KESIMPULAN

KAJIAN BUDAYA DAN MAKNA SIMBOLIS PERILAKU IBU HAMIL

DAN IBU NIFAS

&

‘WE ARE NOTHING WITHOUT HERBS’ : A STORY OF HERBAL

REMEDIES USE DURING PREGNANCY IN RURAL GHANA
('Kita bukan apa-apa tanpa jamu': sebuah kisah pengobatan herbal
digunakan selama kehamilan di pedesaan Ghana)

Disusun :

Dalam Rangka Memenuhi Tugas Keperawatan Maternitas Kelas Reguler XXI C

Oleh :

Frina Meisha Andita Wineyni

Prodi DIII Keperawatan Jurusan Keperawatan

Polikteknik Kesehatan Kemenkes Palangka Raya
2020
 KAJIAN BUDAYA DAN MAKNA SIMBOLIS

PERILAKU IBU HAMIL DAN IBU NIFAS

Studi Kasus pada Suku Banjar di Kecamatan Martapura Timur Kabupaten Banjar
Lia Susvita Sari1, Husaini1, dan Bahrul Ilmi2
1
Program Studi Magister Ilmu Kesehatan Masyarakat Fakultas Kedokteran Universitas Lambung
Mangkurat, Kalimantan Selatan, Indonesia, 70714
2
Poltekkes DepKes RI Banjarmasin, Kalimantan Selatan, Indonesia, 70714
E-mail : lia_svs@yahoo.co.id, husainifawaz@yahoo.com, dan ilmie.bahrul@gmail.com

ABSTRACT

Banjar tribe is indigenous people who inhabit most parts of South Kalimantan is one of them scattered in
Martapura. At the time of pregnancy and postnatal Banjarese many behaviors and taboos that are still
running . Based on this, the researchers wanted to examine more deeply the culture, especially the
cultural and symbolic meaning and behavior of pregnant women during childbirth . The study was
conducted in the District of East Martapura Banjar district because the area is still going strong tribal
culture Banjar Assessing the cultural and symbolic significance behavior of pregnant women and
postpartum mother Martapura Banjar tribe in District East .This study is a qualitative research approach
to content analysis (content analysis) as was conducted in East Martapura. The subject of research
respondents in this study were women who are pregnant (3 months ,6 months ,9 months ) and mother
during childbirth that is running tradition Banjarese taken by purposive sampling, that the selection of
respondents is done deliberately in accordance with the requirements of the respondents were required, 2
Banjar tribe village shaman , and one midwife . So the total respondents in this study were 7 people.
Behavior of pregnant women and postpartum mother Martapura Banjar tribe in the district east are
grouped into three categories receive care that is of the village shaman, customs and health of workers.
While pregnant women and postpartum abstinence are grouped into three categories: behavioral taboos,
food and beverages.

Keywords: cultural, symbolic meaning, Banjarese, pregnant women, postpartum mothers.

ABSTRAK

Suku Banjar ialah penduduk asli yang mendiami sebagian besar wilayah Kalimantan Selatan yaitu salah
satunya tersebar di Martapura. Pada saat kehamilan dan masa nifas suku Banjar banyak perilaku dan
pantangan yang masih dijalankan. Berdasarkan hal tersebut, peneliti ingin mengkaji lebih dalam budaya
khususnya mengenai budaya dan makna simbolis perilaku ibu hamil dan masa nifas. Penelitian dilakukan
di Kecamatan Martapura Timur Kabupaten Banjar karena didaerah tersebut masih kental akan budaya
suku Banjar. Mengkaji budaya dan makna simbolis perilaku ibu hamil dan ibu nifas suku Banjar di
Kecamatan Martapura Timur. Penelitian ini adalah penelitian kualitatif dengan pendekatan analisis isi
(content analysis) yang dilakukan di Kecamatan Martapura Timur. Subjek penelitian yang menjadi
responden dalam penelitian ini adalah ibu yang sedang hamil (3 bulan, 6 bulan, 9 bulan) dan ibu masa
nifas yang menjalankan tradisi suku Banjar yang diambil secara purposive sampling yaitu pemilihan
responden dilakukan secara sengaja sesuai dengan persyaratan responden yang diperlukan, 2 orang dukun
kampung suku Banjar, dan 1 orang bidan. Sehingga total responden dalam penelitian ini adalah 7 orang.
Perilaku ibu hamil dan ibu nifas suku Banjar di Kecamatan Martapura timur yaitu dikelompokkan
menjadi 3 kategori memperoleh perawatan yaitu dari dukun kampung, adat istiadat dan dari tenaga
kesehatan. Sedangkan pantangan ibu hamil dan nifas dikelompokkan menjadi 3 kategori yaitu pantangan
perilaku, makanan dan minuman.

Kata Kunci: budaya, makna simbolis, suku Banjar, ibu hamil, ibu nifas
1. PENDAHULUAN
Millennium Development Goals
(MDGs) adalah Deklarasi Milenium hasil
kesepakatan kepala negara dan perwakilan dari
189 negara Perserikatan Bangsa-bangsa (PBB)
yang mulai dijalankan pada September 2000,
berupa delapan butir tujuan untuk dicapai pada
tahun 2015. Tujuan Millenium Development
Goals (MDGs) merupakan komitmen
Pemerintah Republik Indonesia terhadap
komitmen global yang secara konstitusional juga
diakui dan disahkan serta dituangkan di dalam
Rencana Pembangunan Jangka Panjang (RPJP)
tahun 2005-2025 dan saat ini telah dijabarkan
dalam Rencana Pembangunan Jangka Menengah
Nasional (RPJMN) tahun 2010-2014 melalui
Keputusan Presiden Nomor 5 tahun 2010 yang
disahkan pada bulan Januari 2010. Dalam
RPJMN tahun 2010 bidang Sosial Budaya dan
Kehidupan Beragama dimana termasuk
kesehatan ditetapkan sasaran salah satunya
menurunnya Angka Kematian Ibu (AKI)
menjadi 115 per 100.000 kelahiran hidup tahun
2014 (1).
Berdasarkan Survey Demografi dan
Kesehatan Indonesia (SDKI) tahun 2012, angka
kematian ibu Indonesia masih tinggi sebesar 359
per 100.000 kelahiran hidup. Angka ini sedikit
menurun jika dibandingkan dengan SDKI tahun
1991, yaitu sebesar 390 per 100.000 kelahiran
hidup. Angka ini sedikit menurun meskipun
tidak terlalu signifikan. Target global MDGs ke-
5 adalah menurunkan AKI menjadi 102 per
100.000 kelahiran hidup pada tahun 2015. Data
Profil Kesehatan Propinsi Kalimantan Selatan
menunjukkan bahwa AKI di Propinsi
Kalimantan Selatan tahun 2007 masih cukup
tinggi yaitu 307/100.000 kelahiran hidup. Hal ini
masih jauh di atas rata-rata jika dibandingkan
dengan AKI di Indonesia yaitu 288/100.000
kelahiran hidup (2). AKI Provinsi Kalimantan
Selatan dari tahun 2010 sebanyak 111 orang dan
pada tahun 2014 sebanyak 120 orang.
Sedangkan AKI untuk Kabupaten Banjar yaitu
pada tahun 2011 sebanyak 16 orang, 2012
sebanyak 12 orang, 2013 sebanyak 14 orang dan
2014 sebanyak 24 orang (3). Perawatan
kehamilan dan nifas merupakan salah satu faktor
penting yang harus diperhatikan untuk
mencegah terjadinya komplikasi dan kematian
ketika persalinan, disamping itu juga untuk
menjaga pertumbuhan dan kesehatan janin
Permasalahan yang cukup besar lainnya yang
berpengaruh pada kehamilan adalah masalah
gizi. Permasalahan gizi pada ibu hamil di
Indonesia tidak terlepas dari faktor budaya
setempat. Hal ini disebabkan karena adanya
kepercayaan dan pantanganterhadap beberapa
makanan (4).
2. METODE
Penelitian ini adalah penelitian kualitatif
dengan pendekatan analisis isi (content
analysis). Penelitian dilakukan di Kecamatan
Martapura Timur Kabupaten Banjar. Waktu
penelitian dilaksanakan selama bulan November
2015. Responden dalam penelitian ini adalah ibu
yang sedang hamil (3 bulan, 6 bulan, 9 bulan)
dan ibu masa nifas yang menjalankan tradisi
suku Banjar yang diambil secara purposive
sampling yaitu pemilihan responden dilakukan
secara sengaja sesuai dengan persyaratan
responden yang diperlukan, 2 orang dukun
kampung suku Banjar, dan 1 orang bidan desa.
Sehingga total responden dalam penelitian ini
adalah 7 orang.
3. HASIL DAN PEMBAHASAN
Berdasarkan reduksi data hasil
wawancara yang telah dilakukan, maka data
disajikan sedemikian rupa dalam bentuk
transkrip wawancara. Dari data yang disajikan
maka bisa ditarik intisari dari masalah pokok
sesuai tujuan penelitian pada tabel di bawah ini.
 Tabel 1. Perilaku Dan Makna Simbolis Tentang Perilaku Ibu Hamil Suku Banjar Kecamatan
Martapura Timur
No. Perilaku ibu hamil suku Banjar
1. Ibu hamil melakukan perawatan ke dukun
kampung
a. Pijat
b. Banyu baya, minyak bangsul
2. Ibu hamil melakukan perawatan secara adat
istiadat
a. Herbal (wedak panas dan ramuan
beras kencur)
b. Cincin benang, jariyangaw dan tali
aduk
c. Upacara betapung tawar dan mandi 7
bulanan
d. Tahapan upacara 7 bulanan:
1. Pecahnya kuantan tanah ketika
diduduki
2. Pecahnya mayang dengan
sekali tepuk saja
3. Meloloskan diri dari (benang
dibuat melingkar) lawai pada
tubuh wanita
4. Pecahnya telur ketika diinjak
5. Kelapa tumbuh yang dipangku
dan kemudian digendong
6. Memerciki dengan tepung
tawar
3. Ibu hamil melakukan perawatan ke tenaga
kesehatan
Makna simbolis
a. Membetulkan posisi bayi
b. Terhindar dari gangguan kehamilan dan
proses melahirkan lancar
a. Mengobati bengkak pada kaki
b. Agar tidak di ganggu makhluk halus
c. Mendapat keselamatan dan menolak bala
1. Pecahnya ketuban
2. Proses kelahiran akan berjalan dengan
lancar, tetapi bila perlu ditepuk beberapa
kali agar pecah, konon menandakan proses
kelahiran akan terganggu
3. Mengisyaratkan mudahnya proses
kelahiran
4. Melambangkan proses kelahiran yang
cepat
5. Melambangkan bayi
6. Memberkati
Mendapatkan perawatan kesehatan dari tenaga
kesehatan

Tabel 2. Pantangan Dan Makna Simbolis Tentang Pantangan Ibu Hamil Suku Banjar Di
Kecamatan Martapura Timur

No. Pantangan ibu hamil suku Banjar Makna simbolis

1. Perilaku a. Kesulitan saat proses melahirkan
a. Tidak boleh duduk di depan pintu, b. Gangguan makhluk halus
tidak boleh meletakkan sisir diatas c. Anak lahir cacat d. Gangguan kehamilan
kepala. (anak terlilit tali pusat)
b. Tidak boleh keluar rumah menjelang d. Ari-ari tertinggal
magrib, tidak boleh pergi keluar hutan
c. Tidak boleh membelah puntung atau
kayu api yang ujungnya sudah
terbakar, tidak boleh menganyam
bakul, suami/ibu hamil tidak boleh
menyembelih hewan, apabila ada
orang yang ingin lewat, harus melalui
depan ibu hamil tidak boleh jalan
 belakang.
d. Tidak boleh melilit handuk dileher
e. Tidak boleh menyobek daun pisang
2. Makanan a. Keguguran
a. Tidak boleh makan nanas b. Bayi kembar siam
b. Tidak boleh makan pisang dempet, c. Sifat anak pemarah
terong dempet, telur yang kuningnya
dua
c. Tidak boleh makan makanan yang
sangat pedas
3. Minuman : Minum es Bayi besar

Tabel 3. Perilaku dan makna simbolis tentang perilaku ibu nifas suku Banjar di Kecamatan
Martapura Timur

No. Perilaku ibu nifas suku Banjar Makna simbolis

1. Ibu nifas melakukan perawatan ke dukun Memulihkan kondisi ibu nifas
kampung : Pijat
2. Ibu nifas melakukan perawatan secara adat 1. Menyehatkan dan memulihkan kondisi ibu
istiadat nifas
a. Herbal : 2. Menghilangkan rasa lelah pada badan ibu nifas
1. Ramuan Ragi 40 b. Melangsingkan perut
2. Wedak panas (pilis) c. Luka vagina cepat kering
b. Korset
c. Makan ikan asin dan cacapan
3. Ibu nifas melakukan perawatan ke tenaga Mendapatkan perawatan kesehatan dari tenaga
kesehatan kesehatan

Tabel 4. Pantangan dan makna simbolis tentang pantangan ibu nifas suku Banjar di Kecamatan
Martapura Timur

No. Pantangan ibu nifas suku Banjar Makna simbolis

1. Perilaku a. Badan tidak akan bugar lagi dan cepat tua
a. Tidak diperbolehkan berhubungan b. Gangguan makhluk halus
intim c. vagina bengkak
b. Tidak boleh keluar rumah sebelum 40
hari
c. Kalau duduk kaki tidak boleh di lipat
2. Makanan a. Menyebabkan susunya bau amis, anak bau
a. Tidak boleh makan makanan yang amis dan kencing amis
berbau amis, iwak bapatil (lundu, b. Sakit kepala
puyau, patin) c. Luka setelah melahirkan akan lambat kering
b. Tidak boleh makan ikan papuyu/betok
c. Tidak boleh makan makanan berlemak
(daging-dagingan, kuah bersantan)
3. Minuman : Minum es Anak flu
3.1. Kategori Perilaku Ibu Hamil suku
Banjar di Kecamatan Martapura Timur
Berdasarkan hasil penelitian, perilaku
ibu hamil suku Banjar di Martapura dapat
dikelompokkan menjadi 3 kategori, yaitu ibu
hamil memperoleh perawatan yaitu dari dukun
kampung, adat istiadat atau kebiasaan dan dari
tenaga kesehatan.
a. Ibu Hamil Melakukan Perawatan Ke Dukun
Kampung
1) Ibu Hamil Melakukan Pijat
Ibu hamil suku banjar masih rutin
melakukan pijat hamil ke dukun kampung
yang berada di Desa Kitano maupun Desa
Pematang Baru. Hal ini disebabkan karena
kurangnya pengetahuan dan pemahaman
mengenai dari dampak melakukan pijat ke
dukun. Selain itu adanya kepercayaan dan
kebiasaan turun temurun yang menyebabkan
responden tetap melakukan pijat hamil untuk
membetulkan posisi bayi dan agar
mempermudah proses melahirkan (indepth
interview). Alasan pijat hamil untuk
membenarkan posisi bayi tidak ada dalam
dunia kedokteran dan tindakan tersebut sudah
tidak direkomendasikan walaupun yang
memijat merupakan ahli pijat kehamilan. Pijat
untuk ibu hamil pada dasarnya diperbolehkan
kecuali pada bagian perut karena pijat dapat
membuat peredaran darah menjadi lancar,
sehingga menurunkan ketegangan otot untuk
memperoleh tubuh yang rileks. Tetapi sebelum
melakukan pijat, ibu hamil harus konsultasi
terlebih dahulu dengan tenaga kesehatan,
seperti permyataan Nicholas, bahwa ibu hamil
risiko tinggi harus melakukan konsultasi
dengan tenaga kesehatan sebelum melakukan
pijat kehamilan (8).
2) Ibu Hamil Mengkonsumsi dan Mandi
dengan Banyu (Air) Baya
Banyu baya merupakan air putih biasa
dari bidan kampung atau tokoh adat yang
dibacakan atau ditiupkan sesuatu. Hal ini
disebabkan karena manfaat dari meminum air
baya ini adalah agar terhindar dari berbagai
macam gangguan kehamilan dan dilancarkan
proses melahirkannya (indepth interview).
Kebutuhan cairan sehari hari adalah 50
ml/kgBB/hari, dan kebutuhan eliminasi 1500-
1600ml/hari (9). Menurut Emoto, air akan
merespon kata-kata positif dengan membentuk
kristal yang indah. Sebaliknya jika air
diperlihatkan kata-kata negatif, ia tidak akan
membentuk kristal. Pada saat air dibacakan
doa islam, kristal bersegi enam dengan lima
cabang daun muncul berkilauan. Temuan ini
menjelaskan kenapa air putih yang didoakan
bisa menyembuhkan berbagai macam penyakit
(10). Meminum banyu baya tidak memiliki
dampak negatif bagi ibu hamil selama air yang
dikonsumsi merupakan air bersih dan bebas
dari kontaminan mikroorganisme patogen yang
dapat mengakibatkan waterborn disease.
3) Ibu Hamil Mengkonsumsi dan Mengoleskan
Minyak Bangsul ke Perut
Minyak bangsul adalah minyak yang
dipercaya memudahkan dalam persalinan dan
lancar meluncur seperti minyak.
Penggunaannya yaitu diminum sedikit setiap
pagi saat kehamilan sudah 7 bulan dan
dioleskan ke perut (indepth interview). Ibu
hamil yang mengkonsumsi minyak kelapa
selama trimester ketiga kehamilan telah
mengurangi angka kematian janin.
Mengkonsumsi minyak kelapa selama
kehamilan mungkin membantu melindungi
anak dari efek stres sebelum melahirkan, yang
diyakini menyebabkan masalah perkembangan
neurologis setelah lahir (7).
b. Ibu Hamil melakukan Perawatan secara Adat
Istiadat
1) Ibu Hamil Menggunakan Herbal Apabila
Kaki Bengkak
Perawatan herbal ibu hamil suku Banjar
di Martapura yaitu apabila ibu hamil
mengalami bengkak pada kaki, maka obatnya
yaitu wedak panas atau ramuan beras kencur
yang dioleskan ke kaki ibu hamil (indepth
interview). Secara medis, kencur berkhasiat
untuk antiinflamasi. Hal ini didukung oleh
penelitian Miranti yang menyatakan bahwa
kencur (kaempferia galanga L.) merupakan
salah satu tanaman Suku Zingiberaceae yang
diketahui mengandung minyak atsiri. Secara
empirik rimpang kencur sering digunakan
sebagai obat tradisional, salah satunya untuk
mengobati radang (inflamasi) (11).
2) Ibu Hamil Memakai Cincin Benang
Setelah dinyatakan hamil, seorang ibu
hamil suku Banjar diharuskan memakai cincin
yang terbuat dari beberapa helai benang hitam
di ibu jari. Hal ini dimaksudkan bahwa
pemakaian benang yang dililitkan dalam
jumlah ganjil, 3, 5, 7, 9 adalah agar tidak
diganggu oleh makhluk halus seperti kuyang
yang merupakan makhluk halus dari
kalimantan. Responden menyatakan bahwa
pemakaian benang sebagai cincin adalah untuk
menghindarkan dirinya dari gangguan
makhluk halus dan apabila mereka tidak
memakai, mereka merasa waswas dan tidak
terlindungi (indepth interview). Prinsip
pengobatan jimat menurut Elmberg, adalah
orang menggunakan benda-benda kuat atau
jimat untuk memberi perlindungan terhadap
penyakit (12). Namun, secara medis
pemakaian cincin benang tidak berpengaruh
terhadap kesehatan ibu hamil. Hal ini
dikarenakan pemakaian cincin benang hanya
merupakan tradisi suku Banjar yang masih
berlaku di Kecamatan Martapura Timur.
Kesehatan ibu hamil dipengaruhi oleh perilaku
hidup bersih dan sehat, makanan bergizi, dan
pemeriksaan rutin ke tenaga kesehatan.
3) Ibu Hamil Menanam Jariyangaw dan
Mengikat Tali Aduk/Ijuk
Jariyangaw ini sejenis tanaman
pandanpandanan yang biasa tumbuh di tanah
yang berair, berbau menyengat berdaun lurus
dan panjang. Sedangkan tali aduk bisa
diikatkan di sekeliling rumah atau di atas pintu
rumah. Tali aduk adalah tali yang terbuat dari
anyaman ijuk. Hal ini dilakukan karena apabila
menanam jariyangaw di dekat rumah agar ibu
hamil tidak diganggu kuyang (hantu wanita
yang terbang hanya dengan kepala dan usus
terburai yang suka makan bayi, darah dan
tembuni/plasenta dari ibu yang melahirkan)
(indepth interview). Hal ini sama dengan
pemakaian cincin benang, bahwa secara medis
menanam jariyangaw dan mengikat tali
aduk/ijuk tidak berpengaruh terhadap
kesehatan ibu hamil.
4) Ibu Hamil melakukan Upacara Batapung
Tawar tiap Tiga Bulan
Tapung tawar merupakan sebuah ritual
singkat yang dilakukan oleh tetua adat untuk
memberikan doa keselamatan dan lain
sebagainya dengan cara memercikkan air yang
telah bercampur dengan "minyak likat
baboreh". Air tapung tawar tersebut dipercikan
dengan menggunakan sobekan daun pisang
atau anyaman daun kelapa yang dibentuk
sedemikian rupa. Menurut kepercayaan, air itu
mengandung kekuatan magis dan dapat
memberikan keselamatan bagi orang yang
ditapung tawari (indepth interview).
Masyarakat akan melakukan apa saja yang
dapat dilakukan demi keselamatan ibu dan
bayinya. Keselamatan ibu dan janin tidak
terlepas dari bagaimana kondisi kesehatan ibu
hamil. Status kesehatan ibu hamil dipengaruhi
oleh perawatan kehamilan yang baik oleh ibu
hamil. Perawatan kehamilan yang perlu
diperhatikan menurut Pinem yaitu perawatan
diri (kulit, gigi mulut, perawatan kuku)
payudara, imunisasi, senam hamil,
pemeriksaan kehamilan, serta gizi untuk
perkembangan janin (13).
 5) Ibu Hamil melakukan Upacara Mandi 7
Bulanan
Masyarakat Banjar menganggap bahwa
kehamilan bulan ganjil merupakan saat-saat
yang dianggap sacral. Upacara mandi-mandi
adat Banjar biasanya dilakukan ketika usia
kehamilan 7 bulan yang dimaksudkan untuk
menolak bala dan mendapatkan keselamatan
(indepth interview). Tahapan upacara 7
bulanan memiliki makna khusus yang
berkaitan dengan kehamilan makna tersebut
terbagi menjadi 2 yaitu:
a) Pecahnya Ketuban Pecahnya ketuban
dipercaya apabila kuantan tanah ketika
diduduki pecah. Secara medis, pecahnya
ketuban bukan dikarenakan ritual tersebut.
Faktor yang menyebabkan pecahnya ketuban
menurut Huda diantaranya sungsang,
preeklamsi, anemia, gemelli dan hidramnion.
Faktor tersebut yang merupakan faktor
penyebab kematian ibu dan kematian bayi
(14).
b) Proses Melahirkan Lancar Proses
melahirkan lancar dipercaya apabila mayang
pecah dengan sekali tepuk, ibu hamil dapat
meloloskan diri dari (benang dibuat melingkar)
lawai dan pecahnya telur ketika diinjak. Lancar
tidaknya proses melahirkan secara medis
bukan karena ritual tersebut tetapi menurut
Untari et al, menyebutkan bahwa kelancaran
proses persalinan dipengaruhi oleh 5 P
meliputi : power (tenaga mengejan ibu),
passanger (janin), passage (jalan lahir), psikis
(mental dan kesiapan ibu) dan paramedis (15).
c. Ibu Hamil Melakukan Perawatan ke Tenaga
Kesehatan
Berdasarkan hasil penelitian, di
Martapura Timur para petugas kesehatan rutin
mengadakan kelas bumil. Kegiatan yang
dilakukan antara lain pemeriksaan tinggi dan
berat badan, tekanan darah, tinggi fundus,
imunisasi, pemberian tablet besi dan penyuluhan
(indepth interview). Menurut Lesiyaningsih,
perawatan ibu hamil yang sesuai dengan
pedoman yaitu melakukan pemeriksaan
kehamilan sesuai standar 5 T. Standar 5 T adalah
standar pemeriksaan /perawatan kehamilan
(ANC=Antenatal Care) yang dimaksud adalah
pemeriksaan/ pengukuran tinggi dan berat
badan, tekanan darah, tinggi fundus, pemberian
imunisasi tetanus toxoid, dan pemberian tablet
besi/tablet tambah darah (16).
3.2. Pantangan dan Makna Simbolis Perilaku
Ibu Hamil Suku Banjar di Kecamatan
Martapura Timur dan Pengaruh Serta
Manfaatnya Bagi Kesehatan
a. Pantangan Perilaku
1) Kesulitan Saat Proses Melahirkan
Pantangan perilaku ibu hamil tidak
boleh duduk di depan pintu dan tidak boleh
meletakkan sisir di atas kepala karena
dikhawatirkan akan sulit pada saat melahirkan
(indepth interview). Pantangan tersebut secara
medis tidak berpengaruh dan tidak ada
hubungannya dengan kelancaran proses
melahirkan. Hal tersebut didukung oleh
penelitian Untari et al, yang menyebutkan
bahwa kelancaran proses persalinan
dipengaruhi oleh 5 P meliputi : power (tenaga
mengejan ibu), passanger (janin), passage
(jalan lahir), psikis (mental dan kesiapan ibu)
dan paramedis (15).
2) Gangguan Makhluk Halus
Ibu hamil tidak boleh keluar rumah
menjelang magrib dan tidak boleh keluar
hutan. Hal ini karena kepercayaan wanita
hamil baunya harum sehingga rawan terkena
gangguan mahluk halus (indepth interview).
Secara psikologis ibu hamil mentalnya sensitif
dan mudah takut sehingga pada malam hari
tidak dianjurkan berpergian. Secara medis, ibu
hamil memang tidak dianjurkan untuk
berlamalama terkena udara malam. Hal ini
didukung oleh penelitian Untari et al, yang
menyatakan bahwa secara medis-biologis ibu
hamil tidak dianjurkan keluar malam terlalu
lama, apalagi larut malam. Kondisi ibu dan
janin bisa terancam karena udara malam
kurang bersahabat disebabkan banyak
mengendapkan karbondioksida (CO2) (15).
3) Anak Lahir Cacat
Membelah puntung atau kayu api yang
ujungnya sudah terbakar juga merupakan
pantangan ibu hamil, karena dikhawatirkan
anak yang lahir memiliki bibir sumbing
(indepth interview). Ibu hamil juga
berpantangan tidak boleh menganyam bakul
karena dikhawatirkan anak yang dilahirkan
memiliki jari tangan yang dempet. Suami/ibu
hamil juga tidak boleh menyembelih hewan
karena dikhawatirkan anaknya lahir cacat.
Selain itu, apabila ada orang yang ingin lewat,
harus melalui depan ibu hamil tidak boleh
lewat belakang, karena dikhawatirkan anaknya
nanti menghadap kebelakang (indepth
interview). Secara medis, anak sumbing dan
anak lahir cacat tidak ada hubungannya dengan
perilaku pantangan tersebut. Karena menurut
Loho, sumbing adalah kondisi terbelah pada
bibir akibat embrio perkembangan struktur
wajah yang mengalami gangguan (17). Faktor
yang mempengaruhi bibir sumbing menurut
Townsend et al yaitu faktor genetik atau
keturunan serta bisa terjadi karena faktor obat-
obatan yang bersifat teratogen seperti asetosal
dan aspirin (18).
4) Gangguan Kehamilan
Gangguan kehamilan yang terjadi akibat
melanggar pantangan yaitu anak terlilit tali
pusat yang terjadi karena ibu hamil melilit
handuk di leher (indepth interview). Secara
medis. Terjadinya lilitan tali pusat tidak
disebabkan oleh lilitan handuk di leher ibu
hamil. Menurut Untari, et al, secara medis
hiperaktivitas gerakan bayi yang diduga dapat
menyebabkan lilitan tali pusat karena ibunya
aktif (15). Tali pusat yang panjang juga dapat
menyebabkan bayi terlilit. Selain itu menurut
Kasdu, pada kehamilan kembar dan air
ketuban berlebihan atau polihidramnion,
kemungkinan bayi terlilit tali pusat akan
meningkat (19).
5) Ari-ari Tertinggal (Retensio Plasenta)
Ibu hamil suku Banjar dilarang
menyobek daun pisang, karena dikhawatirkan
ari-ari bayi tertinggal (retensio plasenta)
(indepth interview). Retensio plasenta adalah
tertahannya atau belum lahirnya plasenta
hingga atau melebihi waktu 30 menit setelah
bayi lahir. Faktor-faktor yang mempengaruhi
kejadian retensio plasenta pada ibu bersalin
menurut Ratu et al adalah umur, multiparitas,
dan riwayat kehamilan dan persalinan
terdahulu (20). Jadi, menyobek daun pisang
secara medis tidak ada hubungannya dengan
tertinggalnya ari-ari bayi pada saat melahirkan.
b. Pantangan Makanan dan Minuman
1) Keguguran
Pantangan makanan ibu hamil yaitu
tidak boleh makan nanas karena akan
mengakibatkan keguguran (indepth interview).
Padahal, buah nanas merupakan buah yang
kaya akan vitamin C dan serat yang penting
untuk menjaga kesehatan tubuh dan
melancarkan proses pembuangan sisa-sisa
pencernaan. Namun, apabila mengkonsumsi
terlalu banyak akan berdampak negatif bagi
kesehatan ibu hamil. Hal ini diperkuat oleh
penelitian Untari et al, ibu hamil boleh
mengkonsumsi nanas namun apabila kelebihan
akan menyebabkan asam lambung meningkat
(15).
2) Bayi Kembar Siam
Pantangan makanan lainnya adalah tidak
boleh makan pisang dempet, terong dempet,
telur yang kuningnya dua karena
dikhawatirkan anak akan lahir kembar siam
atau dempet (indepth interview). Secara medis-
biologis lahirnya anak kembar dampet atau
kembar siam tidak dipengaruhi oleh makanan
dempet yang dimakan oleh ibu hamil. Kasus
 kembar siam menurut Madjid menyatakan
bahwa kasus kembar siam ini adalah kembar
monozigot, dimana yang terjadi adalah
kelainan perkembangan dari embrio itu sendiri,
yang gagal berpisah diatas 12 hari setelah
pembuahan (21).
3) Sifat Anak Pemarah
Ibu hamil dilarang makan makanan
pedas karena anak yang dilahirkan nanti bisa
jadi anak yang pemarah (indepth interview).
Terlalu banyak makanan yang pedas pasti akan
membuat perut merasa mual dan mules, namun
hal ini tidak berhubungan dengan sifat anaknya
kelak. Menurut Ismail, pola asuh orang tualah
yang mempengaruhi perkembangan psikologis
anak (22).
4) Bayi Besar
Ibu hamil tidak boleh minum es karena
menyebabkan bayi besar dan akan sulit
melahirkan. Air es tidak membuat janin
menjadi besar, kecuali air esnya dicampur
dengan sirup atau gula. Kandungan
karbohidrat dalam gula inilah yang dapat
menyebabkan berat janin di atas normal.
Menurut Manurung dalam Trisnasiwi et al,
bayi besar biasanya berhubungan dengan ibu
hamil yang mempunyai penyakit kencing
manis dan terlalu banyak mengkonsumsi gula
(23).
3.3. Perilaku dan makna simbolis tentang
perilaku ibu nifas suku Banjar di Kecamatan
Martapura Timur dan pengaruh serta
manfaatnya bagi kesehatan
a. Ibu Nifas Melakukan Pijat ke Dukun
Kampung
Pijat/urut tradisional setelah melahirkan
dengan bidan kampung masih dilakukan oleh
ibu nifas. Di martapura, budaya pijat bagi ibu
nifas dianggap sesuatu yang harus didapatkan
ibu untuk memulihkan kembali kondisi ibu
(indepth interview). Menurut penelitian
Mayasaroh, dukun kampung melakukan pijat
periode pasca kelahiran dalam rangka
penyembuhan penyakit maupun keluhan yang
diderita ibu dan anak (24). Danuatmaja et al
menyatakan bahwa upaya untuk mengatasi nyeri
persalinan dapat menggunakan metode
farmakologi maupun nonfarmakologi. Metode
nonfarmakologi dalam mengatasi nyeri antara
lain homeopathy, hipnobirthing, waterbirth,
relaksasi, akupuntur, yoga, dan massage atau
pemijatan (25).
b. Ibu Nifas Melakukan Perawatan Secara Adat
Istiadat
1) Ibu Nifas Menggunakan Herbal
a) Ibu Nifas Mengkonsumsi Ramuan Ragi 40
Ibu nifas suku Banjar di Martapura
meminum ramuan ragi 40 khas banjar setiap
pagi selama masa nifas. Ragi 40 terdiri dari
berbagai macam rempah yang jumlahnya
sekitar 40 macam. Ibu nifas dianjurkan
meminum ramuan ini setiap pagi selama
masa nifas. Hal ini dimaksudkan untuk
menyehatkan dan memulihkan tenaga ibu
nifas setelah melahirkan (indepth interview).
Tentang ramuan pasca persalinan, setiap
kebudayaan memiliki kepercayaan mengenai
berbagai ramuan atau bahan obat-obatan
yang dapat digunakan pada saat nifas.
Umumnya bahan obat-obatan itu terdiri dari
ramu-ramuan yang diracik dari berbagai
tumbuh-tumbuhan, seperti daundaunan, akar-
akar, atau bahan lainnya yang diyakini
berkhasiat sebagai penguat tubuh (26).
b) Ibu Nifas Menggunakan Bedak Panas
(Pilis)
Ibu nifas juga di anjurkan untuk
mengoleskan wedak panas ke perut, tangan
dan kaki. Wedak panas ini dioleskan setiap
pagi sehabis mandi mulai hari pertama
hingga hari ke 40 setelah melahirkan. Hal ini
dilakukan untuk menghilangkan rasa lelah
pada badan ibu setelah melahirkan (indepth
interview). Pilis yang terbuat dari bahan
alami memang sudah terbukti khasiatnya. Hal
 ini telah dibuktikan oleh Mentari, yang
menyatakan bahwa bahan pilis mengandung
bahan alami seperti, ganthi, kencur, kunyit,
papermint dan kenanga. Pilis dapat
membantu meredakan rasa pusing dan
memperlancar peredaran dareah dan
mencegah darah putih naik ke atas. Ramuan
pilis dapat menjaga kesehatan mata dan
menghilangkan pusing sebesar (70%) (27).
2) Ibu Nifas Menggunakan Korset
Selain wedak panas, ibu nifas suku
Banjar juga menggunakan korset setelah
melahirkan. Hal ini bertujuan agar perut
kembali seperti keadaan sebelum hamil
(indepth interview). Korset merupakan sesuatu
yang sangat diperlukan bagi ibu nifas. Ibu
nifas selalu memakai korset setelah mereka
melahirkan dan ini sudah menjadi kebiasaan
masyarakat pada umumnya begitu pula di
daerah Martapura Timur. Korset memiliki
fungsi unntuk mengecilkan perut setelah ibu
melahirkan. Hal ini didukung oleh penelian
yang dilakukan Theresia, yang menyatakan
bahwa perawatan pasca melahirkan ibu nifas
yaitu menggunakan gurita dan korset karena
berfungsi untuk memaksimalkan involusi uteri
dan memulihkan tonus abdomen (28).
3) Ibu Nifas Memakan Ikan Asin dan Cacapan
Ibu nifas suku Banjar dianjurkan hanya
makan dengan lauk ikan asin dan cacapan.
Cacapan disini adalah asam kamal/asamjawa,
garam, bawang merah dan lombok yang diberi
sedikit air. Hal ini dimaksudkan agar luka
vagina cepat kering. Dampak kesehatan
apabila ibu hanya mengkonsumsi ikan asin
dengan cacapan yaitu ibu nifas akan terkena
hipertensi (indepth interview). Selain itu
kandungan gizi dari ikan asin tidak memenuhi
gizi untuk ibu nifas. Ibu nifas dan menyusui
memerlukan asupan makanan serta nutrisi
yang cukup untuk mengembalikan stamina dan
agar ASI tercukupi.
c. Ibu Nifas Melakukan Perawatan ke Tenaga
Kesehatan
Berdasarkan hasil penelitian, ibu nifas
suku Banjar di Martapura selain melakukan
perawatan tradisional, mereka juga melakukan
pemeriksaan ke bidan desa. Bidan desa
melakukan jemput bola, karena pantangan suku
Banjar yang tidak memperbolehkan ibu nifas
keluar selama 40 hari. Jadi bidan desa berperan
aktif dalam melakukan pemeriksaan ibu nifas.
Pemeriksaan ibu nifas oleh bidan desa antara
lain adalah pemeriksaan tekanan darah, suhu
badan, denyut nadi, keluhan ibu nifas, keadaan
perut, daerah vagina dan payudara serta
memberikan obat-obatan (indepth interview).
Menurut penelitian Wuryanto et al, ibu nifas
mendatangi ketempat pemeriksaan bukan atas
kesadaran tetapi ibu bidan yang aktif
mengunjungi ke rumah ibu nifas untuk
memeriksa, tanpa dipungut biaya. Ibu nifas yang
aktif datang ketempat pemeriksaan biasanya
disebabkan karena ada permasalahan / keluhan
seperti anaknya sakit. Sedangkan bila ada
keluhan pada diri ibu nifas, maka akan lebih
cenderung mendatangi dukun bayi baru
kemudian ke ibu bidan (29).
3.4. Pantangan dan Makna Simbolis tentang
Pantangan Ibu Nifas Suku Banjar di
Kecamatan Martapura Timur dan Pengaruh
Serta Manfaatnya Bagi Kesehatan Pantangan
Perilaku Ibu Nifas
1) Tidak Diperbolehkan Berhubungan Intim
Pantangan perilaku suami dan istri tidak
boleh melakukan hubungan suami istri selama
40 hari setelah melahirkan. Menurut bidan
kampung, apabila melakukan hubungan pada
masa nifas selain ibu nifas belum suci, juga
mengakibatkan ibu akan cepat tua (indepth
interview). Secara medis, berhubungan intim
sebelum 40 hari memang tidak diperbolehkan
karena luka vagina masih belum kering. Hal ini
didukung oleh penelitian Yulianti, yang
menyatakan bahwa berhubungan intim sebelum
40 hari akan menghambat proses penyembuhan
jalan lahir, infeksi atau bahkan perdarahan
belum muncul ataupun pengaruh psikologis,
semisal kekhawatiran akan robeknya jahitan
maupun ketakutan akan hamil lagi (30).
2) Tidak Boleh keluar Rumah sebelum 40Hari
Ibu nifas tidak boleh keluar rumah
sebelum 40 hari, karena dikhawatirkan rentan
dimasuki roh jahat (indepth interview). Ibu nifas
yang tidak diperbolehkan keluar rumah sama
sekali selama 40 hari akan berdampak negatif
bagi kesehatan ibu nifas. Hal ini dikarenakan
apabila ibu nifas tidak keluar rumah dan tidak
terkena paparan sinar matahari maka ibu nifas
akan kekurangan vitamin D. Menurut Holick,
paparan sinar matahari merupakan sumber
vitamin D yang paling baik dan tidak terdapat
kasus intoksikasi vitamin D (31).
3) Kalau Duduk Kaki Tidak Boleh di Lipat
Ibu nifas kalau duduk kaki tidak boleh
dilipat hal ini dapat menyebabkan vagina
menjadi bengkak (indepth interview). Secara
medis, ibu nifas yang baru saja melahirkan harus
memposisikan kaki lurus dan tidak boleh dilipat.
Apabila kaki dalam posisi terlipat, hal ini akan
menyebabkan robekan vagina semakin lebar.
Hal ini didukung oleh penelitian Handayani,
yang menyatakan bahwa secara medis posisi
kaki yang lurus memang lebih menguntungkan
karena membuat aliran darah jadi lancar, selain
itu agar jahitan akibat robekan di vagina tak
melebar ke mana-mana dan juga dimaksudkan
agar aliran darah tidak terhambat (26).
4) Tidak Boleh Mengkonsumsi Makanan Amis,
Ikan Berpatil, Ikan Papuyu
Ibu nifas suku Banjar juga mempunyai
beberapa pantangan makanan yang berbau amis,
iwak bapatil (lundu, puyau, patin). Ibu nifas
tidak boleh makan makanan yang berbau amis
dan ikan berpatil karena ASInya nanti berbau
amis, anak dan kencing juga akan berbau amis.
Selain itu ibu nifas tidak boleh makan ikan
papuyu/betok karena akan mengakibatkankan
sakit kepala (indepth interview). Pantangan ini
sebenarnya menurut kesehatan justru merugikan.
Hal ini dikarenakan menurut Manuaba, protein
hewani merupakan protein lengkap (sempurna)
yang mengandung berbagai asam amino esensial
lengkap yang dapat memenuhi unsur-unsur
biologis (32).
5) Tidak Boleh Mengkonsumsi Makanan
Berlemak
Ibu nifas tidak boleh makan makanan
berlemak (daging-dagingan, kuah bersantan)
karena dikhawatirkan luka vagina setelah
melahirkan lambat kering (indepth interview).
Larnkjaer et al menyatakan bahwa daging,
lemak hewani dan lemak nabati justru sangat
diperlukan untuk pemenuhan kebutuhan gizi ibu
nifas. Ibu nifas dianjurkan makan makanan yang
mengandung asam lemak omega 3 yang banyak
terdapat pada ikan laut seperti kakap, tongkol
dan lemuru. Zat tersebut penting untuk
perkembangan otak yang optimal bagi bayi (33).
6) Tidak Boleh Minum Es
Ibu menyusui tidak boleh minum es
karena mengakibatkan bayinya terkena flu
(indepth interview). Penularan flu secara medis
adalah melalui udara dan bukan melalui ASI
yang diminum bayi dari payudara ibunya.
Seorang bayi akan menjadi pilek jika tertular
oleh ibunya yang sedang flu. Menurut Yuliani,
sebenarnya makanan yang masuk ke dalam
tubuh apalagi ASI mengalami proses yang
sempurna. ASI yang tersimpan dalam payudara
sang ibu tetap hangat dengan suhu 37oC (34).
4. PENUTUP
4.1. Kesimpulan
Berdasarkan hasil penelitian diketahui
bahwa perilaku ibu hamil dan ibu nifas suku
Banjar di Kecamatan Martapura timur yaitu
dikelompokkan menjadi 3 kategori memperoleh
perawatan yaitu dari dukun kampung, adat
istiadat dan dari tenaga kesehatan. Sedangkan
pantangan ibu hamil dan nifas dikelompokkan
menjadi 3 kategori yaitu pantangan perilaku,
makanan dan minuman.
4.2. Saran
Saran yang dapat disampaikan dalam
peneltian ini Bagi dinas kesehatan, dapat
mengadakan pelatihan pijat hamil dan nifas yang
benar kepada dukun kampung di Kecamatan
Martapura Timur selama ± 6 bulan agar pijat
yang dilakukan oleh dukun kampung tidak
membahayakan bagi ibu hamil maupun ibu nifas
dan dapat melakukan pengujian terhadap herbal
yang diperdagangkan di pasar Martapura yang
sering dikonsumsi ibu hamil dan ibu nifas serta
pelatihan mengenai pembuatan ramuan herbal
yang baik dan benar selama 6 bulan kepada para
pedagang di pasar Martapura, kemudian
membuat peraturan daerah/instruksi mengenai
dukun kampung harus bekerjasama dengan
bidan desa. Bagi puskesmas dapat mengadakan
penyuluhan mengenai perilaku, pantangan dan
dampaknya selama hamil dan nifas pada setiap
kali posyandu dan kelas ibu hamil, kemudian
membuat program pendampingan bidan desa
dengan dukun kampung dalam hal kerjasama
melakukan penanganan ibu hamil dan ibu nifas.
Bagi bidan desa dan dukun kampung agar
melakukan kerjasama dalam penanganan ibu
hamil dan ibu nifas. Bagi peneliti selanjutnya
agar lebih menggali lebih dalam lagi mengenai
budaya dan makna simbolis perilaku ibu hamil
dan ibu nifas suku banjar di daerah lainnya.
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 ‘We are nothing without herbs’: a story of herbal remedies
use during pregnancy in rural Ghana
Prince Peprah, Williams Agyemang-Duah, Francis Arthur-Holmes, Hayford Isaac Budu, Emmanuel
Mawuli Abalo, Reforce Okwei & Julius Nyonyo
BMC Complementary and Alternative Medicine volume 19 (2019)

Abstract
Background
Herbal medicine has become the panacea for many rural pregnant women in Ghana
despite the modern western antenatal care which has developed in most parts of the country.
To our knowledge, previous studies investigating herbal medicine use have primarily
reported general attitudes and perceptions of use, overlooking the standpoint of pregnant
women and their attitudes, and utilisation of herbal medicine in Ghana. Knowledge of herbal
medicine use among rural pregnant women and the potential side effects of many herbs in
pregnancy are therefore limited in the country; this qualitative study attempts to address this
gap by exploring the perceptions of herbal medicine usage among pregnant women in rural
Ghana.

Methods
A sample of 30, conveniently selected pregnant women, were involved in this study
from April 11 to June 22, 2017. Data from three different focus group discussions were
thematically analysed and presented based on an a posteriori inductive reduction approach.

Results
The main findings were that pregnant women used herbal medicine, most commonly
ginger, peppermint, thyme, chamomile, aniseeds, green tea, tealeaf, raspberry, and echinacea
leaf consistently throughout the three trimesters of pregnancy. Cultural norms and health
beliefs in the form of personal philosophies, desire to manage one’s own health, illness
perceptions, and a holistic healing approach were ascribed to the widespread use of herbs.

Conclusion
We recommend public education and awareness on disclosure of herbal medicine use
to medical practitioners among pregnant women.
Background
Pregnancy is a condition associated with tremendous physiological changes resulting in
many health challenges, including frequent vomiting, heartburn, nausea, and constipation [1].
These ailments, according to Lisha and Nisha [2], often cause pregnant women to resort to
self-medication including the use of herbal medicine. Consequently, the use of herbal
medicine has increasingly gained more popularity across the globe with women as the main
users of these alternative therapies, [3, 4] specifically during pregnancy [5, 6].

Globally, the incidence of herbal medicine usage among pregnant women ranges
between 7 and 96% [7,8,9,10]. However, variations exist in the utilisation rate of herbal
medicine between developed and emerging economies which is largely attributed to cultural
differences. For example, in developed countries like Australia, United Kingdom, Italy,
Norway, and the United States, the use of herbal medicine among pregnant women ranges
from 10 to 56% [9, 11, 12]. The motivation for the use of herbal medicine has, however,
been linked to the desire to treat pregnancy-related health ailments, perceived safety and
effectiveness, and long personal experience [11, 13]. Moreover, sense of active participation,
independence, and control over health and body, and holistic treatment have been reported to
serve as additional motivations to use of herbal medicine in the developed countries [14, 15].

However, in developing countries, particularly sub-Saharan African countries, the

prevalence of use of herbs among pregnant women is estimated to range from 30 to 70%
indicating a higher prevalence of herbs used in Africa than the Western world [16]. For
instance, about 35% of pregnant women in Cote d’ Ivoire, 31% of pregnant women in
Nigeria, 33% of pregnant women in South Africa and 42% of pregnant women in Tanzania
use herbal medicine [8]. This relatively high prevalence is attributed to three main factors:
1) lack of flexible legislation regulating the distribution and purchase of herbal medicine;
2) cultural and personal beliefs and; 3) the high cost of, and low accessibility to conventional
medicine and health care [17].

In Ghana, there are scant data on the use of herbs among pregnant women, however,
it is openly known that herbal medicine since the precolonial era has played a significant role
during pregnancy, delivery and postpartum care in many parts of the country. Especially in
rural areas, the demand for herbal medicine by pregnant women has increased over the years.
Herbal medicine has, therefore, become a panacea for many rural pregnant women in Ghana
despite the modern western antenatal care which has developed in most parts of the country.

Previous studies investigating herb use in Ghana have reported general attitudes,
perceptions, and prevalence of use, omitting the standpoint of pregnant women in relation to
their attitudes, perceptions and utilisation of herbal medicine. Though such studies exist, they
are mostly concentrated in the developed world and are unlikely to be applicable to the rural
Ghanaian context lagely due to socio-cultural differences. Hence, this study was conducted
with the overarching aim of exploring and bridging the knowledge gap held by rural
Ghanaian pregnant women regarding their attitudinal and perceptional factors influencing
their utilisation of herbal medicine in Birim South District. Findings from this study are also
envisaged to offer useful information to inform policymakers in the health sector of Ghana
towards a possible integrative healthcare policy.

Theoretical approach
There are a number of perspectives that are commonly used to frame research on
attitudes, perceptions, and motivation for herbal medicine utilisation. We adopted Lauver’s
[18] theory of care-seeking behaviour [CSB] to explore perceptions and attitudes toward
herbal medicine among pregnant women in rural Ghana.

This section explains the key components (influential factors of care-seeking) of the
theory and their interrelationships (Fig. 1). The theory of CSB emerged from Triandis’ [19]
general behaviour theory. This theory has been extensively applied in many fields, especially
around behavioural changes towards healthcare utilisation among a specific group of people.
The probability to engage in certain health behaviour is predominantly influenced by two
main variables: psychological variables of affect, utility (expectation and values about
outcome), norms and habits; and facilitating variables such as health insurance, accessibility
and cost-effectiveness (Fig. 1). In explaining individual variables in the theory as captured in
Fig. 1, 'affect' refers to feelings attached to care-seeking, including treatment concerns, and
these affectual concerns may have the potential to influence people away from using certain
healthcare services. In the context of herbal medicine, people remain committed to the use of
herbal medicine and mostly exhibit unwelcome attitudes to the modern healthcare system,
which is often considered as culturally-insensitive [20]. Utility refers to the expectation,
perceived value and overall care-seeking benefits of individuals. With this, several studies
have reported that the perceived efficacy and minimal side effects of herbal medicine are the
benefits pulling people to use such therapies [20,21,22]. According to the theory, norms
describe the social, personal and interpersonal issues to capture in care-seeking. Lauver [18]
explains that an individual’s own beliefs and personal health philosophies on what is a
morally-correct behaviour of seeking care and self-agreement to act based on beliefs by
others influence the motivation to access healthcare. Recommendations from family
members’, friends’ and relatives’ as well as mass media advertisements influence healthcare
decision-making [20, 22]. Moreover, habits represent the way patients act, regarding decision
to seek care expeditiously or not. Gyasi et al. [21] emphasise that this can relate more to the
care behaviours of previous experiences, especially when a similar situation emerges.
However, according to the explanations of the theory, enabling factors such as socio-
economic status, affordable medical costs, and health insurance could influence these
mechanisms. The facilitating conditions are context specific, objective and external factors
that enable one to seek healthcare- thus, they are opposite of conditions that serve as barriers
to care-seeking.
 As seen in Fig. 1, the relationships among the theoretically identified variables are
that psychosocial variables could influence behaviour in interaction with facilitating
conditions [19]. The linkages among the variables identified theoretically suggest that
psychosocial variables could influence the direction and magnitude of health behaviour
either directly or indirectly, and this tendency cannot be underrated. Specifically, the
influences of psychosocial variables on behaviour could be direct, whereas variables
extrinsic to the theory, such as clinical and demographic factors, are proposed to influence
behaviour only indirectly, that is, by mediation through the theoretically identified variables.
The study is, therefore, guided by this systematic and inclusive framework that provides
insight into how individual health beliefs influence their care decisions. As a theory,
the methods and analysis are largely interconnected. The key components (variables
influencing care-seeking behaviour) of the CSB theory underpinned the overall methods of
the study, especially data collection and analysis techniques. In addition, the discussion
section of the study was also guided by the theory as interpretation of the findings was
repeatedly linked to specific theoretically identified variables or factors in the theory for
meaningful conclusions and implications to be made.
Methods
Study design and context
This study adopted a qualitative research approach which allowed the original
feelings, experiences and belief systems of participants to be of much importance [23, 24].
These perspectives ensure maximum interaction between the researchers and the
interviewees to generate a meaningful collaborative effect [25]. This research orientation was
useful because it helped to avoid rigid structural paradigms such as those in positivist
research and adopt more personal/flexible research structures which are receptive to
capturing meanings in human interaction and making sense of what is perceived as reality.
With this, the interviewer and his/her informants are interdependent and mutually interactive
and remain open to new knowledge throughout the study, developed with the help of
informants [24, 25].

The study focused on the Eastern Region which is popularly known for healthcare
and therapeutic pluralism where traditional and conventional medicines are used side by side.
However, herbal medicine dominates in this region. This district was chosen also because of
its location. The district is located within a semi-deciduous forest landscape, which provides
a wide variety of medicinal plant products for traditional and alternative healing purposes.
Hence, the district and communities were considered an ideal location for a study that sought
to explore pregnant women attitudes, perceptions, and utilisation of herbal medicine.

The sample and sampling procedure

Participants for the study were a convenient sample of pregnant women in rural
communities within the Birim South District who were using herbal medicine prior to the
study. The participants were recruited by the researchers themselves from their various
homes, clinics/health centres, and workplaces. This was determined by asking pregnant
women the question ‘Are you using herbal medicine?’ which yielded a ‘yes’ or ‘no’ answer.
Here, herbal medicine was defined as a plant’s seeds, berries, roots, leaves, bark, or flowers
for medicinal purposes. In all, 50 pregnant women were approached and asked this question,
30 were using herbs, 12 were non-herb users whereas 8 declined to answer the question and
subsequently participate in the study. Based on this, 30 pregnant women who were herbal
medicine users were included in the study to obtain high-quality information of herbal
medicine use among pregnant women in rural Ghana. The sampling technique provided the
needed flexibility to focus on participants who were required for the study.
Data generation tool and procedure
We used focus group discussions for data collection because of its flexibility and
openness which enhance unstructured dialogue between the participants and
facilitators/moderators for eliciting multiple perspectives about the topic under investigation
[26,27,28]. We conducted three different focus group sessions with each group made up of
10 participants for a detailed and rich information on the subject matter as recommended
[29, 30]. The discussions were conducted in ‘Twi’ (the predominant language in the study
area) at open places devoid of third-party interference. Each discussion session lasted for
approximately two hours. All participants were assigned numbers for identification. The
opening discussion question asked participants to provide details of their experience with
regard to specific herbal medicine use. This question generated further arguments and
discussions which yielded in-depth data for the study. The discussions were moderated by
the researchers themselves to ensure that similar themes and questions were covered in each
discussion. All discussions were audio-recorded with the consent of the participants. The
moderators made use of cues and prompt to guide and direct the participants into the research
topic area; hence they were able to gather more detailed data set. The focus group method
has a key limitation pertaining to a propensity for groupthink in that members pressure others
to conform to group consensus [31]. Due to the skills of the moderators, conscious
monitoring was undertaken to minimise this tendency.

Data analysis
Data analysis was conducted immediately after all the data were collected to prevent
data loss. The analysis involved several steps based on a common set of principles:
transcribing the interviews; listening to audiotapes, studying the field or reading the
transcripts; developing a data coding system and linking codes or units of data to form
overarching categories or themes [32]. To ensure adequate data management, audio records
were transcribed and listened, and the responses were typed from the “Twi” dialect into the
English language by all the authors individually and cross-checked with the audio records
and handwritten field notes to ensure validity, reliability and quality control. The thematic
approach of analysis chose by the study is dynamic: it is open to change, driven by the
original accounts and observations of the participants and has previously proven to be
reliable in a healthcare setting [33, 34]. This technique also allowed researchers to derive
themes from the experiences the interviewer obtained from the interactions with the
respondents, rather than prior theoretical standpoint of the researchers through a posteriori
inductive reduction approach.

Subsequent themes were compared with the responses to identify common trends,
similarities, and contrasts. We conducted full data verification where all the transcribed and
coded data were checked through proofreading against the original audios and documents to
enhance accurate and quality data for the study. The study results were presented under
specific broad themes and key subjective views of the participants were presented using
quotations.
Results
The findings of the study constitute the analysis of accounts of the sample recruited for
the study. The pregnant women’s positive attitudes, perceptions and regular use of herbs
were identified as a core theme and eight interlinking sub-themes were identified to explain
the core theme. These were:

a. Herbs as the first port of call during pregnancy

b. Indigenous knowledge, friends, relatives and the mass media as sources of herbal
medicine information

c. Personal philosophies and illness perceptions

d. Empowerment, control, and participation

e. Previous unpleasant experiences of using conventional medicine

f. Whole person treatment and perceived efficacy and safety/natural healing

g. Perceived good health status because of herbs use

h. Poor disclosure habit

Background information of the study participants

In all, 30 pregnant women participated in the study. Most of our participants were
aged between 25 and 35 years (19), currently married (23), Christians (25) and attained only
basic school-level education (22). Most participants were self-employed (21) and were
dealing in informal economic activities such as traditional peasant farming, artisanal works
and petty trading which was reflected in the relatively low-income levels, with the majority
receiving monthly income less than GH¢250 ($56.95). Interestingly, most participants (24)
had health insurance, which covers medicine at all public and some private healthcare
facilities but were still using herbs, providing initial indication for their strong preference for
herbal medicine. Table 1 presents the detailed characteristics of the study participants.
Table 1 Sample Characteristics

Variables Categories N (30)

Age (years) 18–24 7
25–35 19
36–45 4
Education None 3
Basic 22
Secondary 3
Vocational 2
Marital status Single 2
Married 23
Divorced 3
Widow 2
Employment status Institutionally employed 2
Self-employed 21
Unemployed 7
Household size 1–3 2
4–6 17
>  6 11
Health insurance status Yes 24
No 6
Average monthly income (GH¢) < 250 15
250–350 9
> 350 6
Religious affiliation Christianity 25
Islam 5
Ethnicity Akan 20
Others 1

Herbs as the first resort during pregnancy

Specifically, herbs remained the first therapy used among all the participants with most
pregnant women using it once during pregnancy. All the participants were using herbs on
regular basis for curative, preventive and health promotion or management therapies. Herbs
are the first port of call before formal health visitation in respondents’ vicinities, especially
during emergency situations. Most of the participants believed that herbs are part and parcel
of their culture and must be used first before any other medicine, when applicable. Other
factors reported included availability, accessibility, and cost-effectiveness:

a. Participant three: I use herbs almost every week to prevent diseases. You know
what? These herbs are accessible, available and very cheap if you are to buy
compared to the conventional medicine.
 b. Participant eleven: For me, herbs are the main medicine that I use. I have prepared
a concoction in my house that I take every morning, afternoon and evening. So, I take
herbs every day, except days that it has finished, even when it gets finished, it does
not take me more than a day to prepare another one. These herbs are effective,
natural and sensitive to our culture, unlike the conventional drugs.

Interestingly, the study participants showed some specific herbs during the interactions.
Participants reported that the most commonly herbs used include: ginger (Zingiber
officinale), peppermint (Mentha × piperita), thyme (Thymus Lamiaceae), sage (Salvia
officinalis), aniseeds (Pimpinella anisum), fenugreek (Trigonella foenum-graecum), green
tea (Camellia sinensis), garlic (Allium sativum), tea leaf (Camellia sinensis), raspberry
(Rubus idaeus), and echinacea leaf (Echinacea purpurea). The herbs participants were using
were mostly of European origin. The herbs displayed by the participants were for the
treatment and prevention of pregnancy-related complications such as relief of back pain,
dizziness, stress, and depression, cold, fever, malaria, vomiting, and nausea reduction, as
well as to prevent miscarriages. For instance, participants specifically mentioned that ginger
and aniseeds are effective for treating many forms of nausea, that sage, and echinacea leaf
provide natural treatment to relieve or cure depression, and that peppermint and garlic are
effective against the common cold. A combination of boiled tealeaf and fenugreek herbs
were described as effective for dizziness, fever, and malaria.

Indigenous knowledge, friends, relatives and the media as

sources of herbal medicine information
Pregnant women have in-depth knowledge about some medicinal plants or herbs that
exist in their communities. It became evident that various kinds of medicinal herbs,
particularly ginger (Zingiber officinale), peppermint (Mentha × piperita), tea leaf (Camellia
sinensis), and raspberry (Rubus idaeus) have been with them since time immemorial and as a
result, knowledge is transmitted from generation to generation and does not require formal
education or training for them to know more about medicinal herbs. It emerged from the
interviews that ginger, peppermint, and tea leaf are mostly grown or collected at the area or
backyard of participants.

a. Participant one: You see, most medicinal herbs we have in this community dated
back in history even pre-colonial period. Our ancestors used them and passed them to
us. So to me, knowledge about herbs is transmitted from one generation to another.
Personally, I do not think I need formal education to get knowledge about herbal
medicines. The same applies to many people in this community, once you are born
into herbs usage, you will automatically have knowledge about them.

Aside from the indigenous knowledge, participants also receive supplementary

information about herbs from friends, relatives, family members through recommendations
and the mass media (radio and television) via advertisement modules. They specifically
mentioned that herbs such as sage, thyme, aniseeds, and fenugreek are mostly bought
commercially based on advertisements.

Some shared opinions are presented below:

b. Participant four: Though we have some local knowledge about herbal medicine, we
also get more information constantly from the mass media. They always advertise and
discuss these therapies on televisions and radios which often provide us with
information. Mostly, our family members and friends also give us information about
some type of herb they know that maybe we are not aware. Have you seen this
medicine? I heard about it on the radio that it is very effective for pain relief and I
have bought it.

Personal philosophies and illness perception

Most of the women's accounts indicated that individual philosophies are directly
connected to their unique religious values and the belief systems which influence their
healthcare seeking behaviours. The notion that herbs are culturally-sensitive was echoed by
the participants with most of them arguing that traditional herbal medicines harmonise with
their religious, cultural and spiritual beliefs:

a. Participant five: One thing is that herbs have been with us for a very long period and
have become part of our tradition, culture, and beliefs. I can tell you with a command
that I have great knowledge about these herbal medicines. I know the inside and out
of most traditional herbs, we were born into their usage. I can tell you that any
member in this community knows specific traditional herbs that he or she relies on.
For herbs knowledge, we have it. This is because it is part of our culture unlike the
conventional medicine that is alien to us. At least, we should have some form of
knowledge about the therapy before using it. But here is the case that we do not have
any knowledge about most of the conventional medicine. So, we use herbs because we
know how it is and how it works.

One pregnant woman also related that by explaining how traditional beliefs have
influenced her to use herbs throughout her pregnancy period:

b. Participant seven: I have a strong belief in the potency of herbs. I know that herbs
are part of our culture and total upbringing. I was born into herbs use and have
grown in it. It always yields good results when I use it to treat any disease I may
suffer from. I think if not herbs, I would have died a long time ago. Herb is my
saviour.

It was further observed that most of the participants believed certain diseases in
pregnancy and complications during childbirth have strong spiritual connections of which
conventional medicine cannot cure. Pregnant women strongly argued that using herbs from
the onset of pregnancy period helps prevent these unforeseen spiritually-motivated diseases.
Thus, participants perceived spiritual illness as a reason to use certain herbs:

c. Participant twenty-five: Just like most pregnant women in this community, I started
using herbs right after pregnancy was confirmed. I do this because, without such
herbs, the likelihood that my child would be affected with diseases is very high. So, I
use it to prevent both physical and spiritual diseases which can affect my pregnancy.

Another participant also related with much emphasis on spirituality:

d. Participant nineteen: You see …. When you are pregnant several eyes are watching
you and not all these eyes are good, some of the eyes watch you with bad intentions to
destroy you the parent or the unborn child. To prevent this, we use certain herbs that
can prevent such unforeseen diseases with spiritual motivations. Because spiritual
diseases must be tackled spiritually through the application of spiritual herbs.

Empowerment, control and participation

The desire to take full responsibility and manage their own health and healing during and
after childbirth was observed to be another factor that influenced participants to use herbs. In
addition, the women emphasised that the use of herbs empower as well as enhancing their
confidence to birth their babies in their own abilities:

a. Participant twenty-four: I cannot allow someone to control my health for me. This is
because I know myself more than the person [Medical doctor or trained health
professional]. I know what is good for me in terms of medicine. I have to control my
own health.

They interestingly explained that allowing someone to take full responsibility and control
of their health may not lead to good health outcomes:

b. Participant twelve: What is the guarantee that I can give birth with no complication
if I do not use herbs? You know what … these herbs help us to be confident that we
can give birth naturally without the help of any midwife. These herbs have helped me
birthed four children with no complication at any point in my deliveries. So, I will
continue to use them to empower me to take control and responsibility for my health.
Previous unpleasant experiences of using conventional medicine
Most of the participants also ascribed dissatisfaction and prior unpleasant experiences
with the use of conventional medicine as reasons for using herbs. Previous unfortunate
experiences, particularly perceived ineffectiveness and the adverse side effects of
conventional medicine have influenced participants’ attitudes and perceptions toward
conventional medicine and thereby pushed them towards herbs use:

a. Participant six: Conventional medicine is mostly ineffective, chemically-infested,

expensive and has serious health implications, at the end, these conventional
medicines will just cure signs and symptoms and not the disease itself. I remember I
was suffering from malaria as the doctor confirmed. I was given several medicines of
which I took them all but the malaria did not go. I battled this for more than two
months. Someone recommended one herbal mixture to me and I took it for only three
days to feel better. Do you think with this experience I will still use conventional
medicine?

In relation to the above comment, one participant also noted that:

b. Participant eleven: I will always use herbal medicine due to what I have observed
about most of the conventional medicine I have used previously. I mostly vomit and
feel dizzy whenever I take those conventional medicines. So, I am always afraid to
take it.

Whole person treatment and perceived efficacy, safety and

natural healing
The study participants viewed the application of herbs as a holistic approach to healing
where whole person treatment is conducted by viewing health and disease through the
integration of mind, body, and spirit. Participants clearly elucidated that herbs do not mostly
target one particular disease but cure holistically with no or minimal effects:

a. Participant five: Herb is everything to me and I really respect these therapies. I see
herbs as effective medicine that can heal all manner of diseases with no or minimal
side effects even when one takes it overdose. To me, I am nothing without herbs.

b. Participant thirty: I am speaking for myself and other pregnant women in this
community, without herbs, most pregnant women would have been dead long ago due
to the fact that most conventional medicine given to us by healthcare providers are
ineffective. It is capable of treating as many as diseases at the same time. So, we have
a special respect for herbs.
 In addition, most of the participants recognised the spiritual dimension of childbirth, as
childbirth is a healing, life-changing event and herbs were believed to be effective for
tackling perceived spiritual diseases:

c. Participant twenty: You will agree with me that midwives at the health centre only
deal with diseases in the physical realm. However, most pregnancy-related illnesses
is spiritually-motivated which need to be cured and prevented through certain
traditional herbs and concoction known to be effective for such illness.

The safety of conventional therapies was a subject of major concern for the study
participants. Most respondents mentioned that prescribed medicine contain chemicals that
may have both momentary and long-term side effects on their pregnancy. On the contrary,
they perceived herbs to be safe and devoid of adverse side effects. It was further observed
that the belief that herbs are safe was based on their understanding of the notion of “natural
being neutral”. Thus, herbs appear natural and therefore considered to be safe for use:

d. Participant thirty: Natural plants are mostly free from health-threatening chemicals
unlike manufactured medicine from a hospital or a chemist’s shop. They (herbal
medicine) are safe because they are natural.

Perceived good health status as a result of herbs use

Pregnant women perceived their health status during the study to be very good and
attributed it to the regular use and perceived effectiveness of herbs:

a. Participant ten: I see my health status as very good, I hardly fall sick and I believe is
because of the traditional herbal medicine that I regularly use.

Interestingly, our study participants shifted the discussion by comparing their health
status to other pregnant women who they know to be not herb users in the community. The
participants perceived their health status as better than the status of pregnant women who use
conventional medicine. They explained that pregnant women who use conventional medicine
mostly report of sickness and often visit hospitals for health care, meanwhile users of herbs
hardly report sickness:

b. Participant twenty-two: I can say my health status is very good. I must attest to the
fact that my health status was not good when I was using orthodox medicine for
disease treatment. With herbs recommended by a friend, my health status has been
very good. Moreover, what I have observed in this community for a long time is that I
see that pregnant women who rely solely on conventional medicine and health care
mostly report illness than the herb users. In all, I see the herb users to be healthier
than the conventional medicine users in this community.
Poor disclosure habit
The study found that pregnant women occasionally used these herbs alongside with the
conventional drugs, but they rarely disclose this to health professionals during hospital visits.
Principal reasons highlighted by pregnant women to account for this non-disclosure included
beliefs that herbs are natural and safe, fear of losing control over their health decisions and
fear that health professionals would victimise, reproach, discourage and possibly stop them
from using herbs:

a. Participant twenty: Most at times we do not tell the doctors and midwives about our
use of herbs, even when they ask us we replied no. To me, when you tell them, they
might not be interested and as a result, stop you from using these therapies. Even,
those medical professionals who are strongly against these herbs can reproach and
discourage you from using herbs.

Also, some participants saw no benefit in disclosing herb use to professionals who they
think did not have adequate knowledge about these herbs and are mostly alien to their
traditional settings including medicine:

b. Participant sixteen: Personally, I see no benefit in the disclosure since most health
professionals do not know much about these herbs and are also alien to our culture.
The doctors have asked me several times, but I have never replied yes, meanwhile I
use it and I will continue to use it.
Discussion
This study has detailed a spectrum of attitudes, perception, and utilisation of herbal
medicine among pregnant women in rural Ghana. Empirical studies exploring socio-
demographic characteristics of pregnant women who use herbs have reported divergent results
due to variations in geographical and economic settings, particularly between developed and
developing countries. In addition, cultural settings and access to conventional medicine and
healthcare services may have an important role in these variations [35]. In a manner inconsistent
with the findings of previous studies on herbal medicine user characteristics [4, 36, 37, 38], this
study revealed that pregnant women using herbal medicine mostly had low incomes as well as
low levels of education [39]. In consonance with the facilitating variables of accessibility and
cost-effectiveness in Fig. 1, the pregnant women studied are enabled to use herbs particularly due
to limited income and accessibility. This is because in most rural areas in Ghana, local herbs are
mostly free and easy to be found usually at the backyard of residences.

The study found that pregnant women have in-depth knowledge about some herbal
medicines which are common to them. As previous research has found [35], knowledge about
herbs is transferred from one generation to the other with users capable of correctly classifying,
describing and identifying the herbal products they used. Meanwhile, information on herbs
which are of foreign origin is becoming accessible through advertisements on various media
outlets such as television and radio.

In line with the explanations of the CSB theory, the study found that personal
philosophies, attitudes, trust, and satisfaction are critical factors that mostly dictate the use of a
healing modality. It can be seen from the explanation of Fig. 1 that factors influencing
participants’ use of herbal medicines are related to both facilitating conditions (satisfaction and
trust) and norms (personal philosophies and attitudes). Thus, in relation to Fig. 1, participants
were enabled to use herbal medicine due to their levels of satisfaction, trust in the herbs, and
personal beliefs about what is morally correct behaviour. For instance, regarding the element of
norms in Fig. 1, in most rural areas in Ghana, pregnancy events are interpreted with spiritual
dimensions and specific complications such as delay in the delivering process and miscarriages
are attributed to witchcraft and gods; pregnant women are thus often motivated from on the onset
of pregnancy period to use certain herbal medicine that they believe to have proved effective in
preventing such unforeseen events.

Meanwhile, patients’ attitudes, trust levels, and satisfaction are important indicators of
quality of healthcare and play a very critical role in influencing patients’ choice of health care
providers [40,41,42,43]. Similarly, Pascoe explained that patients’ satisfaction information can
provide a dependent measure of service quality and serves as a predictor of the health-related
behaviour of patients [44]. Patient satisfaction may be measured in terms of satisfaction with
medical care, satisfaction with providers, and satisfaction with outcomes of treatment [45]. The
trust and satisfaction gained by pregnant women with the use of herbal medicine have influenced
their perceptions and attitudes towards herbal medicine. These attitudes and perceptions of
pregnant women toward herbs reflect their personal experiences as well as their levels of
individual exposure to herbs in the past and present. People may have positive perceptions and
attitudes towards herbal medicine due to their beliefs which are congruent with traditional
healing practices.

Copious contemporary studies in both developed and developing settings, urban and rural
settings have ascertained frequent and high uptake of herbal medicine among pregnant women
for diverse reasons [46,47,48,49]. Similarly, this study demonstrated frequent use of herbal
medicine among pregnant women in rural Ghana. The most frequently used herbal medicine
found among pregnant women were ginger (Zingiber officinale), peppermint (Mentha ×
piperita), thyme (Thymus Lamiaceae), sage (Salvia officinalis), aniseeds (Pimpinella anisum),
fenugreek (Trigonella foenum-graecum), green tea (Camellia sinensis), garlic (Allium sativum),
tea leaf (Camellia sinensis), raspberry (Rubus idaeus), and echinacea leaf (Echinacea purpurea).
These herbs used by pregnant women in rural Ghana as found by the study have been reported
by previous studies in both developed and developing countries
[2, 35, 46, 50,51,52,53,54,55,56,57]. Similar to other study findings [46, 53, 58, 59], these herbs
were first used on daily basis before any other medicine with most pregnant women using them
consistently throughout the three trimesters of pregnancy. However, what makes this finding
extremely interesting is that most of these herbs used by the sampled pregnant women in rural
Ghana were mostly of European and Asian origin, not traditional herbal medicines originating
from Ghana. This result can be attributed to mass media campaigns, migration, and colonial
influence. The establishment of media outlets in a form of diverse radio waves and telecasts have
emerged and contributed immensely to the widespread information about herbs through constant
announcements and advertising modules. These media outlets together with recommendations by
relatives and friends served as significant knowledge sources and awareness proxies for herbal
medicines [2, 35, 40]. This finding implies that more pregnant women are likely to continue
using these herbs since information and awareness of herbal medicines are more likely to spread
across the population in the Region considering the increasing spread of these media outlets and
its associated herbal medicine information dissemination in Ghana.

Various reasons accounting for this regular use of herbal medicine among pregnant
women were associated with cultural, social and economic undertones, which are inconsistent
with previous studies [6, 8, 15, 38]. The perceived effectiveness, safety, cultural sensitivity,
holism, and desire to have control over their health during and after childbirth were the main
mediating factors influencing pregnant women’s attitudes, perceptions and the resultant use of
herbs. This can also be linked to the utility variable (expectations and values about outcomes) in
Fig. 1. Participants were mostly using herbs with the idea that herbs are effective for pregnancy-
related ailments such as back pain, dizziness, stress, cold, fever, malaria, vomiting, and nausea,
which reflects the overall benefits of using herbs.

The argument by pregnant women using herbs was that conventional medicine is not
very effective in dealing with most pregnancy-related diseases. Second, the respondents
bemoaned the fact that upon the use of these medications, the numerous adverse reactions in the
form of side effects threatened the safety of the patients w. In comparison, however, even the
perceived safety and effectiveness associated with herbs has been keenly contested since there is
no substantial empirical evidence and verifiable data explaining the safety of most herbs used by
pregnant women, especially those in rural areas. For instance, Nordeng et al. [38] iterated that
safety, is held to be an important feature of any treatments and interventions by many pregnant
women often resulting in attempts to avoid pharmaceutical treatments during pregnancy or to
approach the use of such therapeutic options with caution [56]. Most pregnant women in our
study and other studies elsewhere often explain the naturality of herbs to mean safety and do not
envisage any side effects of these herbs' consumption during pregnancy [15]. The perceived
effectiveness of herbs is more important to pregnant women than the possible side effects [60].
This finding suggests that, although pregnant women exhibited positive perception and attitudes
towards herbs as well as frequent use of herbal medicines, there is an urgent need to validate the
quality of these traditional herbal medicines through randomised clinical trials and test to prove
these herbs safety in rural Ghana where herbal medicine is widespread; less expensive, more
readily available, accessible and closer to the people than conventional ones.

One area that has generated tremendous debate in midwifery recently is the belief of
midwives and obstetricians supremacy over childbirth [61, 62]. There is a belief that midwives
deny pregnant women the right to have some sort of control over their own health issues and
body as a whole [61, 62]. In addition, supporters of biomedicine have argued that scientific
medical practices are purely concerned with disease and science as well as principles and
methods to the neglect of environmental and social issues in favour of biological ones [63, 64].
This scientific medical practice is often argued to treat diseases, rather than the person and
mostly overlook patient’s individual experience [65, 66]. With scientific medical approach,
health is seen as holistic while herbal medicine use provides a unique holistic way to treat not
just an aspect of the being and or disease-specific but a whole being, considering the importance
of body, mind, and spirit. The notion that herbal medicine conveniently deals with physical,
spiritual and or emotional problems towards a “whole health” restoration by pregnant women
pushes them to take herbs regularly [67,68,69]. This implies that holism remains one major
concept that separates the traditional system of medicine and the conventional counterpart. These
sentiments shared by pregnant women who formed the main participants and unit of analysis in
the study reflect similar feelings described in earlier studies which found that pregnant valued
self-confidence in their capacity to manage their own health issues, linked to sentiments of
autonomy and control [70, 71]. This concept of a whole person approach to health and well-
being may be useful as advocated by World Health Organisation [WHO] that health is “a state of
complete physical, mental and social well-being and not merely absent of disease or infirmity”.

Ben-Ayre and Frenkel [72] argued that the popularity of complementary and alternative
medicine [CAM] therapies of which herbal medicine is part, has affected doctor-patient
communication as patients do not disclose their CAM use to medical practitioners. In fact, this
study reveals that herbal medicines were often used by pregnant women without the knowledge
and support of medical practitioners. The herbs used were mostly self-prepared by combining
different kinds and parts of plants. In agreement with other empirical findings [8, 35, 48],
pregnant women intentionally declined to disclose their use of herbs to their health professionals,
even when asked, but preferred to seek advice from family and friends. The non-disclosure habit
was found to be associated with the belief that herbs are natural and safe, that health
professionals would create feelings of victimisation, reproach, discouragement and possibly stop
their use of herbal medicine, the fear of relinquishing control over decisions concerning their
wellbeing and health, and the belief that health professionals do not have adequate knowledge
concerning the herbs used [15, 46]. In contradiction, Tsui et al. [73] found that 70% of
their Californian respondents had reported their herbal medicine use to a primary healthcare
practitioner or a doctor. This inconsistency could be because of difference in the study settings
and methodological approaches.

The results of this study identified good perceived health status among pregnant women
who were herb users. Pregnant women rated their health status as good and attributed it to the
regular use of herbs. However, these women emphatically mentioned that their health status was
far better than their non-users' counterpart when comparing their rates of sickness complaints and
number of hospital visits. Pregnant women who used herbs argued that non-users of herbal
medicine frequently complain of ailments and as a result visit hospitals on regular basis. With
this, our study participants maintained that using herbal medicines could relieve and prevent
diseases and thus; promote good health during and after pregnancy.

It is also important to note that the CSB theory that guided the study cannot completely
explain the findings of the study. For instance, the perceived health status of participants cannot
be explained by the theory. This is mainly because the theory discusses behaviours toward care-
seeking, and does not explain what the health status of individuals would be after engaging in a
particular health behaviour. This probably calls for an extension of the theory to include health
status.

Some strengths and limitations of this study need to be acknowledged to inform readers
to put the interpretation of the study findings into its right context and perspective. To best of our
knowledge, this is the first study to provide insights into the rural pregnant women’s perspective
of perceptions, attitudes, and utilisation of herbal medicine in Ghana. The study, therefore,
demonstrates a depth of understanding from the views of persons of beneficiaries of herbal
medicine use (pregnant women) and offers an important contribution to address the existing gap
in knowledge. It also probes Ghana’s health policy framework on a potential regulation of
intercultural healthcare system. However, the study has some limitations which are premised on
its methods; particularly sample size and sampling procedures. This study consciously prioritised
the depth of participants’ experiences, rather than merely the breadth. The authors believe that
the limitations are far outmatched by the benefits offered by conducting this first empirical study
on herbal medicine perceptions, attitudes, and utilisation among pregnant women in rural Ghana.
Conclusion
This qualitative study explores the attitudes, perceptions, and utilisation of herbal
medicine among pregnant women in rural Ghana. Many pregnant women reported positive
perceptions and attitudes towards herbs as well as using herbal medicine therapies frequently.
However, rural pregnant women predominantly ascribed perceived efficacy, safety, control and
autonomy over health issues, holistic approach of herbs, availability, accessibility, and cost-
effectiveness as reasons for the widespread herbal medicine use. Therefore, we recommend
public education and awareness on disclosure of herbal medicine use to medical practitioners
among pregnant women. Moreover, the study findings call for further clinical research into the
safety of most herbs used by pregnant women through appropriate institutions such as the Ghana
Health Service.

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KESIMPULAN

Berdasarkan hasil penelitian dari 2 jurnal yang telah saya kumpulkan, dapat disimpulkan
bahwa obat herbal yang digunakan di pedesaan Ghana adalah jahe, peppermint, thyme,
chamomile, aniseeds, teh hijau, tealeaf, raspberry, dan daun Echinacea yang digunakan secara
konsisten sepanjang tiga trimester kehamilan. Serta perilaku ibu hamil dan ibu nifas suku Banjar
di Kecamatan Martapura timur yaitu dikelompokkan menjadi 3 kategori memperoleh perawatan
yaitu dari dukun kampung, adat istiadat dan dari tenaga kesehatan. Sedangkan pantangan ibu
hamil dan nifas dikelompokkan menjadi 3 kategori yaitu pantangan perilaku, makanan dan
minuman.