings and notes taken from IDIs and FGDs into Swahili to reduce individual prejudices while improving transliteration reliability, then into English by two bachelor's degree-holder nurses who were familiar with both languages (Swahili and English). To ensure accuracy, the back translation approach was used, following transcription, the analysis process followed the steps of data familiarization, coding words with similar meanings, and then grouping them to form sub-themes. More grouping of the sub-theme was performed to create main themes with assistance from peer reviewers. Results Background characteristics of study participants Table 1 presents the background characteristics of IDI participants (n = 7), detailing their age, educational level, average income, and past obstetric characteristics. The mean age of respondents was 35.4 ± 7.5 (SD). Most of respondents, 71.4% (n = 5), had informal education, with a smaller proportion, 28.6% (n = 2), having attained primary education. Regarding income, 71.4% (n = 5) earn less than 50,000 Tsh, whereas 28.6% (n = 2) earn an average of 50,000 Tsh or more per month. Regarding past obstetric characteristics, a significant majority of participants (71.4%) reported having more than five children, and traditional birth attendants attended most deliveries (57.1%, n = 4), with 14.3% (n = 1) taking place at health facilities and the remaining 28.6% (n = 2) at home. (Refer Table 1) Also, Table 1 provides details of the background characteristics of FGD respondents (n = 30), including their age, educational level, income, and parity. The age distribution is nearly even, with 46.7% (n = 14) of respondents under 60 years and 53.3% (n = 16) aged 60 years or older. A significant majority, 83.3% (n = 25), had informal education, while 16.7% (n = 5) had achieved primary education. Income levels are also fairly balanced, with 46.7% (n = 14) earning less than 50,000 Tsh and 53.3% (n = 16) earning 50,000 Tsh and above. In terms of parity, a substantial majority of 63.3% (n = 19) have ten or more children, compared to 36.7% (n = 11) who have fewer than ten children. (Refer Table 1) Table 1: Background characteristics frequency distribution table of participants in IDI (n=7) and FGD (n=30) Variables IDI FGD Frequency (n) Percent (%) Frequency (n) Percent (%) Age (years) <35 4 57.1 - - 35-49 3 42.9 - - 50-60 - - 14 46.7 ≥60 - - 16 53.3 Educational level Informal education 5 71.4 25 83.3 The primary level of education 2 28.6 5 16.7 Average income per month <50,000Tsh 5 71.4 14 46.7 ≥50,000Tsh 2 28.6 16 53.3 Past obstetric characteristics Multipara 2 28.6 - - Grand multipara 5 71.4 30 100 Place of delivery Health facility 1 14.3 - - Home 2 28.6 - - TBA 4 57.1 - - Traditional Birth Preparedness Practices among Indigenous Maasai Women in Tanzania An in-depth interview (IDI) with 7 Indigenous Maasai women who had given birth 24 months before the study was conducted. The researcher sought to understand the specific traditional practices that Maasai women engage in for traditional BP during pregnancy, delivery, and the postpartum period, including dietary habits, traditional medicines, and management of complications. The main themes that emerged from the responses were the following: The traditional approaches toward maternal well-being, traditions across childbirth preparation, and a husband’s collaborative roles within the family. (Refer Figure 1). Theme One: The Traditional Approaches to Maternal Well-being In this theme, informants demonstrated that within Maasai traditions, people rely on herbal medicine utilization throughout pregnancy, childbirth, and the postnatal period. Several traditional herbs are commonly utilized during these stages, as they are perceived as guaranteeing a woman's safety and their unborn babies. However, during pregnancy, Maasai women commonly ingest herbal medicine like oitepes . This medicinal preparation serves multiple purposes, including aiding in the management of pregnancy-related symptoms and potentially supporting maternal health as these medicines induce vomiting during pregnancy and assist the woman to have a good appetite after delivery. Moreover, in the context of labor, traditional medicines like Olmangulai, engoitiri, and sanjoi are employed to facilitate labor by increasing contractions, thereby aiding the progress of labor. Additionally, they may be administered if there are obstetric complications such as retained placenta or postpartum bleeding, potentially assisting in the management of these complications. Post-delivery, Maasai women often consume a traditional medicine ( oluai or Olkiloriti) which is mixed with porridge. These medicinal preparation are used to strengthen the body and alleviate postpartum discomfort, providing support during the recovery phase after childbirth . Sub-theme one: Expectant mothers use herbs during pregnancy In this sub-theme, respondents stated that Indigenous Maasai women use traditional medicine to induce vomiting as a way to lower their bile levels during pregnancy. If the mother does not do this, she won't be able to consume enough food after giving birth, which is essential to accelerate her body's energy gain. The participant reported that “During pregnancy, the expectant mother must be given a traditional medicine made up of tea leaves mixed with a little salt (olaisai) which is boiled to make her vomit to remove the bile that can cause her not to eat well soon after childbirth” ( 30 years IDI participant with 5 children). Another participant reported that ‘In Maasai tradition, we prepare ourselves for safe delivery by consuming a traditional medication known as lasi-oltapesi, which induces vomiting to reduce bile accumulation. This helps us to have a good appetite following childbirth’ (32-year-old IDI participant with 5 children) . Also, another participant reported that “In our tradition, a Maasai woman is given medicine during pregnancy to make her vomit to weaken the child so that he does not grow big using oloisikirai and oitepesi which are the bark of trees” (34 years IDI participant with 6 children). However , another participant reported that “We often take several traditional medicines to help us during the entire pregnancy, labor, and the period after childbirth. The elder woman or the Engaitoyon who was chosen would provide herbal medicines to induce vomiting during pregnancy such as engoitiri or sanjoiwhich which is typically administered by mixing with porridge to eliminate bile and promote better appetite after childbirth. During labor - engoitiri or sanjoi to hasten labor, and the period after childbirth -Olkiloritto reduces bleeding and helps remove emudong when it fails to get out easily” ( 45 years old, with 8 children). Sub-theme two: Traditional management of complication In this sub-theme, the respondent narrated that traditionally, Indigenous Maasai people have their own means of managing complications related to pregnancy such as post-delivery hemorrhage and retained placenta. These conditions are managed traditionally by administering traditional herbs to the women such as oloirien, which is given to a woman when the emudong (placenta) fails to be delivered on time (retained placenta). Olmangulai is a traditional medicine that is given to women to control post-delivery bleeding and it is also used in women with retained placenta. Participant reported that “We use green leaves of Oltarakwa for cleaning the birth canal and reducing the amount of bleeding that occurs after a woman has given birth. We use this medicine orally or directly applied to the bleeding sight after it has dried, ground up, and then boiled .” , also the woman’s abdomen is tightly bound using clothes materials to exert pressure on the woman’s abdomen to reduce bleeding” (43 years old IDI participant with 7 children ). Another participant reported that “During labor, we use Olmangulai, if the emudong fails to come out or if the woman is bleeding a lot after giving birth” ( 32-year-old participant with 5 children ). Sub-theme three: Traditional means of labor acceleration From this sub-theme, respondents expressed that, in Maasai tradition, when a woman is in labor, she is given traditional herbs like Olmangulai to augment the labor process thereby shortening the delivery time by strengthening labor pain. The participant reported that “In our tradition, when a woman is in labor, she is given Olmangulai to make labor pain strong and shorten the time for delivery” ( 30 years IDI participant with 5 children). Another respondent reported that ‘During labor: tea leaves mixed with sugar and a lot of ginger are boiled together, and the liquid is given to a woman to make the labor strong, she also takes cow's or sheep's fat to soften the stomach and make her get diarrhea to hasten labor and make the baby pass through the birth canal easily ‘( 43 years old, with 7 children). However, another participant reported that “During labor, we use cow's or sheep's fat to soften the stomach, which ultimately causes diarrhea so that the woman can deliver quickly without any obstacle” ( 45-year-old, with 8 children). Also, another participant reported that We prepare cow's or sheep's fat during pregnancy to soften the stomach and induce diarrhea during labor, thereby reducing the time for delivery (A 39-year IDI participant with 6 children). Theme Two: Traditions around Childbirth Preparations In this theme, respondents said that the Maasai community has their customary preparation for childbirth, as expectant mothers have to undergo dietary modifications and restrictions during pregnancy such as meat, milk, and stiff porridge so that the fetus does not grow too big to affect normal delivery. Additionally, the woman’s husband has to inform his mother so that she can start taking care of his wife, including dietary monitoring and physical exertion restrictions to protect the expectant woman from any adverse effects. Sub-theme one; Food restriction during pregnancy Respondents in this sub-theme stipulated that pregnant women should refrain from consuming specific types of foods like meat, milk, and stiff porridge, especially after their pregnancy reaches four months. She consumes minimal amounts of food or solely porridge, aiming to prevent excessive fetal growth that may hinder normal delivery. Additionally, her mother-in-law cares for her and keeps on watching very closely; if the pregnant woman is caught eating forbidden kinds of food, she is given a lot of water to drink so that she can vomit the food. The participant reported that “My mother-in-law had to monitor my diet during each pregnancy to keep my child in the womb from growing too big to ensure a normal delivery. She had to prevent me from consuming certain foods such as meat, stiff porridge, and milk, and only provide me with porridge. If I ingested prohibited food, she provided me with copious amounts of water, enabling me to vomit the food I had consumed.” ( 26 years IDI participant with 4 children). Another participant reported that “A pregnant mother who is four months pregnancy starts to eat less to prevent the unborn child from growing too big, which can prevent the baby from being born in a normal way” ( 34-year-old participant with 5 children). Also, another participant reported that “Pregnant women consume fruits and green vegetables like spinach; they predominantly consume water and porridge to prevent excessive growth of the baby in the womb, which may impede normal delivery” (43-year-old IDI participant with 7 children). Participant reported that “When a pregnant woman reaches four months onwards, she takes a minimal amount of food, or only porridge, vegetables, and water, so that the child that will be born will not grow too big to impede normal delivery ” (30 years IDI participant with 5 children). However, another participant reported that “ During the early days of pregnancy, the woman’s husband informs his mother about the pregnancy. Subsequently, the mother-in-law will advise the expectant mother to refrain from physical exertion and to avoid certain foods, such as milk and meat, to prevent the baby in the womb from excessive growth” (A 39-years IDI participant with 6 children). Sub-theme two: Traditional preparation for postnatal care In this sub-theme, participants narrated the traditional practice of a woman's husband preparing two goats for slaughter after the woman gives birth. The woman receives the boiled goat's fat to boost her energy quickly. However, community members assist the family in preparing for childbirth by raising funds to purchase goats and rice for the postpartum period. The participant reported that “In Maasai tradition, the husband assumes responsibility for preparing resources such as money, goats, or sheep, which are then slaughtered to provide sustenance for his wife during the period after delivery” (32 years IDI participant with 5 children). Another participant reported that “The woman receives boiled goat's fat and a small portion of meat for sustenance over two days after delivery. The traditional birth attendant, who assisted her with the delivery, receives a portion of the beef, while other community members who visit the household post-birth share the remaining meat. The mother dries, mixes the meat from the second goat with oil, and preserves it for her consumption during the post-delivery period” (39 years IDI participant with 6 children). However, another participant reported that “Maasai community members assist in delivery preparations in cases where the family cannot afford to buy the goats required for the woman after giving birth. Collectively, the community members raise funds to buy two goats, which they later slaughter after childbirth” ( 34 years IDI participant with 5 children). Additionally, another participant reported that “Friends help the expectant mother prepare for childbirth by bringing firewood for postpartum use” ( 30 years IDI participant with 5 children). Sub-theme Four: TBAs provide care and delivery assistance In this sub-theme, respondents said that, during pregnancy, a husband prepares a respected birth attendant to assist the woman during delivery. A husband has the authority and is responsible for selecting a respected traditional birth attendant ( engaitoyoni) in advance before labor starts so that she gets prepared. This attendant palpates the abdomen to determine the position of the fetus. However, if the fetus is lying in an incorrect position, the TBA attempts to adjust the fetus externally to facilitate normal delivery. The participant reported that “With my five kids, I never visited clinics because when my belly got huge, my husband chose a respected engaitoyoni to take care of me. When my belly grew large, she would palpate my abdomen to check if the baby was properly seated in the womb. Suppose the baby in my womb is not sitting in the correct position; in that case, she is capable of turning the baby to a suitable position to enable normal delivery” (34-year-old IDI participant with 5 children) . Another participant reported that “A selected engaitoyoni will be prepared to deliver the woman. She will prepare cow’s fat for use during labor and oil for use after childbirth” (26-year-old IDI participant with 4 children). Also, another participant reported that “ The engaitoyoni of choice is prepared to deliver the mother safely. She stays there from the time she is about to give birth until delivery and will remain with her for a period of one to three weeks after childbirth” ( 39-year-old IDI participant with 6 children) . Sub-theme five: Elderly women’s basic care roles during the continuum of care Respondents stated that Maasai pregnant women typically receive care from their mother-in-law or another experienced adult individual who has given birth, as they possess comprehensive knowledge about childbirth and can provide valuable insights, guidance, and support throughout the pregnancy, labor, delivery, and post-delivery period. The participant reported that “A mother-in-law or an experienced adult who has given birth to many children should be close, as we believe that they know many things about labor and will be able to provide various instructions during childbirth” (39-year-old IDI participant with 6 children) Another participant reported that “Wise adult mothers within the community play an important role in supporting expectant mothers during childbirth. They offer guidance and assistance throughout the process, ensuring the expectant mother's comfort and well-being. Also, a chosen engaitoyoni is prepared to facilitate the delivery, providing necessary oils and food for the mother after childbirth” ( 30-year-old IDI participant, with 5 children). Another participant reported that “Throughout labor, the mother-in-law plays a pivotal role in providing updates on the childbirth progress and offering support to the mother after the delivery” ( 43-year-old IDI participant, having 7 children). Another participant reported that “My mother-in-law took care of me when I was pregnant and after my babies were born” (27-year-old IDI participant with 4 children). Another participant reported that “During the last months of pregnancy, an experienced adult woman must be present at home all the time to instruct her on what to do during delivery ” (34-year-old IDI participant with 5 children) . Sub-theme six: Physical protection during pregnancy Respondents to this theme revealed that pregnant Maasai women avoid carrying heavy loads and walking long distances from home due to fear of injury, seizure, or abortion. When in labor, the Maasai woman refrains from walking, even to a health facility for delivery, due to the difficulties she may encounter while on the way. The participant reported that “Her mother-in-law, or an elderly woman caring for her, advises the pregnant mother not to overexert herself by walking long distances to prevent lightheadedness and abortion” (27-year-old IDI participant with 4 children) Another participant reported that “When it comes to giving birth, we are prevented from even going to the health center for delivery to prevent problems that may happen along the way because the health centers are far away and there is no transport” (42 -year-old IDI participant, with 7 children) Another participant reported that “To ensure that the pregnant mother is in a safe situation, anyone who finds her in a dangerous situation should help her” ( 38-year-old IDI participant with 6 children ) . Theme Three: A husband’s Collaborative Roles within the Family Regarding this theme, participants reported that, according to Maasai traditions, the husband in the family assumes the responsibility of being the pivotal controller over all things during the period of pregnancy, including ensuring that the place where his wife will deliver and the person who will assist her during pregnancy and in the delivery, process is well established. However, he is responsible for ensuring that money for delivery expenses, food, and other family members' requirements are in order, arranging house environments, and renovating the house in preparation for his wife’s delivery. Sub-theme one: A husband is in charge of everything Participants In this sub-theme informed that, traditionally, decisions concerning childbirth are typically made by the husband within Maasai traditional practices. The husband assumes the authority to determine the location of the woman's delivery and select the respected individual who will provide support throughout the process. Given his pivotal role in decision-making, the husband must remain close to his partner during the last months of pregnancy. The participant reported that “The husband has the authority over all things and is the one who makes decisions about whom to assist with delivery and where a woman should deliver; if the husband is not there, any other man in the family or neighbor can make decisions ” (43 years IDI participant with 7 children ). Another participant reported that. “The husband makes the decisions regarding a woman's delivery location and the people who will support her throughout the process” (26 years IDI participant with 4 children). Another participant reported that “The husband is the judge of all things, he will determine any challenge and make decisions about where the mother should deliver and who will assist the woman during pregnancy, delivery, and after delivery” (39 years IDI participant with 6 children) . Sub-theme two: A husband as a breadwinner Participants in this sub-theme stated that a husband assumes several responsibilities in preparation for his wife's delivery, including financial preparation and ensuring that there is enough food for the whole family. He also renovates the house and makes sure the environment around is clean. Participant reported that “When the woman is pregnant, the husband is responsible for preparing money and saving food for the whole family” ( 38 years IDI participant with 6 children ). Another participant revealed that “During the last months of pregnancy, the husband makes sure that he does not go far to provide support when the delivery time approaches” ( 43-year IDI participant, having 7 children). However, another participant identified that; “The husband must be close to his wife when she is about to give birth because he is the main decider of where the wife should give birth” (27 years IDI participant with 4 children). Similarly, another participant reported that “In Maasai tradition, when a woman is pregnant, the husband renovates a house and makes the environment beautiful ” ( 30 years IDI participant with 5 children). Cultural Norms Considered Important for Birth Preparedness among Indigenous Maasai Women in Tanzania Figure 2 outlines the general sub-themes and corresponding themes that emerged from the study. The major two themes were identified, including “The norms connected to the baby" and “Ritual performance during pregnancy and delivery". (Refer Figure 2). Theme One: Norms Connected to the Baby On this theme, informants reported that, according to Maasai cultural norms, pregnant women are forbidden from engaging in sexual intercourse from the moment of conception until after childbirth and until the child is two to three years old. This prohibition is based on the belief that the father's semen may defile the unborn child, leading to various adverse effects, such as being born with whitish materials around the baby's body that make him/her dirty. Peers may impose social punishment for violating this taboo. However, Maasai women don't make any preparations for the baby before birth, fearing that the baby might die soon after delivery and doubting the baby's survival. Sub-theme one: No sex throughout pregnancy and the first two years of life In this sub-theme, findings indicated women are only permitted to share a bed with their spouse after giving birth and until the child is two or three years old to protect the child in the womb (couples do not physically interact). The cultural belief that semen will affect the child's growth and development prevents women from having sex after delivery. Informant reported that “To protect our unborn child, we are not permitted to share the bed during pregnancy, and even after delivery, a man is not allowed to touch me or have sex with me until the child is two to three years old. When the child is born, Maasai elderly women usually assess the baby soon after birth to determine if he/she is clean; if not, peers will punish the man and his wife” (50 years FGD informant). Another informant reported that “In our culture, a woman cannot have sex until after giving birth, and the baby must be between two and three years old to prevent stunting the child's growth.” ( 55 years, FGD respondent ). Also, another respondent reported that : “A Maasai pregnant woman is not allowed to have sex from the moment she becomes pregnant until she gives birth, because we believe that, the father's ejaculate will pollute the child's buttocks, head, armpits, and any places where there are folds” ( 62 years old FGD participant ). Informant responded that During pregnancy, the expectant mothers typically reside with their mother-in-law, with whom they live or share the room until the period after delivery to protect the unborn child from potential dirt and harm. Post-delivery, until the child is two or three years old, the mother refrains from sleeping with her husband to avoid a negative impact on the child's development ” ( 64 years FGD informant). Another respondent reported that “The expectant mother leaves her husband’s room and lives with her mother-in-law for the duration of her pregnancy and she is only permitted to share a bed with her spouse when the child is two years old ” (57 years FGD informant). Sub-them two: No clothing preparation for the unborn child. Within this sub-them, respondents revealed that, in adherence to Maasai tradition, clothes are not purchased for the unborn child until after birth. This belief stems from the intuition that buying clothes beforehand may bring misfortune or death to the child, and they are also not sure whether the child will be born alive or not. However, some Indigenous Maasai women now purchase clothes for their newborn babies, concealing them in the homes of their neighbors The respondent reported that “Traditionally, it is forbidden for us to purchase any clothing as a preparation for a newborn during pregnancy. We are making it unlucky for a baby to die after delivery if we do that. We normally dress the baby with whatever we have at hand when the baby is born” (26 years IDI respondent with 4 children). Another respondent reported that “A Maasai woman should not buy clothes before she gives birth because the child may not be born alive” (32 years IDI with 5 children). However, another respondent reported that “With our traditions, we believe what will be born may not live, or we do not know that the mother who carried it will come to an end, so we should not buy anything for the preparation of the baby, such as clothes” ( 35 years IDI respondent with 8 children). Also, another respondent reported that “ We believe that we should not prepare clothes for the child before birth because he/she may not be born alive” (45 years IDI respondent with 8 children). Additionally, another respondent reported that. ‘We don't buy clothes for the unborn child until the baby is born, as it's a sign that the child will die, and if the child dies, where will the clothes go? (30 years IDI respondent with 5 children). Moreover, another respondent reported “Other Maasai women nowadays buy clothes for the unborn child and hide them in their neighbors’ houses until the child is born “ (A 39-year IDI respondent with 6 children). Theme Two: Ritual Performance during Pregnancy and Delivery Concerning this theme, the informants presented several rituals performed by Maasai elders during the period of pregnancy, in the process of labor and delivery to ensure that the expectant mother and the fetus remain safe. Even when these women fall sick and in circumstances like loss of consciousness following convulsions. However, Maasai resolves conflict culturally during pregnancy to guarantee that a woman does not encounter problems during delivery as a result of disagreements. Sub-theme one: The influence of ancestral spirits during pregnancy and Labor Informants expressed that pregnant women usually seek protection from their ancestral spirits and gods during the period of pregnancy, labor, and delivery, and even when the pregnant woman is sick to ensure the safety of both the mother and her fetus. Informant reported that “Rituals are performed by traditional elders, who ask the spirits of ancestors to protect the mother and her unborn child from bad people and bad spirits” ( 62-year-old FGD participant). Another informant added that; “Should the mother encounter illness during pregnancy, traditional healing practices are sought, with the mother returning home after treatment. A sheep is then slaughtered, and a piece of its skin is tied to the left arm of the pregnant woman as a protective measure. The back of the sheep is offered to the spirits at gravesites, symbolizing a plea for continuous offering protection to the sick mother” ( 59-year-old FGD informant ). Also, the informant expressed that “The Maasai elders will be called to pray to their ancestor’s spirits and spit on them to give their blessings, when the woman fails to delive r, they will pour milk and pray to the ancestors who died a long time ago” ( A 67-year-old FGD participant ). Moreover, another informant said that: “When the mother has labored for a long time, the men of that Boma climb to the top of the house to pray to the ancestors for safe delivery. When he comes down, he touches the mother's belly and gives her words of encouragement that she should give birth without any problems. Sometimes the mother gives birth safely, but on other occasions, it fails, necessitating her hospitalization.  ” ( 56-year-old, FGD participant). Sub-theme two: The cultural way of conflict resolution during pregnancy Informants revealed that Maasai elders lead reconciliation efforts to safeguard pregnant women and their unborn children. Maasai elders perform rituals to reconcile disputes or disagreements with their husbands and other community members, invoking the protection of ancestral spirits against evil forces.  The informant reported that : “In the event of frequent quarrels between the pregnant woman and her husband, when the woman is in labor, a ritual involving the husband putting milk in his mouth, returning it to a cup three times, and then giving it to his wife is performed, symbolizing a plea for safe reconciliation and childbirth” ( A 61-year-old FGD participant). Another informant added “The Maasai elders will resolve any disagreements the pregnant mother has with her husband or mother-in-law to ensure a safe delivery.” (64 years FGD participant). Sub-theme three: Cultural approaches to maternal challenges In this sub-theme, informants reported that when pregnant women fall sick, have repeated miscarriages, or die of newborn babies, they seek treatment from traditional healers and protection. However, women perform rituals during prolonged labor to ensure a normal and safe delivery. An informant reported that. “A woman who experiences recurring miscarriages or the death of a child shortly after birth goes to a traditional healer who performs rituals. She follows the traditional healer's instructions, such as bathing at House Conner or in a bush, to ensure the unborn child does not die like previous babies.” ( 67 years FGD informant ). Another informant reported that ‘When labor takes a long, the husband’s peers are called and talk to the unborn baby in the womb when we go out of the room, you also come out while patting the woman’s abdomen ’ (52 years FGD informant). However, they culturally manage loss of consciousness due to seizures to ensure that the woman regains consciousness and that she is protected from having recurrent attacks. The informant reported that “Culturally, when a pregnant woman loses consciousness following a seizure attack either during pregnancy or when in labor, elders burn osukuroi (a dried traditional medicine) so that a woman can inhale the smoke to regain consciousness and prevent its reoccurrence” ( 65-year FGD informant ). Another informant reported that “When a pregnant woman has experienced a seizure attack and regained consciousness upon awakening. We give her fresh cow's blood from the large blood vessel around the cow's neck, as we believe she has a small amount of blood in her body” (61 years FGD informant) Also, other informants reported that ‘Emasho, which is traditionally dried and smashed, is given to a woman who has lost consciousness following a seizure attack under her lips to help her regain awareness as soon as possible ‘ ( 62 years FGD informant). Discussion In this study, the traditional practices of BP among Indigenous Maasai women in Tanzania were explored. The study findings indicated that Indigenous Maasai women engage in multiple traditional practices of BP such as the use of traditional herbs to induce vomiting during pregnancy. Three themes were developed from the study including traditional approaches to maternal well-being, traditions across childbirth preparations, and a husband’s collaborative roles within the family. Traditional approaches to maternal well-being The findings from this study indicate that Maasai women use several kinds of traditional herbs, such as oloisikirai and oitepes, to induce vomiting during pregnancy. These practices aim to reduce bile accumulation and promote a healthy appetite post-delivery when a woman needs to eat enough food to quickly gain energy after a long pregnancy and delivery journey. Additionally, these herbs prevent the fetus from excessive growth, which could affect normal delivery. However, findings indicate that Maasai women use traditional approaches to accelerate labor, such as Olmangulai and cow’s or sheep’s fats, to fasten the labor and delivery process. In addition, the Maasai population practices their traditional means of managing complications relating to pregnancy such as managing retained placenta through the use of traditional herbs known as oloirien, or olgojorai which are also used to manage postpartum hemorrhage. Thus, relying on these herbals may result in poor maternal and neonatal outcomes due to delays in accessing obstetric services during labor and in case of complications. Moreover, they traditionally use clothing materials to tighten the woman’s abdomen to manage severe bleeding following delivery, which is a beneficial practice. Hence, managing complications related to pregnancy traditionally in the community may increases adverse maternal outcomes due to underutilization of skilled birth attendants for labor and obstetric complications management, and also sepsis as some herbs are applied directly to the birth canal to control hemorrhage which can lead to maternal sepsis as an aseptic technique cannot be practical during the course. This practice can be attributed to insufficient utilization of maternal health services during pregnancy, delivery, and the postnatal period which leads to inadequate information concerning health facility BP practices. These findings are in harmony with previous studies done in Ethiopia (26) indicating the existence of traditional malpractice as women use herbs to facilitate labor. It is a common practice for women to use herbs to facilitate labor and delivery in Ghana (27), Malawi (28), and Tanzania (29) indicated that Maasai women use traditional medicine during pregnancy, delivery, and postnatal. These similarities may be due to the possible existence of common values and reliance on traditional practices during pregnancy, delivery, and postnatal periods among study participants. All these practices may have an impact on the overall well-being of the indigenous Maasai women and the fetus such as rupture of the uterus, dehydration, and fetal distress. Studies indicate that the use of traditional herbs during pregnancy and labor may end up with poor outcomes for the mother and the fetus (28). Moreover, the use of herbal drugs during labor causes intense and persistent contractions that do not match with the cervix's steady dilatation leading to rupture of the uterus and fetal distress (30). In addition, even though they follow traditional practices, there have been reports of negative impacts on both the expectant mother and the fetus from using herbal medicine (24). Several traditional herbs are toxic due to a lack of established dosages and endanger expectant mothers and their neonates (28,31). Therefore, it is imperative to stress that seeking medical professionals' advice is necessary when pregnant women fall sick or notice any complications, rather than relying solely on herbs to improve the well-being of expectant mothers . Traditions across childbirth preparations Dietary restrictions during pregnancy were another prominent traditional practice that was identified in this study among the Indigenous Maasai women. The study found that Indigenous Maasai women traditionally prepare for birth through several approaches, including food restrictions during pregnancy such as meat, stiff porridge, rice, and milk to prevent excessive fetal growth, reflecting traditional practices that aim to ensure smooth childbirth experiences. However, pregnant women sometimes take only porridge, and vegetables and drink a lot of water. The risks related to pregnancy and labor consequences led to the avoidance of these kinds of food. Hence, these practices can affect the well-being of both the mother and the fetus due to a lack of significant food intake during this important period where there is an increased need for adequate nutritious food for energy, proteins, minerals, and vitamins. Also, restrictions on food and erroneous assumptions regarding dietary intake may have a detrimental effect on an expectant mother’s nutritional status as well as her unborn child’s growth and development following delivery. Therefore, it is crucial to educate the Indigenous Maasai community members about the significance of traditionally forbidden foods such as meat and milk, emphasizing their beneficial and recommended consumption during the peripartum period. By educating the Indigenous Maasai communities at large, including community leaders and elderly women, the universal misconceptions about food consumption during pregnancy can be addressed. Similarly, other study findings indicate there are still practices of food prohibition as reported in South Africa (32), Ethiopia (24), and Tanzania (19,25) which revealed that expectant mothers traditionally avoid foods like oily foods, eggs, butternuts, fish, pumpkins, and oranges, which could cause excessive fetal growth, making it difficult to deliver normally. These foods are rich in proteins, carbohydrates, and vital micronutrients which are highly needed during pregnancy for maternal and fetal welfare. However, these similarities might be due to the persistent existence of shared cultural beliefs and misconceptions about food consumption during pregnancy among study participants. Moreover, the study results differ from the study done in Cambodia, indicating a departure from destructive traditional practices such as food restrictions (33) and Nigeria ( Jembi et al., 2023) highlighted that expectant mothers’ dietary behaviors are not affected by cultural food beliefs. The disparities are due to the differences in social demographic characteristics of the study participants. However, the current study included Indigenous Maasai women, where most of the participants had informal education, which can affect the understanding of the significant effects of food restriction during pregnancy on the mother and fetus. Moreover, the study highlighted the prevalent traditional practices among indigenous Maasai women during childbirth preparations, such as relying on TBA assistance during pregnancy, delivery, and even after delivery. From five months of pregnancy onward, these TBAs palpate the expectant woman's abdomen to assess the fetal position and presentation. If the fetus is not in a cephalic presentation, they externally manipulate it to ensure a normal delivery, as is customary in the community. The simple accessibility and availability of TBAs may contribute to the persistence of this practice. Hence, these practices carry a risk of developing complications, such as fetal distress and placental abruption. Therefore, to enhance the health facility BP practices among the Indigenous population, strategies such as community-based educational campaigns should focus on TBAs, enhancing their understanding of the significance of health facility BP practices. This will enable them to support efforts aimed at enhancing maternal healthcare utilization throughout the continuum of care. Moreover, working together with reputable TBAs among Indigenous Maasai populations can bridge the gap between the traditional BP and health facilities. BP practices enable TBAs to facilitate access to maternal health services during pregnancy, labor, delivery, and postnatal care while also providing perceptive knowledge about culturally competent care. However, the same findings were obtained in Ghana (35), Kenya (36), Uganda (37) and Tanzania (19) indicating the persistence of traditional recommendations for TBA assistance and care during pregnancy and delivery since they are respected and trusted. These similarities might be due to similar traditional recognition and perception of TBAs as being experienced, knowledgeable, skilled, and reliable persons across African communities specifically in rural areas. Moreover, the results contradict those of studies conducted in Cambodia (33) and Malaysia (38) which found that women preferred to give birth at health facilities with the help of skilled professionals. The disparity might be due to differences in background and study population; also, the health policy of these countries restricts women from delivering at home and with the assistance of TBAs. Hence, these TBAs may lack the skills and resources to manage obstetric complications once they occur (39,40). Also, traditional practices can influence the use of maternal health services (41). Therefore, dependence on TBAs for maternal and neonatal services can be risky and increase morbidities and mortalities as obstetric complications can happen at any stage during the continuum of care. Additionally, arrangements for experienced adult women to provide care during pregnancy, labor, and postpartum also emerged as a significant finding from the study. Findings indicated that chosen and respected elderly women are mostly the ones who act as carers during these critical periods. They provide instruction to expectant mothers on being brave, avoiding shouting during labor and delivery, and monitoring women's food intake during pregnancy. These individuals' presence not only provides practical assistance but also plays a crucial role in upholding traditional practices, and they may have a lot of traditional experience and information about delivery techniques. Therefore, while the presence and care provided by these elderly women during these critical moments may seem beneficial, it can also negatively impact health facility BP practices. This is because these elders may lack adequate knowledge about the importance of health facilities and the use of skilled birth attendants to advise younger women, potentially increasing the risk of adverse outcomes for both mothers and newborns. However, Canada obtained comparable results, explaining that people respect and perceive older women as experienced populations who can provide information in a traditionally relevant manner (42). Pregnant women in the United Kingdom received a broad spectrum of psychosocial support, which numerous individuals, including their family and female network, appreciated (43). Common traditional practices and the understanding that pregnant women need support during pregnancy, delivery, and postpartum contribute to these similarities. By being involved, pregnant women can get practical and emotional assistance, which helps maintain traditional feelings of social connection. A husband’s collaborative roles within the family The study results revealed that the husband predominantly controls decision-making regarding childbirth among Indigenous Maasai women, including choices about birth attendants and delivery location. This reflects the male-controlled nature of decision-making in the Indigenous Maasai societies in Tanzania, where gender roles and power dynamics can affect the health facility BP practices, resulting in poor maternal and neonatal outcomes. Hence, depending solely on the husband's decision-making can affect the woman's autonomy in making decisions for health facilities and skilled professionals’ utilization during the continuum of care, thereby impacting the health facility BP practices at large, since spouses possess the last say over either accessing health facilities for maternal and neonatal healthcare services or traditionally sticking to the TBAs assistance during the continuum of care. The study results are supported by studies done in Ghana (44) which noted the substantial influence of male partners in reproductive health decisions and adherence to traditional practices, in Ethiopia (45) further noted that decision-making in the household influenced the practice of childbirth and the location of delivery and Zambia (14) women had limited autonomy in decisions about childbirth and relied on their husbands and other family members for decision-making. The explanations for these similarities might be due to the prevailing lack of women's autonomy in decisions and the patriarchal dominance of decision-making among the study participants’ communities. However, contrary to the study done in Ngorongoro Tanzania (25) showed that women had agency in choosing the place of delivery. Variations in the geographical location could be the cause of this discrepancy. The researcher conducted a study in Ngorongoro, specifically in the Nainokanoka ward, where there is the existence of the Naiboisho Development Initiative (NDI). This project aimed to reduce the maternal mortality rate (MMR) in this ward, potentially leading to implementing education on gender roles in decision-making. The findings confirmed that while husbands play a central role in these decisions, there is a growing recognition of the need for women's involvement in these processes. Additionally, the study's findings show that a husband, as the family's primary provider, bears the full burden of managing the household, managing finances, preparing goats for his wife's postpartum slaughter, and ensuring the family's food supply. However, this is a good practice where the expectant woman is supported on some of the significant preparations needed for delivery, such as saving money. Furthermore, he shouldn't travel far in the final months of pregnancy, allowing him to determine the best location for the woman's delivery once labor begins. However, Similar study results were obtained in Nepal (46) demonstrating that males play a variety of roles, even if they are not involved in the practical delivery. The explanation for the correspondence might be due to the critical similarity of men as breadwinners and having comparable responsibilities among study populations. In addition, the study findings highlight the importance of incorporating traditionally acceptable approaches into maternal health initiatives to promote maternal well-being among Indigenous Maasai women in Tanzania, while also acknowledging the positive impacts of traditional practices and addressing harmful traditional practices and values. Hence, approaches aimed at improving health facility BP practices must incorporate strategies to empower women, allowing them to have a more active role in childbirth decisions while addressing the male-controlled context. Therefore, the acknowledgment of the positive traditional practices and recognition of negative ones that affect the health facility BP practices highlights the critical importance of considering Indigenous Maasai knowledge systems in measures to raise awareness and uptake of health facility BP practices among the Indigenous communities. Healthcare professionals may build more collaborative and trustworthy relationships with the indigenous Maasai population by recognizing and honoring these positive traditional practices, thereby increasing the effectiveness of maternal healthcare approaches. The cultural norms considered important for traditional birth preparation practices were explored. The study findings revealed that indigenous Maasai women rely on cultural norms in preparation for childbirth. The study developed two themes: norms connected to the baby and ritual performance during pregnancy and labor. Norms connected to the baby Findings from this study indicated that culturally, pregnant women are restricted from engaging in sexual intercourse from the moment of conception until the child is two to three years old after birth to protect the child's health. However, this prohibition is based on the belief that the father's ejaculates may defile the unborn child, leading to various adverse effects, such as being born with whitish materials around the baby's body that make him/her dirty. Thus, this can affect efforts to raise the uptake of BP practices because it encourages a man to have many wives, which can affect the family's economic status, leading to insufficient access and utilization of skilled birth attendants and health facilities as the man cannot afford the cost for obstetric services, resulting in poor maternal outcomes. However, these results align with a South African study that suggests it's customary for men and women to refrain from sexual activity during pregnancy to prevent sexually transmitted infections (47). These similarities could be explained by common cultural views about sexual practice during pregnancy and the period following delivery. Moreover, the above results are incongruent with studies done in Zimbabwe which indicated that women do have sexual practices during pregnancy as they believe it will make childbirth easier and preserve harmonies in their relationships leading to the prevention of HIV transmission (48). In Ghana, women start sexual practice 40 days after delivery (27). In Uganda, the husband is not allowed to have intercourse with another wife even if she is his co-wife during pregnancy, and sex is resumed one month after delivery (37). These differences may be due to the fact that many societies have different cultural views on sexual practices during pregnancy and postnatally. However, the current study focused on ordinary Indigenous Maasai women, the majority of whom adhered to their cultural norms and values, instead of utilizing maternal and child health services to obtain appropriate information about sexual practices. Hence, this cultural norm facilitates polygamy, which can be a risk for sexually transmitted infections. On the other hand, polygamy serves as a family planning technique to prevent a woman from having too soon pregnancies, which could potentially impact the health of both the mother and children. Studies suggest that to prevent the emergence of concerns or sexual dysfunctions brought on by the changes that occur during pregnancy, healthcare professionals should advocate healthy sexual behavior (49). Ritual performance during pregnancy and delivery Additionally, the study found that Maasai elders perform several rituals during pregnancy and during labor and delivery to safeguard the well-being of the mother and fetus, such as administering fresh cow's blood to a woman who has lost consciousness due to convulsions. Even when these women become ill or experience conditions such as seizures-induced loss of consciousness, they continue to perform rituals. These rituals include taking the sick pregnant woman to a traditional healer for treatment, during which a sheep is slaughtered and a piece of skin is tied to the pregnant woman's left arm symbolizing protection. However, elders carry out rituals for pregnant women in which they implore the spirits of their ancestors to keep women and their fetuses safe from evildoers symbolizing the significant existence of spiritual protection for women and the fetus. Furthermore, in the period of prolonged labor, the husband puts the milk in his mouth and returns it to the cup three times while talking to the mother to deliver in peace believing that the prolonged labor is due to conflict between him and his wife. Hence, these ritual performances may contribute to maternal and perinatal morbidities and mortalities as they further cause delays in seeking obstetric care from skilled practitioners during labor and obstetric complications. Similarly, in Nepal, rituals are performed during pregnancy, childbirth, and postnatal (50). These similarities are because pregnancy and childbirth are social and cultural events with varying significance across different communities. However, these findings highlight the existence of cultural practices that affect healthcare-seeking behavior leading to poor maternal and neonatal outcomes due to delays in seeking obstetric services for delivery and in case of complications. Habte et al. (51) emphasized that cultural norms and practices can profoundly influence attitudes and behaviors toward BPCR. Mosley et al. (52) further underscored that these cultural practices, though sometimes viewed as restrictive, are fundamental to the community's identity and serve as a source of security and continuity. Therefore, these beliefs must be considered when developing measures like community educational campaigns to increase the uptake of health facility BP practices among Indigenous Maasai women to improve maternal and neonatal health. Nonetheless, these cultural norms highlight the holistic beliefs and approaches used by Indigenous Maasai women and the community at large to prepare for safe childbirth, reflecting the deeply ingrained cultural beliefs and rituals surrounding birthing practices within the study population. Hence, the findings emphasize the need for culturally sensitive approaches to improve maternal healthcare utilization. In addition, it is imperatively important to understand and respect the cultural norms, values, and beliefs of the Indigenous Maasai populations to promote maternal and neonatal healthcare equity and reduce disparities in healthcare access and utilization, Policymakers and health professionals can deliver more inclusive and accessible maternal health interventions that align with the needs and choices of Indigenous Maasai women in Tanzania by considering cultural norms in healthcare programs. Incorporating community leaders into the planning and execution of maternal health initiatives ensures widespread acceptance and cultural appropriateness of the interventions. This interaction can enhance community participation and encourage active involvement in maternal health initiatives. Conclusions The study's findings reveal that Indigenous Maasai women in Tanzania adhere to traditional birth practices, which include the utilization of herbal medications and dietary modifications during pregnancy, labor, and postpartum. Their husbands play a crucial role in determining the birth location and providing assistance during labor and delivery, with a preference for traditional birth assistants (TBAs). This preference for TBAs during care and delivery increases the risk of complications for both mothers and newborns. Therefore, the study's findings emphasize an urgent need for community health educational programs focused on creating awareness of the effects of traditional practices such as restriction of food intake during pregnancy and inadequate use of skilled birth attendants among the study population to enhance maternal well-being. Limitations The researcher took into account some of the research limitations, including the fact that the study primarily focused on women who had given birth months prior, which could potentially cause recall bias and misrepresent the childbirth experiences regarding BP practices. The researcher overcame recall bias by referencing the child, who is currently two years old. However, due to language barriers, communication difficulties for both the researcher and the respondents may lead to misunderstanding and misinterpretation of questions and responses. To overcome language barriers, Maasai nurse midwives who were fluent in the local language worked as research assistants and translators to ensure data collection accuracy and consistency. Furthermore, since the study involved the Indigenous Maasai population, social desirability bias may have occurred, with participants giving pieces of information that were socially appropriate rather than the true nature of their BP practices due to fear of judiciousness and cultural prospects. However, the researcher managed to control the bias through a proper introduction, an explanation of the study's purpose, prolonged engagement with participants, the use of anonymity to prevent participant identification through codes, and confidentiality approaches. Declarations Ethics approval and consent to participate The study received an ethical approval from the University of Dodoma Institutional Research Review Committee, with Ref No. MA. 84/261/69/5 approved on January 30, 2014. Additionally, the Arusha Regional Administrative Secretary (RAS), the District Administrative Secretary (DAS), the District Executive Director (DED) from the district where the study was conducted (Longido District Council), the ward and village executives, and Maasai community leaders provided permission to conduct the research in the selected villages. All participants have been made aware of the goals, methods, possible dangers, and advantages of the study, and participation is completely voluntary. Every participant has given their informed consent, guaranteeing that they are aware of their freedom to discontinue participation at any moment without facing any repercussions. Personal information will be kept private and managed in compliance with relevant privacy laws and ethical standards. Participant’s values, dignity, and integrity was safeguarded according to the Declaration of Helsinki by the World Medical Association (2001). Consent for publication: Permission to publish this research article, together with any related data and figures, has been granted by all authors. We certify that we are the owner of the content and that it does not violate any trademarks, copyrights, or privacy rights. I agree to the publication's distribution without payment and acknowledge that it may be utilized in scholarly publications, websites, or other platforms. Availability of data and materials: All data were available without any restrictions Competing interests: The authors have declared that no competing interests exist. Funding: The authors received no specific funding for this work Author Contributions Statement: All authors involved in conceptualization; B.C. Writing- Original draft, Data analysis, methodology, and prepared all figures and tables; E.O. Writing -review and editing, analyzed data, methodology, and supervision; F.M. Writing -review and editing, methodology, analyzed data, and supervision; S.K. Writing -review and editing, analyzed data, methodology, and supervision. Acknowledgements : The authors recognize the University of Dodoma for providing ethical approval to conduct this study. We are also grateful to the Arusha Regional Commissioner’s Office and Longido district authorities for their unlimited support during data collection. Authors' information Bithia A. Chanimbaga, Email: [email protected] Erick D. Oguma, Email: [email protected] Fabiola V. Moshi, Email: [email protected] Stephen M. Kibusi, Email: [email protected] References WHO. Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. WHO, Geneva. 2023. Mustafa MH, Mukhtar AM. Factors associated with antenatal and delivery care in Sudan : analysis of the 2010 Sudan household survey. BMC Health Serv Res. 2015;1–9. Doctor H V., Nkhana-Salimu S, Abdulsalam-Anibilowo M. 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J, Abimbola A. E, Abdurazaq T. I. Nutritional Knowledge and Cultural Food Beliefs on Dietary Practices of Pregnant Women. Int J Home Econ Hosp Allied Res. 2023;2(2):162–72. Aziato L, Omenyo CN. Initiation of traditional birth attendants and their traditional and spiritual practices during pregnancy and childbirth in Ghana. BMC Pregnancy Childbirth. 2018;18(1):1–10. Karanja S, Gichuki R, Igunza P, Muhula S, Ofware P, Lesiamon J, et al. Factors influencing deliveries at health facilities in a rural Maasai Community in. 2018;1–11. Anyendera B, Atwine F, Kyomuhangi T, Kabakyenga, JeromBeinempaka F, Tibe, MacDonald NE. Traditional Rituals and Customs for Pregnant Women in Selected Villages in Southwest Uganda. J Obstet Gynaecol Canada. 2015;37(10):899–900. Muda NAA, Badrin S, Badrin S. Do pregnant women prepare and be ready for birth and its complications? Electron J Gen Med. 2023;20(1):1–5. Esan DT, Ayenioye OH, Ajayi PO, Sokan-Adeaga AA. Traditional birth attendants’ knowledge, preventive and management practices for postpartum haemorrhage in Osun State, Southwestern Nigeria. Sci Rep. 2023;13(1):1–15. Pfeiffer C, Mwaipopo R. Delivering at home or in a health facility ? health-seeking behaviour of women and the role of traditional birth attendants in Tanzania. 2015;2–10. Aryastami NK, Mubasyiroh R. Traditional practices influencing the use of maternal health care services in Indonesia. PLoS One. 2021;16(9 September):1–14. Kandasamy S, Vanstone M, Oremus M, Hill T, Wahi G, Wilson J, et al. Elder women’s perceptions around optimal perinatal health: a constructivist grounded-theory study with an Indigenous community in southern Ontario. C open. 2017;5(2):E411–6. Al-Mutawtah M, Campbell E, Kubis HP, Erjavec M. Women’s experiences of social support during pregnancy: a qualitative systematic review. BMC Pregnancy Childbirth. 2023;23(1). Klobodu C, Milliron BJ, Agyabeng K, Akweongo P, Adomah-Afari A. Maternal birth preparedness and complication readiness in the Greater Accra region of Ghana: A cross-sectional study of two urban health facilities. BMC Pregnancy Childbirth. 2020;20(1):1–9. Aynalem BY, Melesse MF, Bitewa YB. Cultural Beliefs and Traditional Practices During Pregnancy, Child Birth, and the Postpartum Period in East Gojjam Zone, Northwest Ethiopia: A Qualitative Study. Women’s Heal Reports. 2023;4(1):415–22. Lewis S, Lee A, Simkhada P. The role of husbands in maternal health and safe childbirth in rural Nepal: A qualitative study. BMC Pregnancy Childbirth. 2015;15(1):1–10. Nesane K V., Mulaudzi FM. Cultural barriers to male partners’ involvement in antenatal care in Limpopo province. Heal SA Gesondheid. 2024;29:1–9. Ryan JH, Young A, Musara P, Reddy K, Macagna N, Guma V, et al. Sexual Attitudes, Beliefs, Practices, and HIV Risk During Pregnancy and Post-delivery: A Qualitative Study in Malawi, South Africa, Uganda, and Zimbabwe. AIDS Behav. 2022;26(3):996–1005. Fernández-Carrasco FJ, Batugg-Chaves C, Ruger-Navarrete A, Riesco-González FJ, Palomo-Gómez R, Gómez-Salgado J, et al. Influence of Pregnancy on Sexual Desire in Pregnant Women and Their Partners: Systematic Review. Public Health Rev. 2023;44(January). Sharma S, van Teijlingen E, Hundley V, Angell C, Simkhada P. Dirty and 40 days in the wilderness: Eliciting childbirth and postnatal cultural practices and beliefs in Nepal. BMC Pregnancy Childbirth. 2016;16(1):1–12. Habte A, Tamene A, Woldeyohannes D. The uptake of WHO-recommended birth preparedness and complication readiness messages during pregnancy and its determinants among Ethiopian women: A multilevel mixed-effect analyses of 2016 demographic health survey. PLoS One. 2023;18(3 March):1–25. Mosley PD, Saruni K, Lenga B. Factors influencing adoption of facility-assisted delivery - A qualitative study of women and other stakeholders in a Maasai community in Ngorongoro District, Tanzania. BMC Pregnancy Childbirth. 2020;20(1):1–16. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5804566","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":402043951,"identity":"2851ab96-0f03-442f-81e9-dec6897fe69e","order_by":0,"name":"Bithia A. 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About 87% (253,000) of these maternal deaths occur in developing countries; out of this percentage, 70% (202,000 deaths) occur in Sub-Saharan Africa, including Tanzania (1). However, from 2000 to 2020, the maternal mortality rate (MMR) declined from 342 to 223 per 100,000 live births (1).\u0026nbsp;Despite the Sustainable Development Goal (SDG) 3.1 of reducing the maternal mortality rate (MMR) to less than 70 per 100,000 live births by 2030, the trend of MMR remains high, particularly in developing countries.\u003c/p\u003e\n\u003cp\u003eMost maternal deaths are preventable and could be avoided by implementing proven interventions to prevent and manage complications during pregnancy, childbirth, and the postnatal period (2,3). The birth preparedness (BP) approach is a global key aspect of the safe motherhood strategy that can meet SDG 3.1 (4). It encompasses both preparing for a typical childbirth experience and being ready to handle unexpected complications that require emergency obstetric intervention (5). Hence, it encourages pregnant women to seek timely skilled birth attendants when labor begins and in case of obstetric complications.\u003c/p\u003e\n\u003cp\u003eWorld Health Organization estimates that 300 million women in low-income nations experience either temporary or permanent complications associated with pregnancy and childbirth (6). This is due to delayed health-seeking, reaching, and obtaining necessary healthcare services during the period of pregnancy, delivery, and post-partum (7). In addition, the delay in seeking care is accountable for 75% of maternal mortality (8). Furthermore, about 15% of all pregnant women experience potentially fatal conditions that necessitate medical attention, and some will need a significant obstetric intervention to survive (9).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMoreover, obstetric complications can arise at any stage in the pregnancy, delivery process, and after (CDC, 2020). Thus, BP practices continue to be the most important way to reduce the risk of complications such as severe bleeding, obstructed labor, pre-eclampsia, eclampsia, sepsis, and unsafe abortion (10). In addition, these are the primary complications that cause 80% of maternal deaths (1). However, the BP package at the individual level includes identification of the preferred skilled birth attendants, identification of the nearest healthcare facility for acceptable obstetrical services, saving funds for delivery and related emergency obstetric expenses, arranging transportation to a health facility for normal birth and, in case of emergencies, identification of appropriate blood donor, preparing materials for both the mother and newborn and being aware of the obstetric danger signs (11,12).\u003c/p\u003e\n\u003cp\u003eMaasai community, being an Indigenous pastoralist group living in East Africa, has distinct cultural norms, beliefs, and practices that may have an impact on how they seek maternal healthcare services, potentially resulting in unfavorable outcomes for mothers and newborns\u0026nbsp;(13). One of the significant challenges that the Maasai community faces is accessing and utilizing maternal and newborn health services, with many women delivering at home where there is no running water, sterilization, and without the assistance of skilled birth attendants who can manage obstetric complications (14).\u003c/p\u003e\n\u003cp\u003eIn Tanzania, the health system has significantly improved by providing free delivery services at all public health institutions and expanding health services to save the lives of pregnant women and newborns\u0026nbsp;(15). Hence, it has made tremendous progress towards lowering MMR from 556/100,000 live births in 2015/16 to 104/100,000 live births in 2022 (TDHS, 2022). Still, it is out of the SDG 3.1 target of reducing MMR to less than 70/100000 live births by 2030.\u003c/p\u003e\n\u003cp\u003eMoreover, Tanzania has made strategies to strengthen primary health facilities and introduced comprehensive emergency obstetric and newborn care (CEmONC) in health centers, aiming for 80% of deliveries to take place at health facilities (17). Thus, the national coverage for health facility deliveries increased from 51% in 2010 to 81% in 2022 (TDHS, 2022). Despite efforts to encourage women to give birth in healthcare facilities with the assistance of skilled birth attendants who can manage complications when they arise, improvement has been constant, particularly in remote Indigenous populations (19). However, the Maasai community, as an Indigenous pastoralist group in Tanzania, has unique cultural norms, beliefs, and practices that can influence their health-seeking behaviors for maternal health service utilization (20).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDespite the numerous benefits of health facility birth preparedness practices in enhancing maternal and neonatal health outcomes, information is insufficient regarding these practices among Indigenous Maasai women in Tanzania. Therefore, the current study aims to bridge the identified gaps by understanding cultural norms and practices of BP among Indigenous Maasai women in Tanzania. This will facilitate the creation of culturally appropriate strategies to enhance health facility BP practices.\u003c/p\u003e"},{"header":"Methods And Materials","content":"\u003cp\u003e\u003cstrong\u003eStudy settings \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in the Arusha region, specifically in Longido district, to represent the Indigenous Maasai women in Tanzania from 11 April 2024 to 31 May 2024. The region was selected because the Maasai population inhabits it highly. Longido district is one of seven districts of the Arusha region of Tanzania, and it is among three districts where most of the Maasai population lives (Ngorongoro District, Monduli District, and Longido District).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe district has a population of 175,915 residents. Among the population, males 82,887, females 93,028, and \u0026nbsp;7037 females were estimated to deliver in 2022, and it has an area of about 7,786 km2 (21,22). The annual per capita income for Longido district residents is 199.630 Tsh. Almost all districts show an alarming lack of water for both human and livestock use. The Maasai are the dominant group in the district. However, the district is comprised of 18 wads and 41 villages. It has one district hospital, three health centers, and 25 dispensaries (21,22). There are 123 health personnel available out of 292 required. In Longido DC 549 women delivered with the assistance of TBAs and 275 delivered at home, for a total of 824 deliveries that happened in the community (23).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA qualitative descriptive study design was employed to explore information from stakeholders using adapted semi-structured interviews and group discussion guides to explore traditional BP practices and cultural norms considered important for traditional BP practices among indigenous Maasai women in Tanzania, respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKey stakeholders who were willing to share their information and experiences concerning traditional BP practices and cultural norms considered important for traditional BP practices, including Indigenous Maasai women who delivered 24 months before the study participated in IDI, and Indigenous elderly Maasai women involved in FGD after providing verbal and written consent for participation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study included key Indigenous Maasai women stakeholders who resided in the chosen villages, could give consent, and were eager to share their knowledge and experiences on traditional birth preparation and cultural norms crucial to traditional BP practices.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKey Indigenous Maasai stakeholders reported being sick and incapable of communicating verbally.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size determination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePurposive selection of key stakeholders based on their ability to express their ideas and experiences, where 7 informants were interviewed and 30 informants (3 focus group discussions with 10 informants in each group) were involved in IDI and FGD, respectively. However, the sample size for IDI was determined by the saturation level where 7 participants were interviewed, and after interviewing participant number 7, there was no emerging new data. For FGD, the determination of saturation was observed in group three where no new data came up, and that is how the researcher knew the data saturation point had been reached.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling procedure \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA homogenous purposive sampling procedure was employed to select 10 key informants (Maasai women who delivered 24 months before the study to participate in IDIs to share their understanding of traditional practices of BP. Also, 30 key stakeholders (elderly Indigenous Maasai women) were selected purposefully to participate in three FGDs and share knowledge on the cultural norms considered important for traditional BP practices, as they were considered to have rich knowledge concerning the cultural norms considered important for traditional BP practices.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection Method \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQualitative data was collected through IDIs and FGDs, which were conducted with a sample of key informants. The principal investigator and two Maasai nurse midwives research assistants fluent in the Maasai and Swahili languages performed IDIs and FGDs in a quiet place within the community setting, mostly in the village offices and under a tree to provide privacy and confidentiality. Before starting the interview and discussion, the research assistants had two days of intensive orientation to obtain consistency. The first research assistant, acting as a translator, assisted the principal investigator in conducting the interview and guiding the IDIs and FGDs, while the second research assistant handled digital voice recording and note-taking. The local Maasai language was used for both IDIs and FGDs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection tool\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn adapted IDI and FGD guide was used, which included semi-structured questions derived from the previous studies (Solomon \u0026amp; Tesfaye, 2022 \u0026amp; Mosley, 2019). The IDIs\u0026nbsp;were\u0026nbsp;based on traditional birth practices. However, cultural norms considered important for traditional BP were explored through FGDs to guarantee fruitful dialogues. Both IDIs and FGDs were conducted in a local language (Maasai) by two skilled Maasai nurse midwives who were research assistants but also translators and the principal researcher.\u003c/p\u003e\n\u003cp\u003eFurthermore, an audio recorder and notebooks were used to record and to take notes from the participants\u0026rsquo; information throughout the entire IDIs and FGDs after obtaining their verbal and written consent following the provision of an explanation for recording purposes and that the recordings were to be used for the research purposes only, ensuring their anonymity and confidentiality.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe discussions were held in a quiet location within the community to ensure active participation from all participants and to ensure confidentiality and privacy. Each IDI took about 45 to 60 minutes, while each FGD lasted 1 hour and 45 minutes on average. To facilitate fruitful dialogue among participants, the groups were arranged in a semicircle and quiet environment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection procedure \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResearch assistants who were intensively orientated on data collection objectives, instruments, and techniques together with the principal investigator collected qualitative data through the use of semi-structured (open-ended) questions in a face-to-face interview for IDI and FGDs. Before starting data collection, an adequate introduction including the purpose of the research, handling of data, and reassurance of the anonymity and confidentiality of their responses were provided to create rapport, entrustment, and honesty.\u003c/p\u003e\n\u003cp\u003eAdditionally, the interview commenced with broad questions followed by multiple follow-ups and probing questions aimed at eliciting a more profound comprehension of the traditional BP practices from the participants. The participants\u0026rsquo; patience and tolerance for explaining their experiences on the topic determined how long the interview could last. However, about 45 to 60 minutes was used to complete the interview. Before initiating the interview, informants were requested to provide verbal and written informed consent. Important points were summarized right away, and whenever needed to obtain clear information.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEnsuring Trustworthiness \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCredibility\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo ensure credibility, multiple sources of data collection were used, such as recording and taking notes during IDIs and FGDs, to guarantee that findings are not based on a single source of data. Moreover, the tools were shared with experts in the field of research, and their suggestions for improvement were subsequently taken into consideration. Also, data saturation, extended familiarization with the transcript data, and extended interaction with key informants in IDIs were all contributed to the credibility.\u003c/p\u003e\n\u003cp\u003eIn addition, all interviews and discussions were transcribed from the local Maasai language into Swahili by three Maasai nurse midwives who were not part of the research assistance and then translated into English by two Bachelor degree-holder nurses who were conversant in both languages (Swahili and English) for analysis. Also, the data analysis engaged 6-degree holder nurse midwives who were fluent in English.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDependability \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo validate the research findings, numerous data sources were used in gathering information from various sources, including IDIs and FGDs, and various research techniques like probing during IDIs/FGDs. However, member checking was observed by presenting and discussing the preliminary research findings with the participants to verify the dependability of the results, thereby ensuring that their views and experiences on traditional BP and cultural norms considered important for BP practices have been correctly captured and that findings line up with the informants\u0026apos; viewpoints.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConfirmability \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConfirmability was maintained by ensuring that data and interpretations of the findings were surely drawn from the data and not the inquirer\u0026apos;s imagination. This was achieved by taking field notes and audio recordings during the data collection process to make sure that no important data regarding the study that respondents provided was missed. In addition, to protect data, transparency, and obligations were taken into consideration. However, reflexivity was ensured by making study results more objective, transparent, and unbiased through the use of different personnel, from the translation of the findings from the local language to Swahili, then from Swahili to English, and during analysis as six-degree-holder nurses involved in analyzing the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTransferability \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn order to guarantee transferability, a diverse range of key informants were included in the study to capture a wide range of viewpoints and experiences. Whereby, Indigenous Maasai women who delivered 24 months before the study participated in IDI, and Indigenous elderly Maasai women involved in FGD. By guaranteeing that the study represents the experiences of several groups, a diverse sample increases the likelihood that the findings may be extrapolated to other populations or environments, hence improving the findings\u0026apos; transferability.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMoreover, the study employed a well-defined, methodical strategy to data gathering, which was fully explained. This contains details regarding participant selection, data collection methods, and data collection Tools. The study supports the findings\u0026apos; transferability by making sure that others can duplicate the approach in comparable circumstances by providing these details. Moreover, the research findings were comparing and contrasting with other studies that have been conducted among in Indigenous Maasai women on the same research topic.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data were analyzed using inductive thematic analysis guided by Brown and Clark\u0026apos;s (2006). Before starting the transcription process, the voice recordings were fully listened to multiple times. The three Maasai nurse midwives fluent in both the local and Swahili languages who were not part of the research assistants transcribed and translated all voice recordings and notes taken from IDIs and FGDs into Swahili to reduce individual prejudices while improving transliteration reliability, then into English by two bachelor\u0026apos;s degree-holder nurses who were familiar with both languages (Swahili and English).\u003c/p\u003e\n\u003cp\u003eTo ensure accuracy, the back translation approach was used, following transcription, the analysis process followed the steps of data familiarization, coding words with similar meanings, and then grouping them to form sub-themes. More grouping of the sub-theme was performed to create main themes with assistance from peer reviewers.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eBackground characteristics of study participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 presents the background characteristics of IDI participants (n = 7), detailing their age, educational level, average income, and past obstetric characteristics. The mean age of respondents was 35.4 \u0026plusmn; 7.5 (SD). Most of respondents, 71.4% (n = 5), had informal education, with a smaller proportion, 28.6% (n = 2), having attained primary education. Regarding income, 71.4% (n = 5) earn less than 50,000 Tsh, whereas 28.6% (n = 2) earn an average of 50,000 Tsh or more per month. Regarding past obstetric characteristics, a significant majority of participants (71.4%) reported having more than five children, and traditional birth attendants attended most deliveries (57.1%, n = 4), with 14.3% (n = 1) taking place at health facilities and the remaining 28.6% (n = 2) at home. (Refer Table 1)\u003c/p\u003e\n\u003cp\u003eAlso, Table 1 provides details of the background characteristics of FGD respondents (n = 30), including their age, educational level, income, and parity. The age distribution is nearly even, with 46.7% (n = 14) of respondents under 60 years and 53.3% (n = 16) aged 60 years or older. A significant majority, 83.3% (n = 25), had informal education, while 16.7% (n = 5) had achieved primary education. Income levels are also fairly balanced, with 46.7% (n = 14) earning less than 50,000 Tsh and 53.3% (n = 16) earning 50,000 Tsh and above. In terms of parity, a substantial majority of 63.3% (n = 19) have ten or more children, compared to 36.7% (n = 11) who have fewer than ten children. (Refer Table 1)\u003c/p\u003e\n\u003cp\u003eTable 1: Background characteristics frequency distribution table of participants in IDI (n=7) and FGD (n=30)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"648\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.037%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 31.4815%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIDI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 31.4815%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFGD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.037%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.037%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.037%;\"\u003e\n \u003cp\u003e\u0026lt;35\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e57.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.037%;\"\u003e\n \u003cp\u003e35-49\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e42.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.037%;\"\u003e\n \u003cp\u003e50-60\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e46.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.037%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026ge;60\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e53.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.037%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.037%;\"\u003e\n \u003cp\u003eInformal education\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e71.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e83.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.037%;\"\u003e\n \u003cp\u003eThe primary level of education\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e28.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.037%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage income per month\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.037%;\"\u003e\n \u003cp\u003e\u0026lt;50,000Tsh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e71.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e46.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.037%;\"\u003e\n \u003cp\u003e\u0026ge;50,000Tsh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e28.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e53.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.037%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePast obstetric characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.037%;\"\u003e\n \u003cp\u003eMultipara \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e28.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.037%;\"\u003e\n \u003cp\u003eGrand multipara \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e71.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.037%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of delivery\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.037%;\"\u003e\n \u003cp\u003eHealth facility\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.037%;\"\u003e\n \u003cp\u003eHome\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e28.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.037%;\"\u003e\n \u003cp\u003eTBA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e57.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.8148%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTraditional Birth Preparedness Practices among Indigenous Maasai Women in Tanzania\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn in-depth interview (IDI) with 7 Indigenous Maasai women who had given birth 24 months before the study was conducted. The researcher sought to understand the specific traditional practices that Maasai women engage in for traditional BP during pregnancy, delivery, and the postpartum period, including dietary habits, traditional medicines, and management of complications. The main themes that emerged from the responses were the following: The traditional approaches toward maternal well-being, traditions across childbirth preparation, and a husband\u0026rsquo;s collaborative roles within the family. (Refer Figure 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme One: The Traditional Approaches to Maternal Well-being\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this theme, informants demonstrated that within Maasai traditions, people rely on herbal medicine utilization throughout pregnancy, childbirth, and the postnatal period. Several traditional herbs are commonly utilized during these stages, as they are perceived as guaranteeing a woman\u0026apos;s safety and their unborn babies. However, during pregnancy, Maasai women commonly ingest herbal medicine like \u003cem\u003eoitepes\u003c/em\u003e.\u0026nbsp;This medicinal preparation serves multiple purposes, including aiding in the management of pregnancy-related symptoms and potentially supporting maternal health as these medicines induce vomiting during pregnancy and assist the woman to have a good appetite after delivery.\u003c/p\u003e\n\u003cp\u003eMoreover, in the context of labor, traditional medicines like \u003cem\u003eOlmangulai, engoitiri,\u003c/em\u003e and \u003cem\u003esanjoi\u0026nbsp;\u003c/em\u003eare employed to facilitate labor by increasing contractions, thereby aiding the progress of labor. Additionally, they may be administered if there are obstetric complications such as retained placenta or postpartum bleeding, potentially assisting in the management of these complications. Post-delivery, Maasai women often consume a traditional medicine (\u003cem\u003eoluai\u003c/em\u003e or \u003cem\u003eOlkiloriti)\u003c/em\u003e which is mixed with porridge. These medicinal preparation are used to strengthen the body and alleviate postpartum discomfort, providing support during the recovery phase after childbirth\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme one:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eExpectant mothers use herbs during pregnancy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this sub-theme, respondents stated that Indigenous Maasai women use traditional medicine to induce vomiting as a way to lower their bile levels during pregnancy. If the mother does not do this, she won\u0026apos;t be able to consume enough food after giving birth, which is essential to accelerate her body\u0026apos;s energy gain.\u003c/p\u003e\n\u003cp\u003eThe participant reported that\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;During pregnancy, the expectant mother must be given a traditional medicine made up of tea leaves mixed with a little salt (olaisai) which is boiled to make her vomit to remove the bile that can cause her not to eat well soon after childbirth\u0026rdquo;\u003cstrong\u003e\u0026nbsp;(\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e30 years IDI participant with 5 children).\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother participant reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;In Maasai tradition, we prepare ourselves for safe delivery by consuming a traditional medication known as lasi-oltapesi, which induces vomiting to reduce bile accumulation. This helps us to have a good appetite following childbirth\u0026rsquo;\u003c/em\u003e \u003cstrong\u003e(32-year-old IDI participant with 5 children)\u003cem\u003e.\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlso, another participant reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;In our tradition, a Maasai woman is given medicine during pregnancy to make her vomit to weaken the child so that he does not grow big using oloisikirai and oitepesi which are the bark of trees\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(34 years IDI participant with 6 children).\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHowever\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003eanother participant reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We often take several traditional medicines to help us during the entire pregnancy, labor, and the period after childbirth. The elder woman or the Engaitoyon\u003c/em\u003e\u003cem\u003e\u0026nbsp;who was chosen would provide herbal medicines to induce vomiting during pregnancy such as engoitiri or sanjoiwhich which is typically administered by mixing with porridge to\u003c/em\u003e \u003cem\u003eeliminate bile and promote better appetite after childbirth. During labor - engoitiri or sanjoi to hasten labor, and the period after childbirth -Olkiloritto reduces bleeding and helps remove emudong when it fails to get out easily\u0026rdquo; \u003cstrong\u003e(\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e45 years old, with 8 children).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme two: Traditional management of complication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this sub-theme, the respondent narrated that traditionally, Indigenous Maasai people have their own means of managing complications related to pregnancy such as post-delivery hemorrhage and retained placenta. These conditions are managed traditionally by administering traditional herbs to the women such as \u003cem\u003eoloirien,\u003c/em\u003e which is given to a woman when the \u003cem\u003eemudong\u003c/em\u003e (placenta) fails to be delivered on time (retained placenta). Olmangulai\u003cem\u003e\u0026nbsp;\u003c/em\u003eis a traditional medicine that is given to women to control post-delivery bleeding and it is also used in women with retained placenta.\u003c/p\u003e\n\u003cp\u003eParticipant reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We use green leaves of Oltarakwa for cleaning the birth canal and reducing the amount of bleeding that occurs after a woman has given birth. We use this medicine orally or directly applied to the bleeding sight after it has dried, ground up, and then boiled\u003c/em\u003e\u003cstrong\u003e.\u0026rdquo;\u003c/strong\u003e\u003cem\u003e, also the woman\u0026rsquo;s abdomen is tightly bound using clothes materials to exert pressure on the woman\u0026rsquo;s abdomen to reduce bleeding\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(43 years old IDI participant with 7 children\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eAnother participant reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;During labor, we use Olmangulai, if the\u003c/em\u003e \u003cem\u003eemudong fails to come out or if the woman is bleeding a lot after giving birth\u0026rdquo; (\u003c/em\u003e\u003cstrong\u003e32-year-old participant with 5 children\u003c/strong\u003e\u003cstrong\u003e).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme three: Traditional means of labor acceleration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom this sub-theme, respondents expressed that, in Maasai tradition, when a woman is in labor, she is given traditional herbs like \u003cem\u003eOlmangulai\u003c/em\u003e to augment the labor process thereby shortening the delivery time by strengthening labor pain.\u003c/p\u003e\n\u003cp\u003eThe participant reported that\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;In our tradition, when a woman is in labor, she is given Olmangulai to make labor pain strong and shorten the time for delivery\u0026rdquo; \u003cstrong\u003e(\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e30 years IDI participant with 5 children).\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother respondent reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;During labor: tea leaves mixed with sugar and a lot of ginger are boiled together, and the liquid is given to a woman to make the labor strong, she also takes cow\u0026apos;s or sheep\u0026apos;s fat to soften the stomach and make her get diarrhea to hasten labor and make the baby pass through the birth canal easily\u003c/em\u003e \u0026lsquo;(\u003cstrong\u003e43 years old, with 7 children).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHowever, another participant reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;During labor, we use cow\u0026apos;s or sheep\u0026apos;s fat to soften the stomach, which ultimately causes diarrhea so that the woman can deliver quickly without any obstacle\u0026rdquo;\u003cstrong\u003e\u0026nbsp;(\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e45-year-old, with 8 children).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlso, another participant reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWe prepare cow\u0026apos;s or sheep\u0026apos;s fat during pregnancy to soften the stomach and induce diarrhea during labor, thereby reducing the time for delivery\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(A 39-year IDI participant with 6 children).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme Two: Traditions around Childbirth Preparations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this theme, respondents said that the Maasai community has their customary preparation for childbirth, as expectant mothers have to undergo dietary modifications and restrictions during pregnancy such as meat, milk, and stiff porridge so that the fetus does not grow too big to affect normal delivery. Additionally, the woman\u0026rsquo;s husband has to inform his mother so that she can start taking care of his wife, including dietary monitoring and physical exertion restrictions to protect the expectant woman from any adverse effects.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme one; Food restriction during pregnancy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRespondents in this sub-theme stipulated that pregnant women should refrain from consuming specific types of foods like meat, milk, and stiff porridge, especially after their pregnancy reaches four months. She consumes minimal amounts of food or solely porridge, aiming to prevent excessive fetal growth that may hinder normal delivery. Additionally, her mother-in-law cares for her and keeps on watching very closely; if the pregnant woman is caught eating forbidden kinds of food, she is given a lot of water to drink so that she can vomit the food.\u003c/p\u003e\n\u003cp\u003eThe participant reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;My mother-in-law had to monitor my diet during each pregnancy to keep my child in the womb from growing too big to ensure a normal delivery. She had to prevent me from consuming certain foods such as meat, stiff porridge, and milk, and only provide me with porridge. If I ingested prohibited food, she provided me with copious amounts of water, enabling me to vomit the food I had consumed.\u0026rdquo; \u003cstrong\u003e(\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e26 years IDI participant with 4 children).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother participant reported that\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;A pregnant mother who is four months pregnancy\u0026nbsp;starts to eat less to prevent the unborn child from growing too big, which can prevent the baby from being born in a normal way\u0026rdquo;\u003cstrong\u003e\u0026nbsp;(\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e34-year-old participant with 5 children).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlso, another participant reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Pregnant women consume fruits and green vegetables like spinach; they predominantly consume water and porridge to prevent excessive growth of the baby in the womb, which may impede normal delivery\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(43-year-old IDI participant with 7 children).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipant reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;When a pregnant woman reaches four months onwards, she takes a minimal amount of food, or only porridge, vegetables, and water, so that the child that will be born will not grow too big to impede normal delivery\u003c/em\u003e\u0026rdquo;\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(30 years IDI participant with 5 children).\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHowever, another participant reported that\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003c/strong\u003e\u003cem\u003eDuring the early days of pregnancy, the woman\u0026rsquo;s husband informs his mother about the pregnancy. Subsequently, the mother-in-law will advise the expectant mother to refrain from physical exertion and to avoid certain foods, such as milk and meat, to prevent the baby in the womb from excessive growth\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(A 39-years IDI participant with 6 children).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme two:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eTraditional preparation for postnatal care\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this sub-theme, participants narrated the traditional practice of a woman\u0026apos;s husband preparing two goats for slaughter after the woman gives birth. The woman receives the boiled goat\u0026apos;s fat to boost her energy quickly. However, community members assist the family in preparing for childbirth by raising funds to purchase goats and rice for the postpartum period.\u003c/p\u003e\n\u003cp\u003eThe participant reported that\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;In Maasai tradition, the husband assumes responsibility for preparing resources such as money, goats, or sheep, which are then slaughtered to provide sustenance for his wife during the period after delivery\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(32 years IDI participant with 5 children).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother participant reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The woman receives boiled goat\u0026apos;s fat and a small portion of meat for sustenance over two days after delivery. The traditional birth attendant, who assisted her with the delivery, receives a portion of the beef, while other community members who visit the household post-birth share the remaining meat. The mother dries, mixes the meat from the second goat with oil, and preserves it for her consumption during the post-delivery period\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(39 years IDI participant with 6 children).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHowever, another participant reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Maasai community members assist in delivery preparations in cases where the family cannot afford to buy the goats required for the woman after giving birth. Collectively, the community members raise funds to buy two goats, which they later slaughter after childbirth\u0026rdquo;\u003cstrong\u003e\u0026nbsp;(\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e34 years IDI participant with 5 children).\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdditionally, another participant reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Friends help the expectant mother prepare for childbirth by bringing firewood for postpartum use\u0026rdquo; \u003cstrong\u003e(\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e30 years IDI participant with 5 children).\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme Four:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eTBAs provide care and delivery assistance\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this sub-theme, respondents said that, during pregnancy, a husband prepares a respected birth attendant to assist the woman during delivery. A husband has the authority and is responsible for selecting a respected traditional birth attendant (\u003cem\u003eengaitoyoni)\u003c/em\u003e in advance before labor starts so that she gets prepared. This attendant palpates the abdomen to determine the position of the fetus. However, if the fetus is lying in an incorrect position, the TBA attempts to adjust the fetus externally to facilitate normal delivery.\u003c/p\u003e\n\u003cp\u003eThe participant reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;With my five kids, I never visited clinics because when my belly got huge, my husband chose a respected engaitoyoni to take care of me. When my belly grew large, she would palpate my abdomen to check if the baby was properly seated in the womb. Suppose the baby in my womb is not sitting in the correct position; in that case, she is capable of turning the baby to a suitable position to enable normal delivery\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(34-year-old IDI\u003c/strong\u003e \u003cstrong\u003eparticipant with 5 children)\u003cem\u003e.\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother participant reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;A selected engaitoyoni will be prepared to deliver the woman. She will prepare cow\u0026rsquo;s fat for use during labor and oil for use after childbirth\u0026rdquo;\u003c/em\u003e \u003cstrong\u003e(26-year-old\u0026nbsp;IDI participant with 4 children).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlso, another participant reported that\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eThe engaitoyoni of choice is prepared to deliver the mother safely. She stays there from the time she is about to give birth until delivery and will remain with her for a period of one to three weeks after childbirth\u0026rdquo; (\u003c/em\u003e\u003cstrong\u003e39-year-old\u0026nbsp;IDI participant with 6 children)\u003cem\u003e.\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme five: Elderly women\u0026rsquo;s basic care roles during the continuum of care\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRespondents stated that Maasai pregnant women typically receive care from their mother-in-law or another experienced adult individual who has given birth, as they possess comprehensive knowledge about childbirth and can provide valuable insights, guidance, and support throughout the pregnancy, labor, delivery, and post-delivery period.\u003c/p\u003e\n\u003cp\u003eThe participant reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;A mother-in-law or an experienced adult who has given birth to many children should be close, as we believe that they know many things about labor and will be able to provide various instructions during childbirth\u0026rdquo;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(39-year-old IDI participant with 6 children)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother participant reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Wise adult mothers within the community play an important role in supporting expectant mothers during childbirth. They offer guidance and assistance throughout the process, ensuring the expectant mother\u0026apos;s comfort and well-being. Also, a chosen engaitoyoni is prepared to facilitate the delivery, providing necessary oils and food for the mother after childbirth\u0026rdquo;\u003c/em\u003e (\u003cstrong\u003e30-year-old IDI participant, with 5 children).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother participant reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Throughout labor, the mother-in-law plays a pivotal role in providing updates on the childbirth progress and offering support to the mother after the delivery\u0026rdquo;\u0026nbsp;\u003c/em\u003e(\u003cstrong\u003e43-year-old IDI participant, having 7 children).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother participant reported that\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;My mother-in-law took care of me when I was pregnant and after my babies were born\u0026rdquo;\u003c/em\u003e \u003cstrong\u003e(27-year-old IDI participant with 4 children).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother participant reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;During the last months of pregnancy, an experienced adult woman must be present at home all the time to instruct her on what to do during delivery\u003cstrong\u003e\u0026rdquo;\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(34-year-old IDI participant with 5 children)\u003cem\u003e.\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme six: Physical protection during pregnancy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRespondents to this theme revealed that pregnant Maasai women avoid carrying heavy loads and walking long distances from home due to fear of injury, seizure, or abortion. When in labor, the Maasai woman refrains from walking, even to a health facility for delivery, due to the difficulties she may encounter while on the way.\u003c/p\u003e\n\u003cp\u003eThe participant reported that\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Her mother-in-law, or an elderly woman caring for her, advises the pregnant mother not to overexert herself by walking long distances to prevent lightheadedness and abortion\u0026rdquo;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(27-year-old IDI participant with 4 children)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother participant reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;When it comes to giving birth, we are prevented from even going to the health center for delivery to prevent problems that may happen along the way because the health centers are far away and there is no transport\u0026rdquo;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(42 -year-old IDI participant, with 7 children)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother participant reported that\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;To ensure that the pregnant mother is in a safe situation, anyone who finds her in a dangerous situation should help her\u0026rdquo; (\u003c/em\u003e\u003cstrong\u003e38-year-old IDI participant with 6 children\u003cem\u003e)\u003c/em\u003e\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme Three: A husband\u0026rsquo;s Collaborative Roles within the Family\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRegarding this theme, participants reported that, according to Maasai traditions, the husband in the family assumes the responsibility of being the pivotal controller over all things during the period of pregnancy, including ensuring that the place where his wife will deliver and the person who will assist her during pregnancy and in the delivery, process is well established. However, he is responsible for ensuring that money for delivery expenses, food, and other family members\u0026apos; requirements are in order, arranging house environments, and renovating the house in preparation for his wife\u0026rsquo;s delivery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme one: A husband is in charge of everything\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants In this sub-theme informed that, traditionally, decisions concerning childbirth are typically made by the husband within Maasai traditional practices. The husband assumes the authority to determine the location of the woman\u0026apos;s delivery and select the respected individual who will provide support throughout the process. Given his pivotal role in decision-making, the husband must remain close to his partner during the last months of pregnancy.\u003c/p\u003e\n\u003cp\u003eThe participant reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The husband has the authority over all things and is the one who makes decisions about whom to assist with delivery and where a woman should deliver; if the husband is not there, any other man in the family or neighbor can make decisions\u003c/em\u003e\u0026rdquo;\u003cstrong\u003e\u0026nbsp;(43 years IDI participant with 7 children\u003c/strong\u003e\u003cem\u003e).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAnother participant reported that.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The husband makes the decisions regarding a woman\u0026apos;s delivery location and the people who will support her throughout the process\u0026rdquo;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(26 years IDI participant with 4 children).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother participant reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The husband is the judge of all things, he will determine any challenge and make decisions about where the mother should deliver and who will assist the woman during pregnancy, delivery, and after delivery\u0026rdquo;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(39 years IDI participant with 6 children)\u003cem\u003e.\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme two: A husband as a breadwinner\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants in this sub-theme stated that a husband assumes several responsibilities in preparation for his wife\u0026apos;s delivery, including financial preparation and ensuring that there is enough food for the whole family. He also renovates the house and makes sure the environment around is clean.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipant reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;When the woman is pregnant, the husband is responsible for preparing money and saving food for the whole family\u0026rdquo;\u0026nbsp;\u003c/em\u003e(\u003cstrong\u003e38 years IDI participant with 6 children\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eAnother participant revealed that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;During the last months of pregnancy, the husband makes sure that he does not go far to provide support when the delivery time approaches\u0026rdquo;\u003c/em\u003e (\u003cstrong\u003e43-year IDI participant, having 7 children).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHowever, another participant identified that;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The husband must be close to his wife when she is about to give birth because he is the main decider of where the wife should give birth\u0026rdquo;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(27 years IDI participant with 4 children).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSimilarly, another participant reported that \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;In Maasai tradition, when a woman is pregnant, the husband renovates a house and makes the environment beautiful\u003cstrong\u003e\u0026rdquo; (\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e30 years IDI participant with 5 children).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCultural Norms Considered Important for Birth Preparedness among Indigenous Maasai Women in Tanzania\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 2 outlines the general sub-themes and corresponding themes that emerged from the study. The major two themes were identified, including \u0026ldquo;The norms connected to the baby\u0026quot; and \u0026ldquo;Ritual performance during pregnancy and delivery\u0026quot;. (Refer Figure 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme One: Norms Connected to the Baby\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOn this theme, informants reported that, according to Maasai cultural norms, pregnant women are forbidden from engaging in sexual intercourse from the moment of conception until after childbirth and until the child is two to three years old. This prohibition is based on the belief that the father\u0026apos;s semen may defile the unborn child, leading to various adverse effects, such as being born with whitish materials around the baby\u0026apos;s body that make him/her dirty. Peers may impose social punishment for violating this taboo. However, Maasai women don\u0026apos;t make any preparations for the baby before birth, fearing that the baby might die soon after delivery and doubting the baby\u0026apos;s survival.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme one: No sex throughout pregnancy and the first two years of life\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this sub-theme, findings indicated women are only permitted to share a bed with their spouse after giving birth and until the child is two or three years old to protect the child in the womb (couples do not physically interact). The cultural belief that semen will affect the child\u0026apos;s growth and development prevents women from having sex after delivery.\u003c/p\u003e\n\u003cp\u003eInformant reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;To protect our unborn child, we are not permitted to share the bed during pregnancy, and even after delivery, a man is not allowed to touch me or have sex with me until the child is two to three years old. When the child is born, Maasai elderly women usually assess the baby soon after birth to determine if he/she is clean; if not, peers will punish the man and his wife\u0026rdquo;\u003c/em\u003e \u003cstrong\u003e(50 years FGD informant).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother informant reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;In our culture, a woman cannot have sex until after giving birth, and the baby must be between two and three years old to prevent stunting the child\u0026apos;s growth.\u0026rdquo;\u0026nbsp;\u003c/em\u003e(\u003cstrong\u003e55 years, FGD respondent\u003c/strong\u003e\u003cem\u003e).\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAlso, another respondent reported that\u003cem\u003e:\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;A Maasai pregnant woman is not allowed to have sex from the moment she becomes pregnant until she gives birth, because we believe that, the father\u0026apos;s ejaculate will pollute the child\u0026apos;s buttocks, head, armpits, and any places where there are folds\u0026rdquo; \u003cstrong\u003e(\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e62 years old FGD participant\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eInformant responded that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDuring pregnancy, the expectant mothers typically reside with their mother-in-law, with whom they live or share the room until the period after delivery to protect the unborn child from potential dirt and harm. Post-delivery, until the child is two or three years old, the mother refrains from sleeping with her husband to avoid a negative impact on the child\u0026apos;s development\u003c/em\u003e\u0026rdquo; \u003cstrong\u003e\u003cem\u003e(\u003c/em\u003e64 years FGD informant).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother respondent reported that\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The expectant mother leaves her husband\u0026rsquo;s room and lives with her mother-in-law for the duration of her pregnancy and she is only permitted to share a bed with her spouse when the child is two years old\u003c/em\u003e\u0026rdquo;\u003cstrong\u003e\u0026nbsp;(57 years FGD informant).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-them two: No clothing preparation for the unborn child.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWithin this sub-them, respondents revealed that, in adherence to Maasai tradition, clothes are not purchased for the unborn child until after birth. This belief stems from the intuition that buying clothes beforehand may bring misfortune or death to the child, and they are also not sure whether the child will be born alive or not. However, some Indigenous Maasai women now purchase clothes for their newborn babies, concealing them in the homes of their neighbors\u003c/p\u003e\n\u003cp\u003eThe respondent reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Traditionally, it is forbidden for us to purchase any clothing as a preparation for a newborn during pregnancy. We are making it unlucky for a baby to die after delivery if we do that. We normally dress the baby with whatever we have at hand when the baby is born\u0026rdquo;\u003c/em\u003e \u003cstrong\u003e(26 years IDI respondent with 4 children).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother respondent reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;A Maasai woman should not buy clothes before she gives birth because the child may not be born alive\u0026rdquo;\u003c/em\u003e \u003cstrong\u003e(32 years IDI with 5 children).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHowever, another respondent reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;With our traditions, we believe what will be born may not live, or we do not know that the mother who carried it will come to an end, so we should not buy anything for the preparation of the baby, such as clothes\u0026rdquo;\u003cstrong\u003e\u0026nbsp;(\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e35 years IDI respondent with 8 children).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlso, another respondent reported that\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eWe believe that we should not prepare clothes for the child before birth because he/she may not be born alive\u0026rdquo;\u003c/em\u003e \u003cstrong\u003e(45 years IDI respondent with 8 children).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdditionally, another respondent reported that.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;We don\u0026apos;t buy clothes for the unborn child until the baby is born, as it\u0026apos;s a sign that the child will die, and if the child dies, where will the clothes go?\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(30 years IDI respondent with 5 children).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMoreover, another respondent reported\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Other Maasai women nowadays buy clothes for the unborn child and hide them in their neighbors\u0026rsquo; houses\u003c/em\u003e \u003cem\u003euntil the child is born\u003c/em\u003e \u0026ldquo;\u003cstrong\u003e(A 39-year IDI respondent with 6 children).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme Two: Ritual Performance during Pregnancy and Delivery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConcerning this theme, the informants presented several rituals performed by Maasai elders during the period of pregnancy, in the process of labor and delivery to ensure that the expectant mother and the fetus remain safe. Even when these women fall sick and in circumstances like loss of consciousness following convulsions. However, Maasai resolves conflict culturally during pregnancy to guarantee that a woman does not encounter problems during delivery as a result of disagreements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme one: The influence of ancestral spirits during pregnancy and Labor\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformants expressed that pregnant women usually seek protection from their ancestral spirits and gods during the period of pregnancy, labor, and delivery, and even when the pregnant woman is sick to ensure the safety of both the mother and her fetus.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInformant reported that\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Rituals are performed by traditional elders, who ask the spirits of ancestors to protect the mother and her unborn child from bad people and bad spirits\u0026rdquo; (\u003c/em\u003e\u003cstrong\u003e62-year-old FGD participant).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Another informant added that;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Should the mother encounter illness during pregnancy, traditional healing practices are sought, with the mother returning home after treatment. A sheep is then slaughtered, and a piece of its skin is tied to the left arm of the pregnant woman as a protective measure. The back of the sheep is offered to the spirits at gravesites, symbolizing a plea for continuous offering protection to the sick mother\u0026rdquo; (\u003c/em\u003e\u003cstrong\u003e59-year-old FGD informant\u003c/strong\u003e\u003cem\u003e).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAlso, the informant expressed that\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The Maasai elders will be called to pray to their ancestor\u0026rsquo;s spirits and spit on them to give their blessings, when the woman fails to delive\u003c/em\u003er, \u003cem\u003ethey will pour milk and pray to the ancestors who died a long time ago\u0026rdquo; (\u003c/em\u003e\u003cstrong\u003eA 67-year-old FGD participant\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMoreover, another informant said that:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;When the mother has labored for a long time, the men of that Boma climb to the top of the house to pray to the ancestors for safe delivery. When he comes down, he touches the mother\u0026apos;s belly and gives her words of encouragement that she should give birth without any problems. Sometimes the mother gives birth safely, but on other occasions, it fails, necessitating her hospitalization.\u0026nbsp;\u003c/em\u003e\u003cem\u003e\u003c/em\u003e\u003cem\u003e\u0026rdquo; \u003cstrong\u003e(\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e56-year-old, FGD participant).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme two: The cultural way of conflict resolution during pregnancy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformants revealed that Maasai elders lead reconciliation efforts to safeguard pregnant women and their unborn children. Maasai elders perform rituals to reconcile disputes or disagreements with their husbands and other community members, invoking the protection of ancestral spirits against evil forces.\u0026nbsp;\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The informant reported that\u003cem\u003e:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;In the event of frequent quarrels between the pregnant woman and her husband, when the woman is in labor, a ritual involving the husband putting milk in his mouth, returning it to a cup three times, and then giving it to his wife is performed, symbolizing a plea for safe reconciliation and childbirth\u0026rdquo; (\u003c/em\u003e\u003cstrong\u003eA 61-year-old FGD participant).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother informant added\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The Maasai elders will resolve any disagreements the pregnant mother has with her husband or mother-in-law to ensure a safe delivery.\u0026rdquo; \u003cstrong\u003e(64 years FGD participant).\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSub-theme three:\u0026nbsp;Cultural approaches to maternal challenges\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this sub-theme, informants reported that when pregnant women fall sick, have repeated miscarriages, or die of newborn babies, they seek treatment from traditional healers and protection. However, women perform rituals during prolonged labor to ensure a normal and safe delivery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAn informant reported that.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;A woman who experiences recurring miscarriages or the death of a child shortly after birth goes to a traditional healer who performs rituals. She follows the traditional healer\u0026apos;s instructions, such as bathing at House Conner or in a bush, to ensure the unborn child does not die like previous babies.\u0026rdquo;\u003cstrong\u003e\u0026nbsp;(\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e67 years FGD informant\u003cem\u003e).\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother informant reported that\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;When labor takes a long, the husband\u0026rsquo;s peers are called and talk to the unborn baby in the womb when we go out of the room, you also come out while patting the woman\u0026rsquo;s abdomen\u003c/em\u003e\u003cem\u003e\u0026rsquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(52 years FGD informant).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHowever, they culturally manage loss of consciousness due to seizures to ensure that the woman regains consciousness and that she is protected from having recurrent attacks.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe informant reported that\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Culturally, when a pregnant woman loses consciousness following a seizure attack either during pregnancy or when in labor, elders burn osukuroi (a dried traditional medicine) so that a woman can inhale the smoke to regain consciousness and prevent its reoccurrence\u0026rdquo; \u003cstrong\u003e(\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e65-year FGD informant\u003cem\u003e).\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother informant reported that\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;When a pregnant woman has experienced a seizure attack and regained consciousness upon awakening. We give her fresh cow\u0026apos;s blood from the large blood vessel around the cow\u0026apos;s neck, as we believe she has a small amount of blood in her body\u0026rdquo;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;(61 years FGD informant)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlso, other informants reported that\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;Emasho, which is traditionally dried and smashed, is given to a woman who has lost consciousness following a seizure attack under her lips to help her regain awareness as soon as possible \u0026lsquo;\u003cstrong\u003e(\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e62 years FGD informant).\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, the traditional practices of BP among Indigenous Maasai women in Tanzania were explored. The study findings indicated that Indigenous Maasai women engage in multiple traditional practices of BP such as the use of traditional herbs to induce vomiting during pregnancy. Three themes were developed from the study including traditional approaches to maternal well-being, traditions across childbirth preparations, and a husband\u0026rsquo;s collaborative roles within the family.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTraditional approaches to maternal well-being \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings from this study indicate that Maasai women use several kinds of traditional herbs, such as oloisikirai and oitepes, to induce vomiting during pregnancy. These practices aim to reduce bile accumulation and promote a healthy appetite post-delivery when a woman needs to eat enough food to quickly gain energy after a long pregnancy and delivery journey. Additionally, these herbs prevent the fetus from excessive growth, which could affect normal delivery. However, findings indicate that Maasai women use traditional approaches to accelerate labor, such as \u003cem\u003eOlmangulai\u003c/em\u003e and cow\u0026rsquo;s or sheep\u0026rsquo;s fats, to fasten the labor and delivery process.\u003c/p\u003e\n\u003cp\u003eIn addition, the Maasai population practices their traditional means of managing complications relating to pregnancy such as managing retained placenta through the use of traditional herbs known as oloirien, or olgojorai which are also used to manage postpartum hemorrhage. Thus, relying on these herbals may result in poor maternal and neonatal outcomes due to delays in accessing obstetric services during labor and in case of complications. Moreover, they traditionally use clothing materials to tighten the woman\u0026rsquo;s abdomen to manage severe bleeding following delivery, which is a beneficial practice.\u003c/p\u003e\n\u003cp\u003eHence, managing complications related to pregnancy traditionally in the community may increases adverse maternal outcomes due to\u0026nbsp;underutilization of skilled birth attendants for labor and obstetric complications management, and also sepsis as some herbs are applied directly to the birth canal to control hemorrhage which can lead to maternal sepsis as an aseptic technique cannot be practical during the course. This practice can be attributed to insufficient utilization of maternal health services during pregnancy, delivery, and the postnatal period which leads to inadequate information concerning health facility BP practices.\u003c/p\u003e\n\u003cp\u003eThese findings are in harmony with previous studies done in Ethiopia (26) indicating the existence of traditional malpractice as women use herbs to facilitate labor. It is a common practice for women to use herbs to facilitate labor and delivery in Ghana (27), Malawi (28), and Tanzania (29) indicated that Maasai women use traditional medicine during pregnancy, delivery, and postnatal. These similarities may be due to the possible existence of common values and reliance on traditional practices during pregnancy, delivery, and postnatal periods among study participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll these practices may have an impact on the overall well-being of the indigenous Maasai women and the fetus such as rupture of the uterus, dehydration, and fetal distress. Studies indicate that the use of traditional herbs during pregnancy and labor may end up with poor outcomes for the mother and the fetus (28). Moreover, the use of herbal drugs during labor causes intense and persistent contractions that do not match with the cervix\u0026apos;s steady dilatation leading to rupture of the uterus and fetal distress (30). In addition, even though they follow traditional practices, there have been reports of negative impacts on both the expectant mother and the fetus from using herbal medicine (24). Several traditional herbs are toxic due to a lack of established dosages and endanger expectant mothers and their neonates (28,31).\u003c/p\u003e\n\u003cp\u003eTherefore, it is imperative to stress that seeking medical professionals\u0026apos; advice is necessary when pregnant women fall sick or notice any complications, rather than relying solely on herbs to improve the well-being of expectant mothers\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTraditions across childbirth preparations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDietary restrictions during pregnancy were another prominent traditional practice that was identified in this study among the Indigenous Maasai women. The study found that Indigenous Maasai women traditionally prepare for birth through several approaches, including food restrictions during pregnancy such as meat, stiff porridge, rice, and milk to prevent excessive fetal growth, reflecting traditional practices that aim to ensure smooth childbirth experiences. However, pregnant women sometimes take only porridge, and vegetables and drink a lot of water. The risks related to pregnancy and labor consequences led to the avoidance of these kinds of food.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHence, these practices can affect the well-being of both the mother and the fetus due to a lack of significant food intake during this important period where there is an increased need for adequate nutritious food for energy, proteins, minerals, and vitamins. Also, restrictions on food and erroneous assumptions regarding dietary intake may have a detrimental effect on an expectant mother\u0026rsquo;s nutritional status as well as her unborn child\u0026rsquo;s growth and development following delivery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTherefore, it is crucial to educate the Indigenous Maasai community members about the significance of traditionally forbidden foods such as meat and milk, emphasizing their beneficial and recommended consumption during the peripartum period. By educating the Indigenous Maasai communities at large, including community leaders and elderly women, the universal misconceptions about food consumption during pregnancy can be addressed.\u003c/p\u003e\n\u003cp\u003eSimilarly, other study findings indicate there are still practices of food prohibition as reported in South Africa (32), Ethiopia (24), and Tanzania (19,25) which revealed that expectant mothers traditionally avoid foods like oily foods, eggs, butternuts, fish, pumpkins, and oranges, which could cause excessive fetal growth, making it difficult to deliver normally. These foods are rich in proteins, carbohydrates, and vital micronutrients which are highly needed during pregnancy for maternal and fetal welfare.\u003c/p\u003e\n\u003cp\u003eHowever, these similarities might be due to the persistent existence of shared cultural beliefs and misconceptions about food consumption during pregnancy among study participants. Moreover, the study results differ from the study done in Cambodia, indicating a departure from destructive traditional practices such as food restrictions (33) and Nigeria ( Jembi et al., 2023) highlighted that expectant mothers\u0026rsquo; dietary behaviors are not affected by cultural food beliefs. The disparities are due to the differences in social demographic characteristics of the study participants. However, the current study included Indigenous Maasai women, where most of the participants had informal education, which can affect the understanding of the significant effects of food restriction during pregnancy on the mother and fetus. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMoreover, the study highlighted the prevalent traditional practices among indigenous Maasai women during childbirth preparations, such as relying on TBA assistance during pregnancy, delivery, and even after delivery. From five months of pregnancy onward, these TBAs palpate the expectant woman\u0026apos;s abdomen to assess the fetal position and presentation. If the fetus is not in a cephalic presentation, they externally manipulate it to ensure a normal delivery, as is customary in the community. The simple accessibility and availability of TBAs may contribute to the\u0026nbsp;persistence of this practice. Hence, these practices carry a risk of developing complications, such as fetal distress and placental abruption.\u003c/p\u003e\n\u003cp\u003eTherefore, to enhance the health facility BP practices among the Indigenous population, strategies such as community-based educational campaigns should focus on TBAs, enhancing their understanding of the significance of health facility BP practices. This will enable them to support efforts aimed at enhancing maternal healthcare utilization throughout the continuum of care. Moreover, working together with reputable TBAs among Indigenous Maasai populations can bridge the gap between the traditional BP and health facilities. BP practices enable TBAs to facilitate access to maternal health services during pregnancy, labor, delivery, and postnatal care while also providing perceptive knowledge about culturally competent care.\u003c/p\u003e\n\u003cp\u003eHowever, the same findings were obtained in Ghana (35), Kenya (36), Uganda (37) and Tanzania (19) indicating the persistence of traditional recommendations for TBA assistance and care during pregnancy and delivery since they are respected and trusted. These similarities might be due to similar traditional recognition and perception of TBAs as being experienced, knowledgeable, skilled, and reliable persons across African communities specifically in rural areas.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMoreover, the results contradict those of studies conducted in Cambodia (33) and Malaysia (38) which found that women preferred to give birth at health facilities with the help of skilled professionals. The disparity might be due to differences in background and study population; also, the health policy of these countries restricts women from delivering at home and with the assistance of TBAs. Hence, these TBAs may lack the skills and resources to manage obstetric complications once they occur (39,40). Also, traditional practices can influence the use of maternal health services (41). Therefore, dependence on TBAs for maternal and neonatal services can be risky and increase morbidities and mortalities as obstetric complications can happen at any stage during the continuum of care.\u003c/p\u003e\n\u003cp\u003eAdditionally, arrangements for experienced adult women to provide care during pregnancy, labor, and postpartum also emerged as a significant finding from the study. Findings indicated that chosen and respected elderly women are mostly the ones who act as carers during these critical periods. They provide instruction to expectant mothers on being brave, avoiding shouting during labor and delivery, and monitoring women\u0026apos;s food intake during pregnancy. These individuals\u0026apos; presence not only provides practical assistance but also plays a crucial role in upholding traditional practices, and they may have a lot of traditional experience and information about delivery techniques.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTherefore, while the presence and care provided by these elderly women during these critical moments may seem beneficial, it can also negatively impact health facility BP practices. This is because these elders may lack adequate knowledge about the importance of health facilities and the use of skilled birth attendants to advise younger women, potentially increasing the risk of adverse outcomes for both mothers and newborns.\u003c/p\u003e\n\u003cp\u003eHowever, Canada obtained comparable results, explaining that people respect and perceive older women as experienced populations who can provide information in a traditionally relevant manner (42). Pregnant women in the United Kingdom received a broad spectrum of psychosocial support, which numerous individuals, including their family and female network, appreciated (43). Common traditional practices and the understanding that pregnant women need support during pregnancy, delivery, and postpartum contribute to these similarities. By being involved, pregnant women can get practical and emotional assistance, which helps maintain traditional feelings of social connection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA husband\u0026rsquo;s collaborative roles within the family\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study results revealed that the husband predominantly controls decision-making regarding childbirth among Indigenous Maasai women, including choices about birth attendants and delivery location. This reflects the male-controlled nature of decision-making in the Indigenous Maasai societies in Tanzania, where gender roles and power dynamics can affect the health facility BP practices, resulting in poor maternal and neonatal outcomes. Hence, depending solely on the husband\u0026apos;s decision-making can affect the woman\u0026apos;s autonomy in making decisions for health facilities and skilled professionals\u0026rsquo; utilization during the continuum of care, thereby impacting the health facility BP practices at large, since spouses possess the last say over either accessing health facilities for maternal and neonatal healthcare services or traditionally sticking to the TBAs assistance during the continuum of care.\u003c/p\u003e\n\u003cp\u003eThe study results are supported by studies done in Ghana (44) which noted the substantial influence of male partners in reproductive health decisions and adherence to traditional practices, in Ethiopia (45) further noted that decision-making in the household influenced the practice of childbirth and the location of delivery and Zambia (14) women had limited autonomy in decisions about childbirth and relied on their husbands and other family members for decision-making. The explanations for these similarities might be due to the prevailing lack of women\u0026apos;s autonomy in decisions and the patriarchal dominance of decision-making among the study participants\u0026rsquo; communities.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHowever, contrary to the study done in Ngorongoro Tanzania (25)\u0026nbsp; showed that women had agency in choosing the place of delivery. Variations in the geographical location could be the cause of this discrepancy. The researcher conducted a study in Ngorongoro, specifically in the Nainokanoka ward, where there is the existence of the Naiboisho Development Initiative (NDI). This project aimed to reduce the maternal mortality rate (MMR) in this ward, potentially leading to implementing education on gender roles in decision-making. The findings confirmed that while husbands play a central role in these decisions, there is a growing recognition of the need for women\u0026apos;s involvement in these processes.\u003c/p\u003e\n\u003cp\u003eAdditionally, the study\u0026apos;s findings show that a husband, as the family\u0026apos;s primary provider, bears the full burden of managing the household, managing finances, preparing goats for his wife\u0026apos;s postpartum slaughter, and ensuring the family\u0026apos;s food supply. However, this is a good practice where the expectant woman is supported on some of the significant preparations needed for delivery, such as saving money. Furthermore, he shouldn\u0026apos;t travel far in the final months of pregnancy, allowing him to determine the best location for the woman\u0026apos;s delivery once labor begins. \u0026nbsp;However, Similar study results were obtained in Nepal (46) demonstrating that males play a variety of roles, even if they are not involved in the practical delivery. The explanation for the correspondence might be due to the critical similarity of men as breadwinners and having comparable responsibilities among study populations.\u003c/p\u003e\n\u003cp\u003eIn addition, the study findings highlight the importance of incorporating traditionally acceptable approaches into maternal health initiatives to promote maternal well-being among Indigenous Maasai women in Tanzania, while also acknowledging the positive impacts of traditional practices and addressing harmful traditional practices and values. Hence, approaches aimed at improving health facility BP practices must incorporate strategies to empower women, allowing them to have a more active role in childbirth decisions while addressing the male-controlled context.\u003c/p\u003e\n\u003cp\u003eTherefore, the acknowledgment of the positive traditional practices and recognition of negative ones that affect the health facility BP practices highlights the critical importance of considering Indigenous Maasai knowledge systems in measures to raise awareness and uptake of health facility BP practices among the Indigenous communities. Healthcare professionals may build more collaborative and trustworthy relationships with the indigenous Maasai population by recognizing and honoring these positive traditional practices, thereby increasing the effectiveness of maternal healthcare approaches.\u003c/p\u003e\n\u003cp\u003eThe cultural norms considered important for traditional birth preparation practices were explored. The study findings revealed that indigenous Maasai women rely on cultural norms in preparation for childbirth. The study developed two themes: norms connected to the baby and ritual performance during pregnancy and labor.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNorms connected to the baby\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFindings from this study indicated that culturally, pregnant women are restricted from engaging in sexual intercourse from the moment of conception until the child is two to three years old after birth to protect the child\u0026apos;s health. However, this prohibition is based on the belief that the father\u0026apos;s ejaculates may defile the unborn child, leading to various adverse effects, such as being born with whitish materials around the baby\u0026apos;s body that make him/her dirty. Thus, this can affect efforts to raise the uptake of BP practices because it encourages a man to have many wives, which can affect the family\u0026apos;s economic status, leading to insufficient access and utilization of skilled birth attendants and health facilities as the man cannot afford the cost for obstetric services, resulting in poor maternal outcomes.\u003c/p\u003e\n\u003cp\u003eHowever, these results align with a South African study that suggests it\u0026apos;s customary for men and women to refrain from sexual activity during pregnancy to prevent sexually transmitted infections (47). These similarities could be explained by common cultural views about sexual practice during pregnancy and the period following delivery.\u003c/p\u003e\n\u003cp\u003eMoreover, the above results are incongruent with studies done in Zimbabwe which indicated that women do have sexual practices during pregnancy as they believe it will make childbirth easier and preserve harmonies in their relationships leading to the prevention of HIV transmission (48). In Ghana, women start sexual practice 40 days after delivery (27). In Uganda, the husband is not allowed to have intercourse with another wife even if she is his co-wife during pregnancy, and sex is resumed one month after delivery (37). These differences may be due to the fact that many societies have different cultural views on sexual practices during pregnancy and postnatally. However, the current study focused on ordinary Indigenous Maasai women, the majority of whom adhered to their cultural norms and values, instead of utilizing maternal and child health services to obtain appropriate information about sexual practices.\u003c/p\u003e\n\u003cp\u003eHence, this cultural norm facilitates polygamy, which can be a risk for sexually transmitted infections. On the other hand, polygamy serves as a family planning technique to prevent a woman from having too soon pregnancies, which could potentially impact the health of both the mother and children. Studies suggest that to prevent the emergence of concerns or sexual dysfunctions brought on by the changes that occur during pregnancy, healthcare professionals should advocate healthy sexual behavior (49).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRitual performance during pregnancy and delivery \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdditionally, the study found that Maasai elders perform several rituals during pregnancy and during labor and delivery to safeguard the well-being of the mother and fetus, such as administering fresh cow\u0026apos;s blood to a woman who has lost consciousness due to convulsions. Even when these women become ill or experience conditions such as seizures-induced loss of consciousness, they continue to perform rituals. These rituals include taking the sick pregnant woman to a traditional healer for treatment, during which a sheep is slaughtered and a piece of skin is tied to the pregnant woman\u0026apos;s left arm symbolizing protection.\u003c/p\u003e\n\u003cp\u003eHowever, elders carry out rituals for pregnant women in which they implore the spirits of their ancestors to keep women and their fetuses safe from evildoers symbolizing the significant existence of spiritual protection for women and the fetus. Furthermore, in the period of prolonged labor, the husband puts the milk in his mouth and returns it to the cup three times while talking to the mother to deliver in peace believing that the prolonged labor is due to conflict between him and his wife. Hence, these ritual performances may contribute to maternal and perinatal morbidities and mortalities as they further cause delays in seeking obstetric care from skilled practitioners during labor and obstetric complications.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSimilarly, in Nepal, rituals are performed during pregnancy, childbirth, and postnatal (50). These similarities are because pregnancy and childbirth are social and cultural events with varying significance across different communities.\u003c/p\u003e\n\u003cp\u003eHowever, these findings highlight the existence of cultural practices that affect healthcare-seeking behavior leading to poor maternal and neonatal outcomes due to delays in seeking obstetric services for delivery and in case of complications. Habte et al. (51) emphasized that cultural norms and practices can profoundly influence attitudes and behaviors toward BPCR. Mosley et al. (52) further underscored that these cultural practices, though sometimes viewed as restrictive, are fundamental to the community\u0026apos;s identity and serve as a source of security and continuity. Therefore, these beliefs must be considered when developing measures like community educational campaigns to increase the uptake of health facility BP practices among Indigenous Maasai women to improve maternal and neonatal health.\u003c/p\u003e\n\u003cp\u003eNonetheless, these cultural norms highlight the holistic beliefs and approaches used by Indigenous Maasai women and the community at large to prepare for safe childbirth, reflecting the deeply ingrained cultural beliefs and rituals surrounding birthing practices within the study population. Hence, the findings emphasize the need for culturally sensitive approaches to improve maternal healthcare utilization. In addition, it is imperatively important to understand and respect the cultural norms, values, and beliefs of the Indigenous Maasai populations to promote maternal and neonatal healthcare equity and reduce disparities in healthcare access and utilization, Policymakers and health professionals can deliver more inclusive and accessible maternal health interventions that align with the needs and choices of Indigenous Maasai women in Tanzania by considering cultural norms in healthcare programs. Incorporating community leaders into the planning and execution of maternal health initiatives ensures widespread acceptance and cultural appropriateness of the interventions. This interaction can enhance community participation and encourage active involvement in maternal health initiatives.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe study\u0026apos;s findings reveal that Indigenous Maasai women in Tanzania adhere to traditional birth practices, which include the utilization of herbal medications and dietary modifications during pregnancy, labor, and postpartum. Their husbands play a crucial role in determining the birth location and providing assistance during labor and delivery, with a preference for traditional birth assistants (TBAs). This preference for TBAs during care and delivery increases the risk of complications for both mothers and newborns. Therefore, the study\u0026apos;s findings emphasize an urgent need for community health educational programs focused on creating awareness of the effects of traditional practices such as restriction of food intake during pregnancy and inadequate use of skilled birth attendants among the study population to enhance maternal well-being.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThe researcher took into account some of the research limitations, including the fact that the study primarily focused on women who had given birth months prior, which could potentially cause recall bias and misrepresent the childbirth experiences regarding BP practices. The researcher\u0026nbsp;overcame recall bias by referencing the child, who is currently two years old.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHowever, due to language barriers, communication difficulties for both the researcher and the respondents may lead to misunderstanding and misinterpretation of questions and responses. To overcome language barriers, Maasai nurse midwives who were fluent in the local language worked as research assistants and translators to ensure data collection accuracy and consistency.\u003c/p\u003e\n\u003cp\u003eFurthermore, since the study involved the Indigenous Maasai population, social desirability bias may have occurred, with participants giving pieces of information that were socially appropriate rather than the true nature of their BP practices due to fear of judiciousness and cultural prospects. However, the researcher managed to control the bias through a proper introduction, an explanation of the study\u0026apos;s purpose, prolonged engagement with participants, the use of anonymity to prevent participant identification through codes, and confidentiality approaches.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received an ethical approval from the University of Dodoma Institutional Research Review Committee, with Ref No. MA. 84/261/69/5 approved on January 30, 2014. Additionally, the Arusha Regional Administrative Secretary (RAS), the District Administrative Secretary (DAS), the District Executive Director (DED) from the district where the study was conducted (Longido District Council), the ward and village executives, and Maasai community leaders provided permission to conduct the research in the selected villages.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll participants have been made aware of the goals, methods, possible dangers, and advantages of the study, and participation is completely voluntary. Every participant has given their informed consent, guaranteeing that they are aware of their freedom to discontinue participation at any moment without facing any repercussions. Personal information will be kept private and managed in compliance with relevant privacy laws and ethical standards. Participant\u0026rsquo;s values, dignity, and integrity was safeguarded according to the Declaration of Helsinki by the World Medical Association (2001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003ePermission to publish this research article, together with any related data and figures, has been granted by all authors. We certify that we are the owner of the content and that it does not violate any trademarks, copyrights, or privacy rights. I agree to the publication\u0026apos;s distribution without payment and acknowledge that it may be utilized in scholarly publications, websites, or other platforms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e All data were available without any restrictions\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors have declared that no competing interests exist.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The authors received no specific funding for this work\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions Statement:\u0026nbsp;\u003c/strong\u003eAll authors involved in conceptualization; B.C. Writing- Original draft, Data analysis, methodology, and prepared all figures and tables; E.O. Writing -review and editing, analyzed data, methodology, and supervision; F.M. Writing -review and editing, methodology, analyzed data, and supervision; S.K. Writing -review and editing, analyzed data, methodology, and supervision.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eThe authors recognize the University of Dodoma for providing ethical approval to conduct this study. We are also grateful to the Arusha Regional Commissioner\u0026rsquo;s Office and Longido district authorities for their unlimited support during data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBithia A. Chanimbaga, Email: [email protected]\u003c/p\u003e\n\u003cp\u003eErick D. Oguma, Email: [email protected]\u003c/p\u003e\n\u003cp\u003eFabiola V. Moshi, Email: [email protected]\u003c/p\u003e\n\u003cp\u003eStephen M. Kibusi, Email: [email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWHO. 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BMC Pregnancy Childbirth. 2016;16(1):1\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003eHabte A, Tamene A, Woldeyohannes D. The uptake of WHO-recommended birth preparedness and complication readiness messages during pregnancy and its determinants among Ethiopian women: A multilevel mixed-effect analyses of 2016 demographic health survey. PLoS One. 2023;18(3 March):1\u0026ndash;25. \u003c/li\u003e\n\u003cli\u003eMosley PD, Saruni K, Lenga B. Factors influencing adoption of facility-assisted delivery - A qualitative study of women and other stakeholders in a Maasai community in Ngorongoro District, Tanzania. BMC Pregnancy Childbirth. 2020;20(1):1\u0026ndash;16. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-5804566/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5804566/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Preventable maternal morbidities and mortalities due to pregnancy-related complications can arise at any stage in pregnancy, delivery, and after. Despite efforts to encourage women to give birth in healthcare facilities, improvement has remained stagnant, particularly in remote Indigenous Maasai populationsin northern Tanzania. The study aims to explore the cultural norms and birth preparedness practices among Indigenous Maasai women in Northern Tanzania.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: The study employed a descriptive qualitative study design, which was conducted from 11 April 2024 to 31 May 2024, among Indigenous Maasai women. In-depth interviews were conducted with 7 newly delivered Indigenous Maasai women, and three focus group discussions with 30 Indigenous Maasai elderly women. The thematic analysis with inductive approach was used to analyze the qualitative data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The study findings identified five overarching themes and 16 sub-themes, shedding light on the prevalent adherence to cultural norms and traditional practices surrounding childbirth. The themes encompassed traditional preparation for childbirth, culturally rooted approaches to maternal well-being, ritualistic practices during pregnancy and delivery, the collaborative roles of husbands within the family, and cultural norms associated with newborn care. These themes highlight the intricate interplay between cultural traditions and maternal health practices in the study context.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The study's findings reveal that Indigenous Maasai women in Tanzania adhere to traditional birth practices, which include the utilization of herbal medications and dietary modifications during pregnancy, labor, and postpartum. Their husbands play a crucial role in determining the birth location and providing assistance during labor and delivery, with a preference for traditional birth assistants (TBAs). This preference for TBAs during care and delivery increases the risk of complications for both mothers and newborns. Therefore, the study's findings emphasize an urgent need for community health educational programs focused on creating awareness of the effects of traditional practices such as restriction of food intake during pregnancy and inadequate use of skilled birth attendants among the study population to enhance maternal well-being.\u003c/p\u003e","manuscriptTitle":"Cultural Norms and Practices of Birth Preparedness among Indigenous Maasai Women in Northern Tanzania: A Descriptive Qualitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-16 06:03:31","doi":"10.21203/rs.3.rs-5804566/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5b677730-9ecd-4cc4-a38e-317390804044","owner":[],"postedDate":"January 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-16T06:03:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-16 06:03:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5804566","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5804566","identity":"rs-5804566","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}