Crossing the river: Khmer women's perceptions of pregnancy and postpartum.

In Cambodia, a setting of high maternal mortality, little is known about cultural perceptions of pregnancy. Often, cultural perceptions of what is considered normal or problematic guide a woman's decision to seek care. In some settings, the difference between the emic, or cultural insider's perception, and the biomedical perception of what is a serious obstetrical problem may delay lifesaving care. A qualitative study was undertaken to describe an emic perspective of what Khmer women view as normal and view as complications during pregnancy, birth, and postpartum. Focus group and key informant interviews were held to answer the questions: What do Khmer women and their birth attendants view as complications during pregnancy, birth, and postpartum? How are these complications defined? Eighty-eight rural and urban women of childbearing age participated in focus groups in three rural provinces and Phnom Penh. In-depth, semistructured interviews were held with 41 rural and urban women, traditional birth attendants, and trained midwives. Sixty-six hours of taped interviews were transcribed, translated, and analyzed, and descriptions of emic conditions during pregnancy and postpartum were developed. This report details emic categories of antepartum and postpartum conditions identified by these Khmer women. Specific emic categories of normal pregnancy and postpartum are described in detail as well as abnormal emic conditions occurring during the postpartum period. Recommendations are made for use of traditional emic taxonomies as a foundation for explaining biomedical complications and the need for similar studies to guide the development of safe motherhood programs in areas of high maternal mortality.