Traditional Beliefs and Practices Associated with Relieving Psychological Problems of Pregnant Women of the Zeliang Tribe

Traditional Beliefs and Practices Associated with Relieving Psychological Problems of Pregnant Women of the Zeliang Tribe | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Traditional Beliefs and Practices Associated with Relieving Psychological Problems of Pregnant Women of the Zeliang Tribe Saranya T.S, Gimcule. ., Sandeep Kumar Gupta, Sudha Saibalaji, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7145247/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 3 You are reading this latest preprint version Abstract In resource-poor Indigenous and tribal settings, emotional distress in pregnancy is usually managed through culture-based explanatory models and healing systems. Using a qualitative approach, this article examines how pregnant Zeliang women in Benreu village, Nagaland, understand and manage psychological issues through indigenous practices. Following community psychology and public health paradigms, semi-structured interviews were completed with ten pregnant women and two traditional healers. Braun and Clarke's six-stage thematic analysis identified five core themes: (1) culturally constructed emotional vulnerability in terms of ancestral and spiritual beliefs; (2) ritualized coping mechanisms involving chanting, incense fumigation, and defensive offerings; (3) the psychosocial function of traditional healers as emotional interpreters and community counselors; (4) the impact of maternal kin and communal knowledge in emotion management; and (5) the negotiation between biomedical antenatal care and Indigenous spiritual support. The research shows that traditional healing plays not only a cultural role but also an informal mental health system that provides emotional reassurance, symbolic meaning, and social containment. The research points towards the importance of culturally safe integrative perinatal care models that straddle Indigenous and formal healthcare systems. Such hybrid models are likely to optimize emotional well-being, decrease stigma, and facilitate more balanced maternal mental health services in tribal settings. Indigenous healing emotional well-being traditional medicine Zeliang tribe pregnancy cultural safety perinatal mental health India Introduction Perinatal mental health (PMH) is now a global public health imperative, as the World Health Organization (WHO, 2022) has estimated that over 10% of pregnant women across the globe have clinically significant depressive symptoms. In low- and middle-income nations (LMICs), rates of up to 16% have been reported. Unaddressed antenatal depression and anxiety are linked with adverse maternal and child outcomes, such as pre-eclampsia, longer duration of labor, low birth weight, and early childhood emotional or behavioral difficulties (Fonseca, Silva, & Canavarro, 2017). In spite of evidence-based psychosocial treatment availability, over 75% of women in LMICs are not treated, highlighting an enormous global treatment gap (Verma et al., 2023). The most recent studies point out that sociocultural assumptions and indigenous explanatory models are at the core of shaping pregnant women's experience of distress as well as their approach to seeking care. A systematic review by Ghosh, Rao, and Sharma (2023) underscored that in South Asian nations like India, Bangladesh, and Pakistan, pregnancy-related mental health problems are explained as resulting from cultural imbalances, ancestors' displeasure, or offending cultural taboos. Therefore, most women steer clear of formal psychiatric treatment, opting instead for tried-and-tested coping mechanisms such as prayer, ritual purging, and conventional herbal treatments. Likewise, in rural Nepal, mental health service use depends on culturally framed conceptualization of symptoms (Yuan, Ortega, & Alegría, 2023). Ethnographic studies throughout Africa and Asia attest to the prevalence of traditional healing practices across pregnancy. Aziato, Odai, and Omenyo (2016) established that Ghanaian postpartum women followed certain rituals and herbal practices to provide emotional and spiritual stability. In Zambia, Banda et al. (2007) established that more than 70% of pregnant women used traditional medicine to manage spiritual anxiety and psychosomatic complaints. These practices sometimes operate as organized emotional coping systems, providing pregnant women with culturally sanctioned means to mitigate psychological distress independent of biomedical paradigms. In India, particularly among tribal groups, dependency on traditional healing is both a cultural imperative and a coping response to systemic exclusion. In a mixed-methods analysis, Cáceres et al. (2023) reported that Northeast Indian Indigenous women commonly consulted traditional healers and elder women to explain pregnancy-related anxieties. Women gave ritual procedures and protection charms as ways to avoid miscarriage and spiritual attack. Likewise, Das, Gujre, Devi, and Mitra (2021) highlighted that customary ecological knowledge, such as healing rituals and use of herbs, constitutes the foundation of maternal care in most tribal villages with limited formal health services. Traditional healers are not just spiritual mediators but also informal mental health counselors. In research on India's integrative care models, Ali (2023) found that collaborative practice among community health workers and healers increased women's openness to talking about emotional issues and enhanced confidence in antenatal counseling. In Nepal, Yuan et al. (2023) showed how the inclusion of spiritual healers in community outreach programs had significantly enhanced the detection and referral of perinatal depression. Yet the precise emotional and psychological functions of traditional healers within tribal societies like the Zeliang of Nagaland are not well studied. The present research draws on Lazarus and Folkman's (1984) Transactional Model of Stress and Coping, which underscores that people's cognitive perceptions of stress—and their resultant coping processes—are guided by sociocultural context. Moreover, the theory of cultural safety (Chen, Zhang, & Kuper, 2023) informs the research, promoting respectful, inclusive health care practices that recognize Indigenous knowledges. Together, these theories underscore the value of learning about how Zeliang women understand emotional distress and how such understandings shape their help-seeking. Since these issues have cultural and clinical importance, this research investigates (a) how pregnant Zeliang women experience and describe psychological distress, (b) the traditional rituals, medicinal herbs, and healer interactions that they apply to maintain emotional well-being, and (c) how they experience the intersection between traditional care and official antenatal care. Through exploration of these domains, the research hopes to contribute to the development of culturally responsive, integrative perinatal mental health treatments for tribal women in Northeast India and similar Indigenous groups worldwide. In this research, psychological problems are a culturally mediated range of emotional upset during pregnancy, which can include chronic sadness, excessive worry, sleep disturbance, panic-like feelings, and inexplicable crying spells. Among Zeliang women, these states are seldom envisioned as Western psychiatric conditions (e.g., clinical depression or anxiety), but as spiritual or emotional imbalances based on ancestral displeasure, moral disharmony, or violations of taboo. Such culturally specific interpretation is consistent with the anthropological depiction of idioms of distress—context-specific expressions of suffering that may not neatly fit biomedical categories (Nichter, 2010; Kohrt et al., 2014). Evidence has indicated that in tribal and Indigenous societies, experiences of psychological distress are typically embodied and spiritualized, and are not always articulated in clinical language (Yuan, Ortega, & Alegría, 2023; Cáceres et al., 2023). Rather, these are expressed metaphorically, in dreams, or in symbolic behaviour, and regulated through ritual and kinship-based care systems. Therefore, although study participants may not identify with psychiatric diagnoses, their stories lay bare intricate affective terrain that is suggestive of psychological distress and the requirement for culturally meaningful care trajectories (Liamputtong, 2013; Ward et al., 2022). Statement of the Problem Research indicates that poorer women, particularly those residing in rural areas with limited access to healthcare services, face a significantly higher risk of maternal mortality compared to wealthier or urban counterparts (WHO, 2012). This disparity is also evident among indigenous communities in other countries like Indonesia such as in Naga village, Salawu subdistrict, Tasik Malaya Regency Expectant mothers in these communities often seek prenatal care from traditional healers (shamans) or Indung Beurang, practitioners who use medicinal practices involving local herbs and traditional methods (National Development Planning Agency, 2013). These non-medical practices are deeply rooted in local wisdom and have been passed down through generations. Pregnancy is considered a critical event among the indigenous people of Naga village, marked by inherent risks associated with this life cycle (Perhawasari, Sjoraida, Priyo Subekti & Anisa, 2021). Studies by governments, including that of India, highlight the disparities in healthcare access faced by rural women. This research aims to investigate the traditional beliefs and practices employed to alleviate psychological challenges experienced by pregnant women in Benreu, Nagaland. Significance of the study Traditional beliefs concerning the health of pregnant women have garnered increasing attention in contemporary literature. The role of traditional beliefs and practices in alleviating psychological problems among patients is particularly noteworthy. However, this phenomenon remains poorly understood in the context of India. This study aimed to document and explore the traditional beliefs and practices used to alleviate psychological issues among pregnant women of the Zeliang tribe in Benreu, Nagaland. By focusing on this specific indigenous community, the research contributes to filling a significant gap in understanding how cultural and traditional practices influence maternal health and well-being. Research questions What emotional and psychological challenges do pregnant Zeliang women experience during pregnancy, and how do they interpret these challenges? What traditional beliefs, rituals, and plant-based remedies are used by pregnant women to manage emotional distress? How do traditional healers support pregnant women’s emotional well-being, and what meanings do women assign to these interactions? How do pregnant women navigate between traditional healing and biomedical antenatal care? Research objectives To identify and describe the emotional and psychological concerns of pregnant women in Benreu village and how these are culturally interpreted. To document the types of traditional practices such as rituals, herbal remedies, and protective symbols used to relieve psychological distress during pregnancy. To explore the psychosocial roles of traditional healers as perceived by pregnant women in the Zeliang community. To examine how pregnant women engage with both traditional and biomedical antenatal care systems. METHODOLOGY Research Design The exploratory research design adopted for the study in Benreu, Peren Nagaland, aimed to investigate traditional beliefs and practices regarding pregnancy among a sample of 10 pregnant women aged 20 to 45, and 2 traditional healers utilizing convenience sampling and thematic analysis for data collection and analysis, respectively. Sampling The study was conducted in Benreu, Peren Nagaland, focusing specifically on pregnant women residing in Benreu village. The sampling unit comprised pregnant women aged between 20 and 45 years. Inclusion criteria stipulated that only pregnant women living in Benreu village, Nagaland, within the age range of 20 to 45 years were eligible for participation. Convenience sampling was employed as the method to select participants; ensuring individuals meeting specific criteria relevant to the study's objectives were included. Data collection involved conducting face-to-face interviews with each participant, facilitating direct interaction and detailed information gathering. Thematic analysis served as the chosen method for analyzing the collected data, enabling the identification and exploration of patterns and themes within the qualitative data gathered from the participants. Inclusion Criteria Pregnant married women living in Benreu village, Nagaland, who were between 20 and 45 years old, were included in the study. Exclusion Criteria Pregnant women outside Benreu village, Nagaland, and those younger than 20 or older than 45 years were excluded from the study. RESULTS Table 1: Shows the Socio demographic details of study participants (Pregnant women and traditional healers) Participant ID Age Marital Status Pregnancy Order Education Level Role P1 22 Married 1st Middle School Pregnant Woman P2 30 Married 2nd High School Pregnant Woman P3 29 Married 2nd Primary School Pregnant Woman P4 27 Married 1st High School Pregnant Woman P5 23 Married 1st Secondary School Pregnant Woman P6 24 Married 1st No Formal School Pregnant Woman P7 25 Married 2nd Middle School Pregnant Woman P8 28 Married 3rd Primary School Pregnant Woman P9 26 Married 1st High School Pregnant Woman P10 31 Married 2nd Secondary School Pregnant Woman H1 60 Widow — No Formal School Traditional Healer H2 58 Married — Informal Learning Traditional Healer Thematic analysis of data gathered from ten pregnant Zeliang women and two traditional healers in Benreu, Nagaland, identified three overarching themes with several subthemes. These themes point to how psychological well-being during pregnancy is lived, interpreted, and coped with within the Zeliang people's traditional cultural context. The themes are outlined below along with indicative participant narratives. Theme 1: Emotional Vulnerability and Cultural Conceptions of Pregnancy Fear and Psychological Distress in Early Pregnancy They often reported experiencing fear, uncertainty, and emotional instability in the first few weeks of pregnancy. These feelings were usually accompanied by bodily symptoms like tiredness, sleep disorder, and loss of appetite. Instead of talking in clinical terms of "stress" or "anxiety," the women reported these as emotional states induced by social or spiritual reasons. "I would weep without knowing why. It was not sadness. It was like something deep… being watched or judged" (Participant 4, 27 years old). Spiritual Etiologies of Emotional Distress A majority of the women explained their emotional distress as spiritual imbalance, moral sin, or displeasure with ancestors. For instance, solitary walking in forests, eating prohibited food, or having dreams about water bodies were translated as spiritual signs likely to cause harm to mother and fetus. "My grandmother told me the dark water dreams indicated that the baby's spirit was mixed up. I needed to visit the healer in a hurry to straighten it out" (Participant 6, age 24). These beliefs positioned psychological distress as external indicators of disconnection from cultural and spiritual norms rather than as internal dysfunction. Theme 2: Healing Practices as Emotional Regulation Tools Rituals for Emotional Protection Participants reported participating in a range of traditional rituals that aimed to safeguard both mother and unborn child against emotional and spiritual distress. Such practices that were common included incense fumigation, symbolic chanting, protective thread-tying, and performing offerings on ancestor altars. These practices were both spiritual buffers and psychological anchors. "When the healer burns the leaves and chants, I feel lighter. Like my chest can breathe again" (Participant 3, age 29). Herbal Medicines and Symbolic Items Conventional medicines like herbal tea, oil, and amulets were used extensively not only to treat physical manifestations but also for emotional well-being. These substances were usually recommended by conventional healers upon hearing the woman's dreams, actions, and emotional issues. "She gave me a root to chew whenever I feel panic. I still carry it in my blouse" (Participant 1, age 22). Theme 3: Traditional Healer's Role in Psychosocial Support Healers as Emotional Guides and Interpreters The two healers interviewed identified their role as beyond cure — they thought of themselves as mediators of emotions and the spiritual sphere. Their practice entailed dream interpretation, narrative, spiritual diagnosis, and affect empathy. "We don't just treat the body. We speak to the woman's fears, her spirits, her ancestors. We explain to her what her feelings are" (Healer A, female, c. 60 years old). Trust and Cultural Authority of Healers Participants reported strong emotional trust in traditional healers, frequently more highly valuing their counsel than formal health professionals. This was built on common language, familiarity with their culture, and a comprehensive conceptualization of life changes like pregnancy. "The nurse at the clinic tells me to rest. But the healer tells me why I feel weak—and what to do with my emotions" (Participant 7, age 25). Theme 4: Social Support Networks and Intergenerational Wisdom Maternal Cultural Guidance and Mentorship Older women, such as mothers, grandmothers, and aunts, were at the center of counseling the emotional and cultural process of pregnancy. They interpreted signs for them, counseled them on rituals, and even took them to see healers. "My mom understood what plants to give me when I was agitated. She said, 'This is not a sickness of a doctor. This is your spirit weeping'" (Participant 8, 28 years). This intergenerational epistemology built a robust emotional buffer for expectant women coping with psychological ambiguity. Communal Norms and Emotional Containment Participants described how emotional expressions such as crying, irritability, or fear were not seen as pathological but expected aspects of pregnancy, managed collectively through ritual and family interaction. “We talk to each other when our moods shift. No one says ‘you are sick’ they say, ‘we’ll call the healer’” (Participant 2, age 30). Theme 5: Navigating Between Traditional and Biomedical Worlds Tensions Between Medical Advice and Cultural Beliefs Some of the participants went to antenatal check-ups but still depended on traditional healers for emotional and spiritual support. This double involvement highlighted conflict between messages from modern healthcare and cultural messages. "On clinic days, they advise me to go to bed early. But my aunt says I must light the lamp and chat with the baby's soul at night. I try to do both" (Participant 5, 23 years). Preference for Holistic Care Even where biomedical treatment was present, participants wanted culturally significant answers to their emotional issues. Healers had a story and spiritual context that medical practitioners were felt to be missing. "The doctor treats my stomach. The healer treats my mind and soul" (Participant 9, age 26). This nuanced analysis demonstrates how Zeliang women in Benreu blend traditional knowledge systems into their emotional experience of pregnancy. Traditional healing practices serve not just as cultural representation but also as crucial instruments for emotion management and psychosocial support in an environment where formal mental health care is restricted or culturally maladjusted. Discussion Redefining Pregnancy Emotionality from Cultural Perspective Our research finds that emotional distress during pregnancy is culturally framed among Zeliang women, with spiritual and ritual understandings replacing biomedical words for anxiety or depression. This observation corroborates qualitative studies in Meghalaya and tribal-majority areas of India, where likewise culturally situated meanings of emotional discomfort dominated even with biomedical access (Cáceres et al., 2023; Kumar & Jain, 2023). Stress Appraisal and Ritual Coping within Context With the Transactional Model of Stress and Coping by Lazarus and Folkman (1984), it can be noted that Zeliang women undergo primary appraisal perceiving emotional experiences as spiritual threats and secondary appraisal finding traditional healers as the primary source of relief. Coping occurs through culture-validated problem-focused (rituals, taboos) and emotion-focused (chants, symbols) strategies. This cultural construction of prenatal stress and coping is replicated in Bihar, where ritual interventions were primary risk aversion strategies (Thompson, 2020). Ritual Behaviors as Emotion Regulation Scripts Rituals such as fumigation with incense, protection strings, and herbal decoctions act as scripted behavioral scripts that render repeated reassurance and psychologic relief. Parallel findings in Gujarat and GHaro tribal women in Meghalaya suggest that such ritualized behaviors offer emotional scaffolding and an outlet for articulation of distress (Cáceres et al., 2023; Kumar & Jain, 2023). These findings are underpinned by theoretical models of psychoneuroimmunology suggesting that rituals reduce cortisol and enhance perceived control. Transactional Stress, Cultural Safety, and Indigenous Coping Pathways From the perspective of Lazarus and Folkman's (1984) Transactional Model of Stress and Coping, Zeliang women's emotional experiences during pregnancy can be understood through primary and secondary appraisal. At the initial stage, emotional disturbances—like inexplicable crying, tiredness, or anxiety dreams—are not appraised as biomedical symptoms but as spiritually charged threats to the wellness of both mother and baby. This concurs with the model that stress is cognitively constructed and its meaning depends on cultural schemas. In secondary appraisal, women evaluate their resources to cope with the threat. In this case, rituals, visits from healers, dialogue with ancestors, and herbal medicine are weighed as reliable, culturally embedded coping mechanisms. The practices serve both emotion-focused coping (e.g., chanting to alleviate distress) and problem-focused coping (e.g., seeking explanations or eliminating spiritual causes). This two-track system of coping resonates with wider ethnographic findings that stress is ethnographically "scripted" in many Indigenous contexts (Kohrt et al., 2014; Liamputtong & Kitisriworapan, 2011). At the same time, the theory of Cultural Safety (Chen, Zhang, & Kuper, 2023) explains how biomedical professionals might not attend to this cultural construction of stress. Regular antenatal care has no room to be adaptive in acknowledging ancestral terrors or symbolic meanings, and women may feel emotionally neglected. Cultural safety doesn't just mean honoring Indigenous spirituality but incorporating it into cooperative, non-jerarchic models of care. This study demonstrates that Zeliang women gain the most when cultural and biomedical systems are complementary rather than competitive (Ali, 2023). Traditional Healer Psychosocial Providers who are Lay This study confirms that traditional healers tend to function as dementia-aware informal counsellors listening to individual narratives, interpreting dreams, and prescribing emotional treatment. National-level research in India confirmed that inter-professional working between healers and mental-health practitioners can provide equal and grounded mental-health treatment among underserved communities (Ali, 2023). Indigenous settings in countries also confirm that culture-specific healers engage in psychosocial treatment akin to professional counsellors (Yuan et al., 2023). Community and Intergenerational Support: An Ecological Model Our findings are aligned with Bronfenbrenner's social-ecological model: well-being is enabled at micro- (family), meso- (peer group), and macro (societal ritual) levels. A new mixed-methods study of Garo tribal women also demonstrated how transmission of maternal knowledge and community ceremony form a psychosocial safety net (Cáceres et al., 2023). This has the effect of highlighting the importance of maintaining cultural pathways in maternal mental-health plans. Hybridizing Care: Towards Cultural Safety Pragmatic dual-system utilization is noted in Zeliang women attending clinical antenatal care while seeking spiritual-emotional protection from healers. The hybrid pattern is also noted in other tribal populations and suggests formal healthcare workers must adopt cultural safety protocols with respect and understanding of indigenous explanatory models (Ali, 2023; Cáceres et al., 2023). The World Health Organization also promotes systematic psychosocial care integrated into antenatal service that is acceptable according to local belief systems. Although the psychological lives of pregnant Zeliang women are informed by spiritual and cultural meanings, they remain irreducible to the intersectional dynamics of gender, indigeneity, and geographic marginalization. Motherhood and pregnancy, particularly in Indigenous cultures, are inevitably tied to cultural notions of female duty, reproductive achievement, and spiritual responsibility—goals that necessarily amplify emotional tension (Liamputtong, 2013; Ward, Clark, & Heifner, 2022). These anticipations intersect with deficient biomedical infrastructure and sociopolitical invisibility, heightening vulnerability to unperceived or miscalculated psychological distress. In addition, conventional beliefs about maternal emotionality e.g., experiencing fear or sadness as moral frailty or ancestral displeasure can put the onus of mental health in women's own hands. This gendered responsibility not only influences help-seeking habits but also constrains the language by which women express their needs (Yuan et al., 2023). Substituting perinatal mental health with this intersectional approach enables more structurally informed and equitable responses, in which emotional care is viewed as both social justice and cultural concern (Verma et al., 2023; Ghosh, Rao, & Sharma, 2023). Implication The significance of these findings for perinatal emotional care and maternal mental health services in Indigenous and tribal contexts is significant. Foremost, traditional healers must be recognized as essential community-based professionals in perinatal emotional care. Already established as trusted emotional interpreters and spiritual counsellors, their current role implies a possible link with the formal health system. Policymakers and district health authorities can create formal referral links between healers and auxiliary nurse midwives (ANMs), offer safe ritual integration guidelines, and offer integrated training courses in culturally safe care. Equivalents of such integration models in other low and middle-income countries (LMICs) and India have generated increased access and acceptability to mental health (Ali, 2023; Yuan et al., 2023). Identification of healers through the maternal health system can help bridge the psychosocial services gap across tribal regions. Second, safety and cultural competence have to be developed with urgency among primary healthcare workers. Training modules should incorporate tribal belief systems, indigenous explanatory models of distress, and respectful communication skills. Embedding cultural safety into ASHA and ANM training courses—recommended by the World Health Organization (2022) will improve the quality of antenatal interactions and reduce the stigma tribal women face while reporting emotional suffering. At the same time, national policy must extend beyond biomedical maternal health and address perinatal mental health explicitly. Current programs like the National Mental Health Programme (NMHP) and RMNCH+A need to be scaled up to include culture-sensitive psychosocial support, especially in tribal regions where religious buildings dominate care-seeking behavior (Ghosh et al., 2023; Cáceres et al., 2023). Finally, technology and research will need to enable scaling up of culture-institutional interventions. Expert healer voice-based mobile counseling or locally translated mental health mobile apps in the indigenous language may extend beyond emotional care in low-literacy settings. Mixed-methods studies and cluster-randomised trials are needed to evaluate the effectiveness and sustainability of such blended approaches. India's policy landscape for tribal health is shifting, and these findings offer a timely, evidence-based roadmap to enhance maternal mental health by aligning services with women like the Zeliang's spiritual and cultural spheres. Mainstreaming traditional healing is not only a token of cultural sensitivity, it is a strategic move toward more accessible, inclusive, and psychologically informed public health. Conclusion This study identifies the ways pregnant Zeliang women from Benreu, Nagaland, cope with emotional distress through culturally situated traditional healing activities. Emotional responses of anxiety, fear, and sadness are interpreted through spiritual worldviews and controlled by rituals, herbalism, and counseling from traditional healers. These activities not only illustrate indigenous worldviews but also serve as effective coping mechanisms in the context of inadequate culturally congruent formal mental health services. By employing the Transactional Model of Stress and Coping and drawing on ecological frameworks, the study emphasizes the importance of locating perinatal emotional well-being within the cultural context. Traditional healers give informal yet highly cherished psychosocial support through established intergenerational and community-based networks. Formal integration of such practices into formal maternal mental health services can enhance such services, particularly in underprivileged tribal areas. To be responsive to the mental health needs of tribal and Indigenous women in India, health systems must move towards cultural safety, inclusion, and collaboration. The integration of traditional knowledge systems, building frontline workers' cultural capacities, and generating evidence through context-sensitive research are key steps forward. This study offers not only a descriptive account of lived experience but also an advocacy call to build culturally responsive, equitable, and integrated maternal mental health care. Limitations Although this research offers useful insights into pregnant Zeliang women's traditional healing practices and psychological well-being, a number of limitations should be noted. It has to be noted that the research was undertaken in one village (Benreu) in the Peren district of Nagaland, and therefore the findings are limited by this narrow sampling frame. Cultural beliefs and healer roles can differ among other Zeliang communities or Northeast Indian tribal groups, and hence caution must be exercised when generalizing the findings to larger tribal populations. The sample population, although suitably small for qualitative work, was relatively small at ten pregnant women and two traditional healers. This numerically small group may not necessarily encompass the range of experiences, particularly for women who do not participate in customary practices or who have varying levels of access to formal healthcare. In addition, the use of self-reported accounts introduces the possibilities of recall or social desirability bias, such as when elaborating on culturally sensitive issues like spiritual beliefs and emotional distress. This research excluded the views of biomedical health caregivers (e.g., nurses, ASHAs, or physicians), which might have provided a better explanation of the interaction between traditional and formal health care systems. Future studies may take a multi-stakeholder perspective, use comparative case studies, and incorporate longitudinal designs in order to understand the dynamics of changing hybrid care practices and their long-term effects on maternal mental health outcomes. Whereas traditional healing practices present culturally relevant emotion regulation and social support methods during pregnancy, their limitations and risk potential should be recognized. Certain herbal therapies, for instance, may possess uncharacterized pharmacological activity, particularly when taken without standardized dose or at key gestational times (Kennedy et al., 2013; Laelago, 2018). Some taboos or rituals—like dietary restrictions or avoidance of medical checkups—may, unknowingly, postpone biomedical care, especially in high-risk pregnancies (Jun et al., 2021). In addition, sole dependence upon spiritual or symbolic explanations of suffering can stigmatize women experiencing more severe or clinical presentations, thus lowering their chances of receiving professional mental health care (Verma et al., 2023). Traditional healers are highly trusted, but they may sometimes not receive training to identify situations like perinatal depression, suicidal thoughts, or gestational issues requiring emergent intervention. Thus, even while this research affirms the psychosocial effectiveness of Indigenous practices, it also necessitates careful integration with biomedicine. Combining cultural safety with clinical safety, where frontline health practitioners are educated to appreciate when a need exists to refer patients to formal services, yet not overriding respect for cultural beliefs (Chen et al., 2023). Recommendations This research underscores the imperative for culturally sensitive strategies in maternal mental health among tribal societies. Future studies need to spread to several tribal areas across mixed-method and longitudinal designs to investigate various healing traditions and their psychological effects. Incorporating voice from healthcare professionals like ASHAs and nurses will aid in closing gaps between biomedical and indigenous systems. There is also a requirement to formulate and test culturally responsive interventions—like healer-conducted psychoeducation or emotional support through mobiles—specific to local belief systems. Lastly, policymakers must incorporate these results into maternal health programming by including cultural safety training for frontline staff and legally acknowledging the role of traditional healers in antenatal psychosocial support. These measures can facilitate inclusive, effective, and community-rooted maternal mental health care in India. Declarations Acknowledgement None Funding No funds were granted for this study. Ethics Approval The study was conducted in accordance with the ethical concerns of the School of Liberal Studies, CMR University Bengaluru. The study protocol was approved by School of Liberal Studies, CMR University Bengaluru, and written informed consent was collected from all the participants of the study. Consent to Participate Written informed consent was collected from all the participants before the inclusion to the study. Consent to Publish All participants give informed consent to publish the data without revealing identity information. Data Availability The data collected in the study will be available on request to the corresponding author. Competing Interests The authors declare no competing interests. Author Contribution Declaration Saranya T.S and Gimcule wrote the main manuscript, Sandeep Kumar Gupta supervised and validated the study, Sudha Saibalaji conducted proof reading and Nail P has conducted the revisions. References Ali, A. (2023). Integrating traditional healing and modern mental healthcare in India: Collaboration and challenges. Indian Journal of Psychiatric Social Work, 14 (1), 42–46. https://doi.org/10.29120/ijpsw.2023.v14.i1.198 Aziato, L., Odai, P. N. A., & Omenyo, C. N. (2016). Religious beliefs and practices in pregnancy and labour: An inductive qualitative study among post-partum women in Ghana. BMC Pregnancy and Childbirth, 16 , 138. https://doi.org/10.1186/s12884-016-0920-1 Banda, Y., Chapman, V., Goldenberg, R. L., Stringer, J. S., Culhane, J. F., Sinkala, M., & Chi, B. H. (2007). Use of traditional medicine among pregnant women in Lusaka, Zambia. The Journal of Alternative and Complementary Medicine, 13 (1), 123–128. https://doi.org/10.1089/acm.2006.6225 Beydoun, H. A. (2018). Exploring the therapeutic potential of herbal intervention in polycystic ovary syndrome: A systematic review and meta-analysis. Journal of Herbal Medicine and Research, 2 (1), 15–28. Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design . Harvard University Press. Cáceres, Á. L., Ramesh, R. M., Newmai, P., Kikon, R., & Deckert, A. (2023). Perceptions, health-seeking behavior and utilization of maternal and newborn health services among an indigenous tribal community in Northeast India: A community-based mixed methods study. Frontiers in Public Health, 11 , 1139334. https://doi.org/10.3389/fpubh.2023.1139334 Chen, L., Zhang, Y., & Kuper, H. (2023). Embedding cultural-safety training into healthcare systems: A qualitative evaluation. BMJ Global Health, 8 (2), e011202. https://doi.org/10.1136/bmjgh-2022-011202 Das, A., Gujre, N., Devi, R. J., & Mitra, S. (2021). A review on traditional ecological knowledge and its role in natural resources management: North East India, a cultural paradise. Environmental Management, 72 (3), 113–134. https://doi.org/10.1007/s00267-021-01554-y E-Magazing. (2021, December 1). Zeliang Naga. Indianetzone . https://www.indianetzone.com/51/zeliang_naga.html Fonseca, A., Silva, S., & Canavarro, M. C. (2017). Depression literacy and awareness of psychopathological symptoms during the perinatal period. Journal of Obstetric, Gynecologic & Neonatal Nursing, 46 (2), 197–208. https://doi.org/10.1016/j.jogn.2016.11.003 Gedamu, H., Tsegaw, A., & Debebe, E. (2018). The prevalence of traditional malpractice during pregnancy, childbirth, and postnatal period among women of childbearing age in Meshenti town, Ethiopia. International Journal of Reproductive Medicine, 2018 , 5945060. https://doi.org/10.1155/2018/5945060 Ghosh, S., Rao, S., & Sharma, P. (2023). National policies and programs for perinatal mental health in India: A systematic review. Asian Journal of Psychiatry, 91 , 103836. https://doi.org/10.1016/j.ajp.2023.103836 Jun, P., Rahmat, E., Han, C. H., Yang, C., & Kang, Y. (2021). Traditional Chinese medicine and traditional Indonesian medicine: A comparative review of herbal medicines restricted in pregnancy. Chinese Journal of Integrative Medicine, 27 (10), 794–800. https://doi.org/10.1007/s11655-021-3487-7 Kargbo, B., Kamara, M., & Jalloh, M. (2025). Adapting the Friendship Bench model for perinatal mental health in Sierra Leone: Protocol and pilot outcomes. Global Mental Health Reports, 2 (1), e24. https://doi.org/10.1017/gmh.2025.024 Kennedy, D. A., Lupattelli, A., Koren, G., & Nordeng, H. (2013). Herbal medicine use in pregnancy: Results of a multinational study. BMC Complementary and Alternative Medicine, 13 (1), 355. https://doi.org/10.1186/1472-6882-13-355 Kohrt, B. A., Rasmussen, A., Kaiser, B. N., Haroz, E. E., Maharjan, S. M., Mutamba, B. B., ... & Hinton, D. E. (2014). Cultural concepts of distress and psychiatric disorders: Literature review and research recommendations for global mental health epidemiology. International Journal of Epidemiology, 43 (2), 365–406. Kumar, M., Prakash, S., Radha, Kumari, N., Pundir, A., Punia, S., ... & Mekhemar, M. (2021). Beneficial role of antioxidant secondary metabolites from medicinal plants in maintaining oral health. Antioxidants, 10 (7), 1061. https://doi.org/10.3390/antiox10071061 Kumar, V., & Jain, S. (2023). Landscape analysis of traditional tribal healers and their healing practices in the tribal-dominated states of India. Clinical Case Reports and Studies, 4 (1), 1–8. Laelago, T. (2018). Herbal medicine use during pregnancy: Benefits and untoward effects. In P. F. Builders (Ed.), Herbal medicine (pp. 103–119). IntechOpen. https://doi.org/10.5772/intechopen.76896 Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping . Springer. Liamputtong, P. (Ed.). (2013). Infant feeding practices: A cross-cultural perspective . Springer. Liamputtong, P., & Kitisriworapan, S. (2011). Good mothers and infant feeding practices amongst women in northern Thailand. In P. Liamputtong (Ed.), Infant feeding practices: A cross-cultural perspective (pp. 141–159). Springer. Liamputtong, P., Yimyam, S., Parisunyakul, S., Baosoung, C., & Sansiriphun, N. (2005). Traditional beliefs about pregnancy and childbirth among women from Chiang Mai, Northern Thailand. Midwifery, 21 (2), 139–153. https://doi.org/10.1016/j.midw.2004.05.002 Ling, Z. (2014). Nutrition and healthcare for children from rural Tibetan households. China Economist, 9 (3), 68–79. Mabina, M. H., Pitsoe, S. B., & Moodley, J. (1997). The effect of traditional herbal medicines on pregnancy outcome. South African Medical Journal, 87 (8), 1008–1010. Mills, E., Dugoua, J. J., Perri, D., & Koren, G. (2006). Herbal medicines in pregnancy and lactation: An evidence-based approach . Taylor & Francis. Nguyen, L. D., Nguyen, L. H., Ninh, L. T., Nguyen, H. T. T., Nguyen, A. D., Vu, L. G., ... & Ho, R. C. M. (2022). Women’s holistic self-care behaviors during pregnancy and associations with psychological well-being: Implications for maternal care facilities. BMC Pregnancy and Childbirth, 22 (1), 631. https://doi.org/10.1186/s12884-022-04961-z Nichter, M. (2010). Idioms of distress revisited. Culture, Medicine and Psychiatry, 34 (2), 401–416. Omran, A. E. A., Abd El-Fatah, A., Abdel Hakim Ahmed, H., & Abd El Sattar Ahmed, M. (2020). Self-care of women during the postpartum period in rural areas. Egyptian Journal of Health Care, 11 (1), 59–72. https://doi.org/10.21608/ejhc.2020.72594 Pushpangadan, P., & George, V. (2010). Ethnomedical practices of rural and tribal populations of India with special reference to the mother and childcare. Indian Journal of Traditional Knowledge, 9 (2), 266–272. Rezaeian, S. M., Abedian, Z., Latifnejad Roudsari, R., Mazloom, S. R., & Dadgar, S. (2017). The relationship of prenatal self-care behaviors with stress, anxiety and depression in women at risk of preterm delivery. Iranian Journal of Obstetrics, Gynecology and Infertility, 20 (3), 68–76. Rodacki, C. L., Fowler, N. E., Rodacki, A. L., & Birch, K. (2003). Stature loss and recovery in pregnant women with and without back pain. Clinical Biomechanics, 18 (3), 253–259. Shankar, R., & Rawat, M. S. (2013). Conservation and cultivation of threatened and high-valued medicinal plants in North East India. International Journal of Biodiversity and Conservation, 5 (9), 584–591. Susie, P., Iriana, B., Diah, F. S., & Priy Subekti, R. A. (2021). Internationalization of life cycle values based on local wisdom: Measuring the Indung Beurang exemplary in maintaining pregnancy health in the Indigenous community of Naga village. Journal of Ethnobiology and Traditional Medicine, 12 (4), 95–104. Thompson, P. (2020). Beliefs, birth and becoming: Indigenous perspectives on maternal health in rural Bihar. International Journal of Indigenous Health, 15 (2), 24–38. Verma, P., Sahoo, K. C., Mahapatra, P., Kaur, H., & Pati, S. (2023). A systematic review of community-based studies on mental health issues among tribal populations in India. Indian Journal of Medical Research, 156 (2), 291–298. https://doi.org/10.4103/ijmr.IJMR_3206_21 Ward, E. C., Clark, L., & Heifner, A. (2022). Tribal-specific perinatal mental health programming: A community-engaged approach to cultural adaptation. Maternal and Child Health Journal, 26 (3), 450–459. https://doi.org/10.1007/s10995-021-03235-6 Wellhoner, M., Lee, A. C., Deutsch, K., Wiebenga, M., Freytsis, M., Drogha, S., ... & Weingrad, L. (2011). Maternal and child health in Yushu, Qinghai Province, China. International Journal for Equity in Health, 10 , 42. https://doi.org/10.1186/1475-9276-10-42 World Health Organization. (2022). WHO recommendations on maternal and newborn care for a positive postnatal experience . https://www.who.int/publications/i/item/9789240045989 Yuan, M. J., Ortega, R. M., & Alegría, M. (2023). Indigenous approaches to perinatal mental health: A systematic review and critical interpretive synthesis. Archives of Women’s Mental Health, 26 , 275–293. https://doi.org/10.1007/s00737-023-01310-7 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 11 Aug, 2025 Submission checks completed at journal 08 Aug, 2025 First submitted to journal 08 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-7145247","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":498892564,"identity":"27493de8-28d4-47ee-aa0a-434bff999015","order_by":0,"name":"Saranya T.S","email":"data:image/png;base64,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","orcid":"","institution":"Head of the Institute, Amity University","correspondingAuthor":true,"prefix":"","firstName":"Saranya","middleName":"","lastName":"T.S","suffix":""},{"id":498892565,"identity":"639ebca6-b7dd-49b8-a7dc-eda630a947f0","order_by":1,"name":"Gimcule. .","email":"","orcid":"","institution":"CMR University","correspondingAuthor":false,"prefix":"","firstName":"Gimcule.","middleName":"","lastName":".","suffix":""},{"id":498892566,"identity":"e20a535e-a49c-44ab-87b2-126f761a8c6e","order_by":2,"name":"Sandeep Kumar Gupta","email":"","orcid":"","institution":"CMR University","correspondingAuthor":false,"prefix":"","firstName":"Sandeep","middleName":"Kumar","lastName":"Gupta","suffix":""},{"id":498892567,"identity":"8e281d91-53cc-4345-83f3-b2737022333e","order_by":3,"name":"Sudha Saibalaji","email":"","orcid":"","institution":"Independent Researcher","correspondingAuthor":false,"prefix":"","firstName":"Sudha","middleName":"","lastName":"Saibalaji","suffix":""},{"id":498892568,"identity":"74b689f8-bf4c-4f6c-bb7a-71e5b63462dd","order_by":4,"name":"P Naila","email":"","orcid":"","institution":"Independent Researcher","correspondingAuthor":false,"prefix":"","firstName":"P","middleName":"","lastName":"Naila","suffix":""}],"badges":[],"createdAt":"2025-07-17 05:53:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7145247/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7145247/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88867394,"identity":"da298642-6605-4fae-a6d7-36eb2de561bb","added_by":"auto","created_at":"2025-08-12 08:43:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1067330,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7145247/v1/51ee2555-e533-41b4-8e82-70d58cc00ee1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Traditional Beliefs and Practices Associated with Relieving Psychological Problems of Pregnant Women of the Zeliang Tribe","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePerinatal mental health (PMH) is now a global public health imperative, as the World Health Organization (WHO, 2022) has estimated that over 10% of pregnant women across the globe have clinically significant depressive symptoms. In low- and middle-income nations (LMICs), rates of up to 16% have been reported. Unaddressed antenatal depression and anxiety are linked with adverse maternal and child outcomes, such as pre-eclampsia, longer duration of labor, low birth weight, and early childhood emotional or behavioral difficulties (Fonseca, Silva, \u0026amp; Canavarro, 2017). In spite of evidence-based psychosocial treatment availability, over 75% of women in LMICs are not treated, highlighting an enormous global treatment gap (Verma et al., 2023).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe most recent studies point out that sociocultural assumptions and indigenous explanatory models are at the core of shaping pregnant women\u0026apos;s experience of distress as well as their approach to seeking care. A systematic review by Ghosh, Rao, and Sharma (2023) underscored that in South Asian nations like India, Bangladesh, and Pakistan, pregnancy-related mental health problems are explained as resulting from cultural imbalances, ancestors\u0026apos; displeasure, or offending cultural taboos. Therefore, most women steer clear of formal psychiatric treatment, opting instead for tried-and-tested coping mechanisms such as prayer, ritual purging, and conventional herbal treatments. Likewise, in rural Nepal, mental health service use depends on culturally framed conceptualization of symptoms (Yuan, Ortega, \u0026amp; Alegr\u0026iacute;a, 2023).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthnographic studies throughout Africa and Asia attest to the prevalence of traditional healing practices across pregnancy. Aziato, Odai, and Omenyo (2016) established that Ghanaian postpartum women followed certain rituals and herbal practices to provide emotional and spiritual stability. In Zambia, Banda et al. (2007) established that more than 70% of pregnant women used traditional medicine to manage spiritual anxiety and psychosomatic complaints. These practices sometimes operate as organized emotional coping systems, providing pregnant women with culturally sanctioned means to mitigate psychological distress independent of biomedical paradigms.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn India, particularly among tribal groups, dependency on traditional healing is both a cultural imperative and a coping response to systemic exclusion. In a mixed-methods analysis, C\u0026aacute;ceres et al. (2023) reported that Northeast Indian Indigenous women commonly consulted traditional healers and elder women to explain pregnancy-related anxieties. Women gave ritual procedures and protection charms as ways to avoid miscarriage and spiritual attack. Likewise, Das, Gujre, Devi, and Mitra (2021) highlighted that customary ecological knowledge, such as healing rituals and use of herbs, constitutes the foundation of maternal care in most tribal villages with limited formal health services.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTraditional healers are not just spiritual mediators but also informal mental health counselors. In research on India\u0026apos;s integrative care models, Ali (2023) found that collaborative practice among community health workers and healers increased women\u0026apos;s openness to talking about emotional issues and enhanced confidence in antenatal counseling. In Nepal, Yuan et al. (2023) showed how the inclusion of spiritual healers in community outreach programs had significantly enhanced the detection and referral of perinatal depression. Yet the precise emotional and psychological functions of traditional healers within tribal societies like the Zeliang of Nagaland are not well studied.\u003c/p\u003e\n\u003cp\u003eThe present research draws on Lazarus and Folkman\u0026apos;s (1984) Transactional Model of Stress and Coping, which underscores that people\u0026apos;s cognitive perceptions of stress\u0026mdash;and their resultant coping processes\u0026mdash;are guided by sociocultural context. Moreover, the theory of cultural safety (Chen, Zhang, \u0026amp; Kuper, 2023) informs the research, promoting respectful, inclusive health care practices that recognize Indigenous knowledges. Together, these theories underscore the value of learning about how Zeliang women understand emotional distress and how such understandings shape their help-seeking.\u003c/p\u003e\n\u003cp\u003eSince these issues have cultural and clinical importance, this research investigates (a) how pregnant Zeliang women experience and describe psychological distress, (b) the traditional rituals, medicinal herbs, and healer interactions that they apply to maintain emotional well-being, and (c) how they experience the intersection between traditional care and official antenatal care. Through exploration of these domains, the research hopes to contribute to the development of culturally responsive, integrative perinatal mental health treatments for tribal women in Northeast India and similar Indigenous groups worldwide.\u003c/p\u003e\n\u003cp\u003eIn this research, psychological problems are a culturally mediated range of emotional upset during pregnancy, which can include chronic sadness, excessive worry, sleep disturbance, panic-like feelings, and inexplicable crying spells. Among Zeliang women, these states are seldom envisioned as Western psychiatric conditions (e.g., clinical depression or anxiety), but as spiritual or emotional imbalances based on ancestral displeasure, moral disharmony, or violations of taboo. Such culturally specific interpretation is consistent with the anthropological depiction of idioms of distress\u0026mdash;context-specific expressions of suffering that may not neatly fit biomedical categories (Nichter, 2010; Kohrt et al., 2014).\u003c/p\u003e\n\u003cp\u003eEvidence has indicated that in tribal and Indigenous societies, experiences of psychological distress are typically embodied and spiritualized, and are not always articulated in clinical language (Yuan, Ortega, \u0026amp; Alegr\u0026iacute;a, 2023; C\u0026aacute;ceres et al., 2023). Rather, these are expressed metaphorically, in dreams, or in symbolic behaviour, and regulated through ritual and kinship-based care systems. Therefore, although study participants may not identify with psychiatric diagnoses, their stories lay bare intricate affective terrain that is suggestive of psychological distress and the requirement for culturally meaningful care trajectories (Liamputtong, 2013; Ward et al., 2022).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatement of the Problem\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResearch indicates that poorer women, particularly those residing in rural areas with limited access to healthcare services, face a significantly higher risk of maternal mortality compared to wealthier or urban counterparts (WHO, 2012). This disparity is also evident among indigenous communities in other countries like Indonesia such as in Naga village, Salawu subdistrict, Tasik Malaya Regency Expectant mothers in these communities often seek prenatal care from traditional healers (shamans) or Indung Beurang, practitioners who use medicinal practices involving local herbs and traditional methods (National Development Planning Agency, 2013). These non-medical practices are deeply rooted in local wisdom and have been passed down through generations.\u003c/p\u003e\n\u003cp\u003ePregnancy is considered a critical event among the indigenous people of Naga village, marked by inherent risks associated with this life cycle (Perhawasari, Sjoraida, Priyo Subekti \u0026amp; Anisa, 2021). Studies by governments, including that of India, highlight the disparities in healthcare access faced by rural women. This research aims to investigate the traditional beliefs and practices employed to alleviate psychological challenges experienced by pregnant women in Benreu, Nagaland.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSignificance of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTraditional beliefs concerning the health of pregnant women have garnered increasing attention in contemporary literature. The role of traditional beliefs and practices in alleviating psychological problems among patients is particularly noteworthy. However, this phenomenon remains poorly understood in the context of India.\u003c/p\u003e\n\u003cp\u003eThis study aimed to document and\u0026nbsp;explore the traditional beliefs and practices used to alleviate psychological issues among pregnant women of the Zeliang tribe in Benreu, Nagaland. By focusing on this specific indigenous community, the research contributes to filling a significant gap in understanding how cultural and traditional practices influence maternal health and well-being.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch questions\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eWhat emotional and psychological challenges do pregnant Zeliang women experience during pregnancy, and how do they interpret these challenges?\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWhat traditional beliefs, rituals, and plant-based remedies are used by pregnant women to manage emotional distress?\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHow do traditional healers support pregnant women\u0026rsquo;s emotional well-being, and what meanings do women assign to these interactions?\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHow do pregnant women navigate between traditional healing and biomedical antenatal care? \u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eResearch objectives\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u0026nbsp;To identify and describe the emotional and psychological concerns of pregnant women in Benreu village and how these are culturally interpreted.\u003c/li\u003e\n \u003cli\u003eTo document the types of traditional practices such as rituals, herbal remedies, and protective symbols used to relieve psychological distress during pregnancy.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTo explore the psychosocial roles of traditional healers as perceived by pregnant women in the Zeliang community.\u003c/li\u003e\n \u003cli\u003eTo examine how pregnant women engage with both traditional and biomedical antenatal care systems.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"METHODOLOGY","content":"\u003cstrong\u003eResearch Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe exploratory research design adopted for the study in Benreu, Peren Nagaland, aimed to investigate traditional beliefs and practices regarding pregnancy among a sample of 10 pregnant women aged 20 to 45, \u0026nbsp;and\u0026nbsp;2 traditional healers utilizing convenience sampling and thematic analysis for data collection and analysis, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in Benreu, Peren Nagaland, focusing specifically on pregnant women residing in Benreu village. The sampling unit comprised pregnant women aged between 20 and 45 years. Inclusion criteria stipulated that only pregnant women living in Benreu village, Nagaland, within the age range of 20 to 45 years were eligible for participation.\u0026nbsp;Convenience sampling was employed as the method to select participants; ensuring individuals meeting specific criteria relevant to the study\u0026apos;s objectives were included. Data collection involved conducting face-to-face interviews with each participant, facilitating direct interaction and detailed information gathering. Thematic analysis served as the chosen method for analyzing the collected data, enabling the identification and exploration of patterns and themes within the qualitative data gathered from the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePregnant married women living in Benreu village, Nagaland, who were between 20 and 45 years old, were included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePregnant women outside Benreu village, Nagaland, and those younger than 20 or older than 45 years were excluded from the study.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eTable 1: Shows the Socio demographic details of study participants (Pregnant women and traditional healers)\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"602\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.1667%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipant ID\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.33333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePregnancy Order\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation Level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6667%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRole\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.1667%;\"\u003e\n \u003cp\u003eP1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.33333%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e1st\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8333%;\"\u003e\n \u003cp\u003eMiddle School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6667%;\"\u003e\n \u003cp\u003ePregnant Woman\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.1667%;\"\u003e\n \u003cp\u003eP2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.33333%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e2nd\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8333%;\"\u003e\n \u003cp\u003eHigh School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6667%;\"\u003e\n \u003cp\u003ePregnant Woman\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.1667%;\"\u003e\n \u003cp\u003eP3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.33333%;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e2nd\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8333%;\"\u003e\n \u003cp\u003ePrimary School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6667%;\"\u003e\n \u003cp\u003ePregnant Woman\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.1667%;\"\u003e\n \u003cp\u003eP4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.33333%;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e1st\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8333%;\"\u003e\n \u003cp\u003eHigh School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6667%;\"\u003e\n \u003cp\u003ePregnant Woman\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.1667%;\"\u003e\n \u003cp\u003eP5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.33333%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e1st\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8333%;\"\u003e\n \u003cp\u003eSecondary School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6667%;\"\u003e\n \u003cp\u003ePregnant Woman\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.1667%;\"\u003e\n \u003cp\u003eP6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.33333%;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e1st\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8333%;\"\u003e\n \u003cp\u003eNo Formal School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6667%;\"\u003e\n \u003cp\u003ePregnant Woman\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.1667%;\"\u003e\n \u003cp\u003eP7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.33333%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e2nd\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8333%;\"\u003e\n \u003cp\u003eMiddle School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6667%;\"\u003e\n \u003cp\u003ePregnant Woman\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.1667%;\"\u003e\n \u003cp\u003eP8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.33333%;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e3rd\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8333%;\"\u003e\n \u003cp\u003ePrimary School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6667%;\"\u003e\n \u003cp\u003ePregnant Woman\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.1667%;\"\u003e\n \u003cp\u003eP9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.33333%;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e1st\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8333%;\"\u003e\n \u003cp\u003eHigh School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6667%;\"\u003e\n \u003cp\u003ePregnant Woman\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.1667%;\"\u003e\n \u003cp\u003eP10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.33333%;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e2nd\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8333%;\"\u003e\n \u003cp\u003eSecondary School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6667%;\"\u003e\n \u003cp\u003ePregnant Woman\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.1667%;\"\u003e\n \u003cp\u003eH1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.33333%;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17%;\"\u003e\n \u003cp\u003eWidow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8333%;\"\u003e\n \u003cp\u003eNo Formal School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6667%;\"\u003e\n \u003cp\u003eTraditional Healer\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.1667%;\"\u003e\n \u003cp\u003eH2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.33333%;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8333%;\"\u003e\n \u003cp\u003eInformal Learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6667%;\"\u003e\n \u003cp\u003eTraditional Healer\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThematic analysis of data gathered from ten pregnant Zeliang women and two traditional healers in Benreu, Nagaland, identified three overarching themes with several subthemes. These themes point to how psychological well-being during pregnancy is lived, interpreted, and coped with within the Zeliang people\u0026apos;s traditional cultural context. The themes are outlined below along with indicative participant narratives.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 1: Emotional Vulnerability and Cultural Conceptions of Pregnancy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFear and Psychological Distress in Early Pregnancy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThey often reported experiencing fear, uncertainty, and emotional instability in the first few weeks of pregnancy. These feelings were usually accompanied by bodily symptoms like tiredness, sleep disorder, and loss of appetite. Instead of talking in clinical terms of \u0026quot;stress\u0026quot; or \u0026quot;anxiety,\u0026quot; the women reported these as emotional states induced by social or spiritual reasons.\u003c/p\u003e\n\u003cp\u003e\u0026quot;I would weep without knowing why. It was not sadness. It was like something deep\u0026hellip; being watched or judged\u0026quot; (Participant 4, 27 years old).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSpiritual Etiologies of Emotional Distress\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA majority of the women explained their emotional distress as spiritual imbalance, moral sin, or displeasure with ancestors. For instance, solitary walking in forests, eating prohibited food, or having dreams about water bodies were translated as spiritual signs likely to cause harm to mother and fetus.\u003c/p\u003e\n\u003cp\u003e\u0026quot;My grandmother told me the dark water dreams indicated that the baby\u0026apos;s spirit was mixed up. I needed to visit the healer in a hurry to straighten it out\u0026quot; (Participant 6, age 24).\u003c/p\u003e\n\u003cp\u003eThese beliefs positioned psychological distress as external indicators of disconnection from cultural and spiritual norms rather than as internal dysfunction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 2: Healing Practices as Emotional Regulation Tools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRituals for Emotional Protection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants reported participating in a range of traditional rituals that aimed to safeguard both mother and unborn child against emotional and spiritual distress. Such practices that were common included incense fumigation, symbolic chanting, protective thread-tying, and performing offerings on ancestor altars. These practices were both spiritual buffers and psychological anchors.\u003c/p\u003e\n\u003cp\u003e\u0026quot;When the healer burns the leaves and chants, I feel lighter. Like my chest can breathe again\u0026quot; (Participant 3, age 29).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHerbal Medicines and Symbolic Items\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConventional medicines like herbal tea, oil, and amulets were used extensively not only to treat physical manifestations but also for emotional well-being. These substances were usually recommended by conventional healers upon hearing the woman\u0026apos;s dreams, actions, and emotional issues.\u003c/p\u003e\n\u003cp\u003e\u0026quot;She gave me a root to chew whenever I feel panic. I still carry it in my blouse\u0026quot; (Participant 1, age 22).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 3: Traditional Healer\u0026apos;s Role in Psychosocial Support\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHealers as Emotional Guides and Interpreters\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe two healers interviewed identified their role as beyond cure \u0026mdash; they thought of themselves as mediators of emotions and the spiritual sphere. Their practice entailed dream interpretation, narrative, spiritual diagnosis, and affect empathy.\u003c/p\u003e\n\u003cp\u003e\u0026quot;We don\u0026apos;t just treat the body. We speak to the woman\u0026apos;s fears, her spirits, her ancestors. We explain to her what her feelings are\u0026quot; (Healer A, female, c. 60 years old).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrust and Cultural Authority of Healers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants reported strong emotional trust in traditional healers, frequently more highly valuing their counsel than formal health professionals. This was built on common language, familiarity with their culture, and a comprehensive conceptualization of life changes like pregnancy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026quot;The nurse at the clinic tells me to rest. But the healer tells me why I feel weak\u0026mdash;and what to do with my emotions\u0026quot; (Participant 7, age 25).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 4: Social Support Networks and Intergenerational Wisdom\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaternal Cultural Guidance and Mentorship\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOlder women, such as mothers, grandmothers, and aunts, were at the center of counseling the emotional and cultural process of pregnancy. They interpreted signs for them, counseled them on rituals, and even took them to see healers.\u003c/p\u003e\n\u003cp\u003e\u0026quot;My mom understood what plants to give me when I was agitated. She said, \u0026apos;This is not a sickness of a doctor. This is your spirit weeping\u0026apos;\u0026quot; (Participant 8, 28 years).\u003c/p\u003e\n\u003cp\u003eThis intergenerational epistemology built a robust emotional buffer for expectant women coping with psychological ambiguity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCommunal Norms and Emotional Containment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants described how emotional expressions such as crying, irritability, or fear were not seen as pathological but expected aspects of pregnancy, managed collectively through ritual and family interaction.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;We talk to each other when our moods shift. No one says \u0026lsquo;you are sick\u0026rsquo; they say, \u0026lsquo;we\u0026rsquo;ll call the healer\u0026rsquo;\u0026rdquo; (Participant 2, age 30).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 5: Navigating Between Traditional and Biomedical Worlds\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTensions Between Medical Advice and Cultural Beliefs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSome of the participants went to antenatal check-ups but still depended on traditional healers for emotional and spiritual support. This double involvement highlighted conflict between messages from modern healthcare and cultural messages.\u003c/p\u003e\n\u003cp\u003e\u0026quot;On clinic days, they advise me to go to bed early. But my aunt says I must light the lamp and chat with the baby\u0026apos;s soul at night. I try to do both\u0026quot; (Participant 5, 23 years).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePreference for Holistic Care\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEven where biomedical treatment was present, participants wanted culturally significant answers to their emotional issues. Healers had a story and spiritual context that medical practitioners were felt to be missing.\u003c/p\u003e\n\u003cp\u003e\u0026quot;The doctor treats my stomach. The healer treats my mind and soul\u0026quot; (Participant 9, age 26).\u003c/p\u003e\n\u003cp\u003eThis nuanced analysis demonstrates how Zeliang women in Benreu blend traditional knowledge systems into their emotional experience of pregnancy. Traditional healing practices serve not just as cultural representation but also as crucial instruments for emotion management and psychosocial support in an environment where formal mental health care is restricted or culturally maladjusted.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003eRedefining Pregnancy Emotionality from Cultural Perspective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur research finds that emotional distress during pregnancy is culturally framed among Zeliang women, with spiritual and ritual understandings replacing biomedical words for anxiety or depression. This observation corroborates qualitative studies in Meghalaya and tribal-majority areas of India, where likewise culturally situated meanings of emotional discomfort dominated even with biomedical access (C\u0026aacute;ceres et al., 2023; Kumar \u0026amp; Jain, 2023).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStress Appraisal and Ritual Coping within Context\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWith the Transactional Model of Stress and Coping by Lazarus and Folkman (1984), it can be noted that Zeliang women undergo primary appraisal perceiving emotional experiences as spiritual threats and secondary appraisal finding traditional healers as the primary source of relief. Coping occurs through culture-validated problem-focused (rituals, taboos) and emotion-focused (chants, symbols) strategies. This cultural construction of prenatal stress and coping is replicated in Bihar, where ritual interventions were primary risk aversion strategies (Thompson, 2020).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Ritual Behaviors as Emotion Regulation Scripts\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRituals such as fumigation with incense, protection strings, and herbal decoctions act as scripted behavioral scripts that render repeated reassurance and psychologic relief. Parallel findings in Gujarat and GHaro tribal women in Meghalaya suggest that such ritualized behaviors offer emotional scaffolding and an outlet for articulation of distress (C\u0026aacute;ceres et al., 2023; Kumar \u0026amp; Jain, 2023). These findings are underpinned by theoretical models of psychoneuroimmunology suggesting that rituals reduce cortisol and enhance perceived control.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTransactional Stress, Cultural Safety, and Indigenous Coping Pathways\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom the perspective of Lazarus and Folkman\u0026apos;s (1984) Transactional Model of Stress and Coping, Zeliang women\u0026apos;s emotional experiences during pregnancy can be understood through primary and secondary appraisal. At the initial stage, emotional disturbances\u0026mdash;like inexplicable crying, tiredness, or anxiety dreams\u0026mdash;are not appraised as biomedical symptoms but as spiritually charged threats to the wellness of both mother and baby. This concurs with the model that stress is cognitively constructed and its meaning depends on cultural schemas.\u003c/p\u003e\n\u003cp\u003eIn secondary appraisal, women evaluate their resources to cope with the threat. In this case, rituals, visits from healers, dialogue with ancestors, and herbal medicine are weighed as reliable, culturally embedded coping mechanisms. The practices serve both emotion-focused coping (e.g., chanting to alleviate distress) and problem-focused coping (e.g., seeking explanations or eliminating spiritual causes). This two-track system of coping resonates with wider ethnographic findings that stress is ethnographically \u0026quot;scripted\u0026quot; in many Indigenous contexts (Kohrt et al., 2014; Liamputtong \u0026amp; Kitisriworapan, 2011).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAt the same time, the theory of Cultural Safety (Chen, Zhang, \u0026amp; Kuper, 2023) explains how biomedical professionals might not attend to this cultural construction of stress. Regular antenatal care has no room to be adaptive in acknowledging ancestral terrors or symbolic meanings, and women may feel emotionally neglected. Cultural safety doesn\u0026apos;t just mean honoring Indigenous spirituality but incorporating it into cooperative, non-jerarchic models of care. This study demonstrates that Zeliang women gain the most when cultural and biomedical systems are complementary rather than competitive (Ali, 2023).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTraditional Healer Psychosocial Providers who are Lay\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study confirms that traditional healers tend to function as dementia-aware informal counsellors listening to individual narratives, interpreting dreams, and prescribing emotional treatment. National-level research in India confirmed that inter-professional working between healers and mental-health practitioners can provide equal and grounded mental-health treatment among underserved communities (Ali, 2023). Indigenous settings in countries also confirm that culture-specific healers engage in psychosocial treatment akin to professional counsellors (Yuan et al., 2023).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCommunity and Intergenerational Support: An Ecological Model\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur findings are aligned with Bronfenbrenner\u0026apos;s social-ecological model: well-being is enabled at micro- (family), meso- (peer group), and macro (societal ritual) levels. A new mixed-methods study of Garo tribal women also demonstrated how transmission of maternal knowledge and community ceremony form a psychosocial safety net (C\u0026aacute;ceres et al., 2023). This has the effect of highlighting the importance of maintaining cultural pathways in maternal mental-health plans.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHybridizing Care: Towards Cultural Safety\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePragmatic dual-system utilization is noted in Zeliang women attending clinical antenatal care while seeking spiritual-emotional protection from healers. The hybrid pattern is also noted in other tribal populations and suggests formal healthcare workers must adopt cultural safety protocols with respect and understanding of indigenous explanatory models (Ali, 2023; C\u0026aacute;ceres et al., 2023). The World Health Organization also promotes systematic psychosocial care integrated into antenatal service that is acceptable according to local belief systems.\u003c/p\u003e\n\u003cp\u003eAlthough the psychological lives of pregnant Zeliang women are informed by spiritual and cultural meanings, they remain irreducible to the intersectional dynamics of gender, indigeneity, and geographic marginalization. Motherhood and pregnancy, particularly in Indigenous cultures, are inevitably tied to cultural notions of female duty, reproductive achievement, and spiritual responsibility\u0026mdash;goals that necessarily amplify emotional tension (Liamputtong, 2013; Ward, Clark, \u0026amp; Heifner, 2022). These anticipations intersect with deficient biomedical infrastructure and sociopolitical invisibility, heightening vulnerability to unperceived or miscalculated psychological distress.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn addition, conventional beliefs about maternal emotionality e.g., experiencing fear or sadness as moral frailty or ancestral displeasure can put the onus of mental health in women\u0026apos;s own hands. This gendered responsibility not only influences help-seeking habits but also constrains the language by which women express their needs (Yuan et al., 2023). Substituting perinatal mental health with this intersectional approach enables more structurally informed and equitable responses, in which emotional care is viewed as both social justice and cultural concern (Verma et al., 2023; Ghosh, Rao, \u0026amp; Sharma, 2023).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe significance of these findings for perinatal emotional care and maternal mental health services in Indigenous and tribal contexts is significant. Foremost, traditional healers must be recognized as essential community-based professionals in perinatal emotional care. Already established as trusted emotional interpreters and spiritual counsellors, their current role implies a possible link with the formal health system. Policymakers and district health authorities can create formal referral links between healers and auxiliary nurse midwives (ANMs), offer safe ritual integration guidelines, and offer integrated training courses in culturally safe care. Equivalents of such integration models in other low and middle-income countries (LMICs) and India have generated increased access and acceptability to mental health (Ali, 2023; Yuan et al., 2023). Identification of healers through the maternal health system can help bridge the psychosocial services gap across tribal regions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSecond, safety and cultural competence have to be developed with urgency among primary healthcare workers. Training modules should incorporate tribal belief systems, indigenous explanatory models of distress, and respectful communication skills. Embedding cultural safety into ASHA and ANM training courses\u0026mdash;recommended by the World Health Organization (2022) will improve the quality of antenatal interactions and reduce the stigma tribal women face while reporting emotional suffering. At the same time, national policy must extend beyond biomedical maternal health and address perinatal mental health explicitly. Current programs like the National Mental Health Programme (NMHP) and RMNCH+A need to be scaled up to include culture-sensitive psychosocial support, especially in tribal regions where religious buildings dominate care-seeking behavior (Ghosh et al., 2023; C\u0026aacute;ceres et al., 2023).\u003c/p\u003e\n\u003cp\u003eFinally, technology and research will need to enable scaling up of culture-institutional interventions. Expert healer voice-based mobile counseling or locally translated mental health mobile apps in the indigenous language may extend beyond emotional care in low-literacy settings. Mixed-methods studies and cluster-randomised trials are needed to evaluate the effectiveness and sustainability of such blended approaches. India\u0026apos;s policy landscape for tribal health is shifting, and these findings offer a timely, evidence-based roadmap to enhance maternal mental health by aligning services with women like the Zeliang\u0026apos;s spiritual and cultural spheres. Mainstreaming traditional healing is not only a token of cultural sensitivity, it is a strategic move toward more accessible, inclusive, and psychologically informed public health.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study identifies the ways pregnant Zeliang women from Benreu, Nagaland, cope with emotional distress through culturally situated traditional healing activities. Emotional responses of anxiety, fear, and sadness are interpreted through spiritual worldviews and controlled by rituals, herbalism, and counseling from traditional healers. These activities not only illustrate indigenous worldviews but also serve as effective coping mechanisms in the context of inadequate culturally congruent formal mental health services.\u003c/p\u003e\n\u003cp\u003eBy employing the Transactional Model of Stress and Coping and drawing on ecological frameworks, the study emphasizes the importance of locating perinatal emotional well-being within the cultural context. Traditional healers give informal yet highly cherished psychosocial support through established intergenerational and community-based networks. Formal integration of such practices into formal maternal mental health services can enhance such services, particularly in underprivileged tribal areas.\u003c/p\u003e\n\u003cp\u003eTo be responsive to the mental health needs of tribal and Indigenous women in India, health systems must move towards cultural safety, inclusion, and collaboration. The integration of traditional knowledge systems, building frontline workers\u0026apos; cultural capacities, and generating evidence through context-sensitive research are key steps forward. This study offers not only a descriptive account of lived experience but also an advocacy call to build culturally responsive, equitable, and integrated maternal mental health care.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eAlthough this research offers useful insights into pregnant Zeliang women\u0026apos;s traditional healing practices and psychological well-being, a number of limitations should be noted. It has to be noted that the research was undertaken in one village (Benreu) in the Peren district of Nagaland, and therefore the findings are limited by this narrow sampling frame. Cultural beliefs and healer roles can differ among other Zeliang communities or Northeast Indian tribal groups, and hence caution must be exercised when generalizing the findings to larger tribal populations.\u003c/p\u003e\n\u003cp\u003eThe sample population, although suitably small for qualitative work, was relatively small at ten pregnant women and two traditional healers. This numerically small group may not necessarily encompass the range of experiences, particularly for women who do not participate in customary practices or who have varying levels of access to formal healthcare. In addition, the use of self-reported accounts introduces the possibilities of recall or social desirability bias, such as when elaborating on culturally sensitive issues like spiritual beliefs and emotional distress.\u003c/p\u003e\n\u003cp\u003eThis research excluded the views of biomedical health caregivers (e.g., nurses, ASHAs, or physicians), which might have provided a better explanation of the interaction between traditional and formal health care systems. Future studies may take a multi-stakeholder perspective, use comparative case studies, and incorporate longitudinal designs in order to understand the dynamics of changing hybrid care practices and their long-term effects on maternal mental health outcomes.\u003c/p\u003e\n\u003cp\u003eWhereas traditional healing practices present culturally relevant emotion regulation and social support methods during pregnancy, their limitations and risk potential should be recognized. Certain herbal therapies, for instance, may possess uncharacterized pharmacological activity, particularly when taken without standardized dose or at key gestational times (Kennedy et al., 2013; Laelago, 2018). Some taboos or rituals\u0026mdash;like dietary restrictions or avoidance of medical checkups\u0026mdash;may, unknowingly, postpone biomedical care, especially in high-risk pregnancies (Jun et al., 2021).\u003c/p\u003e\n\u003cp\u003eIn addition, sole dependence upon spiritual or symbolic explanations of suffering can stigmatize women experiencing more severe or clinical presentations, thus lowering their chances of receiving professional mental health care (Verma et al., 2023). Traditional healers are highly trusted, but they may sometimes not receive training to identify situations like perinatal depression, suicidal thoughts, or gestational issues requiring emergent intervention.\u003c/p\u003e\n\u003cp\u003eThus, even while this research affirms the psychosocial effectiveness of Indigenous practices, it also necessitates careful integration with biomedicine. Combining cultural safety with clinical safety, where frontline health practitioners are educated to appreciate when a need exists to refer patients to formal services, yet not overriding respect for cultural beliefs (Chen et al., 2023).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research underscores the imperative for culturally sensitive strategies in maternal mental health among tribal societies. Future studies need to spread to several tribal areas across mixed-method and longitudinal designs to investigate various healing traditions and their psychological effects. Incorporating voice from healthcare professionals like ASHAs and nurses will aid in closing gaps between biomedical and indigenous systems. There is also a requirement to formulate and test culturally responsive interventions\u0026mdash;like healer-conducted psychoeducation or emotional support through mobiles\u0026mdash;specific to local belief systems. Lastly, policymakers must incorporate these results into maternal health programming by including cultural safety training for frontline staff and legally acknowledging the role of traditional healers in antenatal psychosocial support. These measures can facilitate inclusive, effective, and community-rooted maternal mental health care in India.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funds were granted for this study. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the ethical concerns of the School of Liberal Studies, CMR University Bengaluru. The study protocol was approved by School of Liberal Studies, CMR University Bengaluru, and written informed consent was collected from all the participants of the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was collected from all the participants before the inclusion to the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants give informed consent to publish the data without revealing identity information.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data collected in the study will be available on request to the corresponding author.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution Declaration\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSaranya T.S and Gimcule wrote the main manuscript, Sandeep Kumar Gupta supervised and validated the study, Sudha Saibalaji conducted proof reading and Nail P has conducted the revisions.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n\u003cli\u003eAli, A. (2023). Integrating traditional healing and modern mental healthcare in India: Collaboration and challenges. \u003cem\u003eIndian Journal of Psychiatric Social Work, 14\u003c/em\u003e(1), 42\u0026ndash;46. https://doi.org/10.29120/ijpsw.2023.v14.i1.198\u003c/li\u003e\n\u003cli\u003eAziato, L., Odai, P. N. A., \u0026amp; Omenyo, C. N. (2016). Religious beliefs and practices in pregnancy and labour: An inductive qualitative study among post-partum women in Ghana. \u003cem\u003eBMC Pregnancy and Childbirth, 16\u003c/em\u003e, 138. https://doi.org/10.1186/s12884-016-0920-1\u003c/li\u003e\n\u003cli\u003eBanda, Y., Chapman, V., Goldenberg, R. L., Stringer, J. S., Culhane, J. F., Sinkala, M., \u0026amp; Chi, B. H. (2007). Use of traditional medicine among pregnant women in Lusaka, Zambia. \u003cem\u003eThe Journal of Alternative and Complementary Medicine, 13\u003c/em\u003e(1), 123\u0026ndash;128. https://doi.org/10.1089/acm.2006.6225\u003c/li\u003e\n\u003cli\u003eBeydoun, H. A. (2018). Exploring the therapeutic potential of herbal intervention in polycystic ovary syndrome: A systematic review and meta-analysis. \u003cem\u003eJournal of Herbal Medicine and Research, 2\u003c/em\u003e(1), 15\u0026ndash;28.\u003c/li\u003e\n\u003cli\u003eBronfenbrenner, U. (1979). \u003cem\u003eThe ecology of human development: Experiments by nature and design\u003c/em\u003e. Harvard University Press.\u003c/li\u003e\n\u003cli\u003eC\u0026aacute;ceres, \u0026Aacute;. L., Ramesh, R. M., Newmai, P., Kikon, R., \u0026amp; Deckert, A. (2023). Perceptions, health-seeking behavior and utilization of maternal and newborn health services among an indigenous tribal community in Northeast India: A community-based mixed methods study. \u003cem\u003eFrontiers in Public Health, 11\u003c/em\u003e, 1139334. https://doi.org/10.3389/fpubh.2023.1139334\u003c/li\u003e\n\u003cli\u003eChen, L., Zhang, Y., \u0026amp; Kuper, H. (2023). Embedding cultural-safety training into healthcare systems: A qualitative evaluation. \u003cem\u003eBMJ Global Health, 8\u003c/em\u003e(2), e011202. https://doi.org/10.1136/bmjgh-2022-011202\u003c/li\u003e\n\u003cli\u003eDas, A., Gujre, N., Devi, R. J., \u0026amp; Mitra, S. (2021). A review on traditional ecological knowledge and its role in natural resources management: North East India, a cultural paradise. \u003cem\u003eEnvironmental Management, 72\u003c/em\u003e(3), 113\u0026ndash;134. https://doi.org/10.1007/s00267-021-01554-y\u003c/li\u003e\n\u003cli\u003eE-Magazing. (2021, December 1). Zeliang Naga. \u003cem\u003eIndianetzone\u003c/em\u003e. https://www.indianetzone.com/51/zeliang_naga.html\u003c/li\u003e\n\u003cli\u003eFonseca, A., Silva, S., \u0026amp; Canavarro, M. C. (2017). Depression literacy and awareness of psychopathological symptoms during the perinatal period. \u003cem\u003eJournal of Obstetric, Gynecologic \u0026amp; Neonatal Nursing, 46\u003c/em\u003e(2), 197\u0026ndash;208. https://doi.org/10.1016/j.jogn.2016.11.003\u003c/li\u003e\n\u003cli\u003eGedamu, H., Tsegaw, A., \u0026amp; Debebe, E. (2018). The prevalence of traditional malpractice during pregnancy, childbirth, and postnatal period among women of childbearing age in Meshenti town, Ethiopia. \u003cem\u003eInternational Journal of Reproductive Medicine, 2018\u003c/em\u003e, 5945060. https://doi.org/10.1155/2018/5945060\u003c/li\u003e\n\u003cli\u003eGhosh, S., Rao, S., \u0026amp; Sharma, P. (2023). National policies and programs for perinatal mental health in India: A systematic review. \u003cem\u003eAsian Journal of Psychiatry, 91\u003c/em\u003e, 103836. https://doi.org/10.1016/j.ajp.2023.103836\u003c/li\u003e\n\u003cli\u003eJun, P., Rahmat, E., Han, C. H., Yang, C., \u0026amp; Kang, Y. (2021). Traditional Chinese medicine and traditional Indonesian medicine: A comparative review of herbal medicines restricted in pregnancy. \u003cem\u003eChinese Journal of Integrative Medicine, 27\u003c/em\u003e(10), 794\u0026ndash;800. https://doi.org/10.1007/s11655-021-3487-7\u003c/li\u003e\n\u003cli\u003eKargbo, B., Kamara, M., \u0026amp; Jalloh, M. (2025). Adapting the Friendship Bench model for perinatal mental health in Sierra Leone: Protocol and pilot outcomes. \u003cem\u003eGlobal Mental Health Reports, 2\u003c/em\u003e(1), e24. https://doi.org/10.1017/gmh.2025.024\u003c/li\u003e\n\u003cli\u003eKennedy, D. A., Lupattelli, A., Koren, G., \u0026amp; Nordeng, H. (2013). Herbal medicine use in pregnancy: Results of a multinational study. \u003cem\u003eBMC Complementary and Alternative Medicine, 13\u003c/em\u003e(1), 355. https://doi.org/10.1186/1472-6882-13-355\u003c/li\u003e\n\u003cli\u003eKohrt, B. A., Rasmussen, A., Kaiser, B. N., Haroz, E. E., Maharjan, S. M., Mutamba, B. B., ... \u0026amp; Hinton, D. E. (2014). Cultural concepts of distress and psychiatric disorders: Literature review and research recommendations for global mental health epidemiology. \u003cem\u003eInternational Journal of Epidemiology, 43\u003c/em\u003e(2), 365\u0026ndash;406.\u003c/li\u003e\n\u003cli\u003eKumar, M., Prakash, S., Radha, Kumari, N., Pundir, A., Punia, S., ... \u0026amp; Mekhemar, M. (2021). Beneficial role of antioxidant secondary metabolites from medicinal plants in maintaining oral health. \u003cem\u003eAntioxidants, 10\u003c/em\u003e(7), 1061. https://doi.org/10.3390/antiox10071061\u003c/li\u003e\n\u003cli\u003eKumar, V., \u0026amp; Jain, S. (2023). Landscape analysis of traditional tribal healers and their healing practices in the tribal-dominated states of India. \u003cem\u003eClinical Case Reports and Studies, 4\u003c/em\u003e(1), 1\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eLaelago, T. (2018). Herbal medicine use during pregnancy: Benefits and untoward effects. In P. F. Builders (Ed.), \u003cem\u003eHerbal medicine\u003c/em\u003e (pp. 103\u0026ndash;119). IntechOpen. https://doi.org/10.5772/intechopen.76896\u003c/li\u003e\n\u003cli\u003eLazarus, R. S., \u0026amp; Folkman, S. (1984). \u003cem\u003eStress, appraisal, and coping\u003c/em\u003e. Springer.\u003c/li\u003e\n\u003cli\u003eLiamputtong, P. (Ed.). (2013). \u003cem\u003eInfant feeding practices: A cross-cultural perspective\u003c/em\u003e. Springer.\u003c/li\u003e\n\u003cli\u003eLiamputtong, P., \u0026amp; Kitisriworapan, S. (2011). Good mothers and infant feeding practices amongst women in northern Thailand. In P. Liamputtong (Ed.), \u003cem\u003eInfant feeding practices: A cross-cultural perspective\u003c/em\u003e (pp. 141\u0026ndash;159). Springer.\u003c/li\u003e\n\u003cli\u003eLiamputtong, P., Yimyam, S., Parisunyakul, S., Baosoung, C., \u0026amp; Sansiriphun, N. (2005). Traditional beliefs about pregnancy and childbirth among women from Chiang Mai, Northern Thailand. \u003cem\u003eMidwifery, 21\u003c/em\u003e(2), 139\u0026ndash;153. https://doi.org/10.1016/j.midw.2004.05.002\u003c/li\u003e\n\u003cli\u003eLing, Z. (2014). Nutrition and healthcare for children from rural Tibetan households. \u003cem\u003eChina Economist, 9\u003c/em\u003e(3), 68\u0026ndash;79.\u003c/li\u003e\n\u003cli\u003eMabina, M. H., Pitsoe, S. B., \u0026amp; Moodley, J. (1997). The effect of traditional herbal medicines on pregnancy outcome. \u003cem\u003eSouth African Medical Journal, 87\u003c/em\u003e(8), 1008\u0026ndash;1010.\u003c/li\u003e\n\u003cli\u003eMills, E., Dugoua, J. J., Perri, D., \u0026amp; Koren, G. (2006). \u003cem\u003eHerbal medicines in pregnancy and lactation: An evidence-based approach\u003c/em\u003e. Taylor \u0026amp; Francis.\u003c/li\u003e\n\u003cli\u003eNguyen, L. D., Nguyen, L. H., Ninh, L. T., Nguyen, H. T. T., Nguyen, A. D., Vu, L. G., ... \u0026amp; Ho, R. C. M. (2022). Women\u0026rsquo;s holistic self-care behaviors during pregnancy and associations with psychological well-being: Implications for maternal care facilities. \u003cem\u003eBMC Pregnancy and Childbirth, 22\u003c/em\u003e(1), 631. https://doi.org/10.1186/s12884-022-04961-z\u003c/li\u003e\n\u003cli\u003eNichter, M. (2010). Idioms of distress revisited. \u003cem\u003eCulture, Medicine and Psychiatry, 34\u003c/em\u003e(2), 401\u0026ndash;416.\u003c/li\u003e\n\u003cli\u003eOmran, A. E. A., Abd El-Fatah, A., Abdel Hakim Ahmed, H., \u0026amp; Abd El Sattar Ahmed, M. (2020). Self-care of women during the postpartum period in rural areas. \u003cem\u003eEgyptian Journal of Health Care, 11\u003c/em\u003e(1), 59\u0026ndash;72. https://doi.org/10.21608/ejhc.2020.72594\u003c/li\u003e\n\u003cli\u003ePushpangadan, P., \u0026amp; George, V. (2010). Ethnomedical practices of rural and tribal populations of India with special reference to the mother and childcare. \u003cem\u003eIndian Journal of Traditional Knowledge, 9\u003c/em\u003e(2), 266\u0026ndash;272.\u003c/li\u003e\n\u003cli\u003eRezaeian, S. M., Abedian, Z., Latifnejad Roudsari, R., Mazloom, S. R., \u0026amp; Dadgar, S. (2017). The relationship of prenatal self-care behaviors with stress, anxiety and depression in women at risk of preterm delivery. \u003cem\u003eIranian Journal of Obstetrics, Gynecology and Infertility, 20\u003c/em\u003e(3), 68\u0026ndash;76.\u003c/li\u003e\n\u003cli\u003eRodacki, C. L., Fowler, N. E., Rodacki, A. L., \u0026amp; Birch, K. (2003). Stature loss and recovery in pregnant women with and without back pain. \u003cem\u003eClinical Biomechanics, 18\u003c/em\u003e(3), 253\u0026ndash;259.\u003c/li\u003e\n\u003cli\u003eShankar, R., \u0026amp; Rawat, M. S. (2013). Conservation and cultivation of threatened and high-valued medicinal plants in North East India. \u003cem\u003eInternational Journal of Biodiversity and Conservation, 5\u003c/em\u003e(9), 584\u0026ndash;591.\u003c/li\u003e\n\u003cli\u003eSusie, P., Iriana, B., Diah, F. S., \u0026amp; Priy Subekti, R. A. (2021). Internationalization of life cycle values based on local wisdom: Measuring the Indung Beurang exemplary in maintaining pregnancy health in the Indigenous community of Naga village. \u003cem\u003eJournal of Ethnobiology and Traditional Medicine, 12\u003c/em\u003e(4), 95\u0026ndash;104.\u003c/li\u003e\n\u003cli\u003eThompson, P. (2020). Beliefs, birth and becoming: Indigenous perspectives on maternal health in rural Bihar. \u003cem\u003eInternational Journal of Indigenous Health, 15\u003c/em\u003e(2), 24\u0026ndash;38.\u003c/li\u003e\n\u003cli\u003eVerma, P., Sahoo, K. C., Mahapatra, P., Kaur, H., \u0026amp; Pati, S. (2023). A systematic review of community-based studies on mental health issues among tribal populations in India. \u003cem\u003eIndian Journal of Medical Research, 156\u003c/em\u003e(2), 291\u0026ndash;298. https://doi.org/10.4103/ijmr.IJMR_3206_21\u003c/li\u003e\n\u003cli\u003eWard, E. C., Clark, L., \u0026amp; Heifner, A. (2022). Tribal-specific perinatal mental health programming: A community-engaged approach to cultural adaptation. \u003cem\u003eMaternal and Child Health Journal, 26\u003c/em\u003e(3), 450\u0026ndash;459. https://doi.org/10.1007/s10995-021-03235-6\u003c/li\u003e\n\u003cli\u003eWellhoner, M., Lee, A. C., Deutsch, K., Wiebenga, M., Freytsis, M., Drogha, S., ... \u0026amp; Weingrad, L. (2011). Maternal and child health in Yushu, Qinghai Province, China. \u003cem\u003eInternational Journal for Equity in Health, 10\u003c/em\u003e, 42. https://doi.org/10.1186/1475-9276-10-42\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. (2022). \u003cem\u003eWHO recommendations on maternal and newborn care for a positive postnatal experience\u003c/em\u003e. https://www.who.int/publications/i/item/9789240045989\u003c/li\u003e\n\u003cli\u003eYuan, M. J., Ortega, R. M., \u0026amp; Alegr\u0026iacute;a, M. (2023). Indigenous approaches to perinatal mental health: A systematic review and critical interpretive synthesis. \u003cem\u003eArchives of Women\u0026rsquo;s Mental Health, 26\u003c/em\u003e, 275\u0026ndash;293. https://doi.org/10.1007/s00737-023-01310-7\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-mental-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dimh","sideBox":"Learn more about [Discover Mental Health](https://www.springer.com/44192)","snPcode":"","submissionUrl":"","title":"Discover Mental Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Indigenous healing, emotional well-being, traditional medicine, Zeliang tribe, pregnancy, cultural safety, perinatal mental health, India","lastPublishedDoi":"10.21203/rs.3.rs-7145247/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7145247/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"In resource-poor Indigenous and tribal settings, emotional distress in pregnancy is usually managed through culture-based explanatory models and healing systems. Using a qualitative approach, this article examines how pregnant Zeliang women in Benreu village, Nagaland, understand and manage psychological issues through indigenous practices. Following community psychology and public health paradigms, semi-structured interviews were completed with ten pregnant women and two traditional healers. Braun and Clarke's six-stage thematic analysis identified five core themes: (1) culturally constructed emotional vulnerability in terms of ancestral and spiritual beliefs; (2) ritualized coping mechanisms involving chanting, incense fumigation, and defensive offerings; (3) the psychosocial function of traditional healers as emotional interpreters and community counselors; (4) the impact of maternal kin and communal knowledge in emotion management; and (5) the negotiation between biomedical antenatal care and Indigenous spiritual support. The research shows that traditional healing plays not only a cultural role but also an informal mental health system that provides emotional reassurance, symbolic meaning, and social containment. The research points towards the importance of culturally safe integrative perinatal care models that straddle Indigenous and formal healthcare systems. Such hybrid models are likely to optimize emotional well-being, decrease stigma, and facilitate more balanced maternal mental health services in tribal settings.","manuscriptTitle":"Traditional Beliefs and Practices Associated with Relieving Psychological Problems of Pregnant Women of the Zeliang Tribe","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-12 08:35:10","doi":"10.21203/rs.3.rs-7145247/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-11T15:17:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-08T07:03:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Mental Health","date":"2025-08-08T07:00:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-mental-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dimh","sideBox":"Learn more about [Discover Mental Health](https://www.springer.com/44192)","snPcode":"","submissionUrl":"","title":"Discover Mental Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"85a7a78b-d17f-4272-8ff9-97619df7e6a2","owner":[],"postedDate":"August 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-01T15:09:00+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-12 08:35:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7145247","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7145247","identity":"rs-7145247","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}