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Table 2 Pertinent features of included studies

From: Complementary medicine products used in pregnancy and lactation and an examination of the information sources accessed pertaining to maternal health literacy: a systematic review of qualitative studies

Author (date) Country (economic classification a) Number of participants Data collection method Data analysis method Study aims CMPs reported on in the papers b Stage in the continuum of childbearing reporting use of the CMP as interpreted by the author c Information sources women access for CMPs
Aborigo et al. (2012) [60] Ghana (LMIC) 253 (including 35 women with newborn infants; 8 traditional birth attendants and local healers; 16 community leaders; 4 Focus Group Discussions [FGDs] with 8–10 grandmothers each; and 12 compound heads) In-depth interviews [IDIs] and Focus group discussions [FGDs] Not stated To explore breastfeeding initiation and supplementation; cultural practices around breastfeeding initiation; and implications for the improvement of infant health Herbal medicines Breastfeeding Traditional Birth Attendants (TBAs); herbalists; other local healers; women’s mothers-in-law and grandmothers; heads of households
Callister et al. (2011) [61] Three countries: The People’s Republic of China (UPIC), Taiwain (HIC) and USA (HIC) 34 Chinese women (10 living in Guangzhou, China, 12 living Taiwan, and 12 who had immigrated to western United States.) In-depth interviews Not stated Comparison of childbirth experiences of Chinese women in their countries of origin with those who had immigrated to the USA before giving birth; provide insights on Chinese women’s cultural practices and beliefs associated with giving birth for nurses and midwives in the USA. Herbal medicines Pregnancy and postnatal month Shared cultural traditions; women’s mothers and mothers-in-law
Dako-Gyeke et al. (2013) [62] Ghana (LMIC) 55 (including 17 pregnant and 15 postnatal women; 10 nurse-midwives; 2 medical doctors; 3 community members; 3 spiritualists; 1 traditional birth attendant; 1 herbalist) In-depth interviews and Focus group discussions Not stated Describe the beliefs, perspectives and knowledge of pregnancy and birth of peri-Urban Ghanaian women and how these influence the health care seeking behaviour these women. Herbal medicines Pregnancy, labour and birth Herbalists, TBAs and some spiritualists
Damanik (2009) [51] Indonesia (LMIC) 64 (including 24 current mothers; 36 grandmothers) In-depth interviews and Focus group discussions Content analysis and Ethnography To gather information about cultural beliefs and practices around the use of the plant Torbangun (Coleus amboinicus Lour) as a galactagogue by Indonesian women postnatally. Herbal medicines Breastfeeding and the postpartum month Shared cultural traditions; mothers, mothers-in-law, and husbands of the new mother
Ejidokun (2000) [54] Nigeria (LMIC) 25 (23 pregnant women; 2 health care providers who were also local grandmothers and midwives) Focus group discussions (23 pregnant women) and in depth interviews (2 health professionals) Thematic content analysis Assess the knowledge, attitudes and practices related to maternal anaemia among pregnant women, health workers land the community in two Nigerian sites; to identify barriers and enablers to the use of folic acid and iron tablets by pregnant women; assess family members’ and maternal health care providers’ awareness of maternal anaemia, and how much importance they attach to it. Iron and folic acid tablets Pregnancy Media: radio & printed advertisements on buses; health clinic workers; information given in places of worship like mosques.
Elter et al. (2016) [58] Thailand (UPIC) 16 (all pregnant women) In-depth interviews, participant observations, and a demographic record Interpretive phenomenology To explore first-time Thai mothers’ experiences of postpartum family practices, particularly their experiences and understandings of spiritual healing. Herbal medicines Early postnatal period including breastfeeding Shared cultural knowledge; family elders
Grewal et al. (2008) [43] Canada (HIC) 15 (postnatal women with babies less than 3 months) [N.B. 5 health care professionals and community leaders also provided recommendations based on the study findings] In-depth interviews Naturalistic qualitative descriptive design Describe knowledge and cultural traditions of newly immigrated Punjabi women’s pregnancy, birth and postnatal experiences in Canada; the role of family and community in these experiences and how women incorporate these beliefs and practices into the Canadian health care system; and women’s interactions with the Canadian health care system Herbal medicines Labour and birth, early postnatal period and breastfeeding Shared cultural knowledge; elders especially female family members including mothers, mothers-in-law, and sisters-in-law and husbands (if no extended family around) prepared the herbs in foods and teas for the women
Holst et al. (2009) [52] United Kingdom (HIC) 6 pregnant women (all women were recruited from an antenatal clinic and had used herbs in pregnancy) One Focus Group Discussion Content analysis To increase understanding of women’s reasons for using herbal products during pregnancy Herbal medicines Pregnancy Family and friends; internet; CAM and biomedical HCPs
Juntunen et al. (2000) [7] Tanzania (LIC) 49 (including 28 women; 21 men; informant also included a pastor; traditional healer; farmers; teachers; village health workers; traditional birth attendant; and trained hospital staff) Open-ended interviews and participatory observation Ethnography To identify cultural care practices and beliefs around health protection the Bena people use throughout their lifetime Herbal medicines Pregnancy, labour and birth, early postnatal period Local traditional African healers; older women in the community
Lamxay et al. (2011) [56] Lao People’s Democratic Republic (LMIC) 30 (23 women; 7 men) Group interviews and individual interviews Ethnobotanical research To study the activities and diet followed by the Kry ethnic group in Lao People’s Democratic Republic during pregnancy, childbirth and postpartum confinement period, and identify medicinal plants used during these times. Herbal medicines Pregnancy, labour and birth, postpartum period and breastfeeding Husbands and other relatives, other mothers who had given birth several times and acted as assistants to the birthing woman
Liamputtong et al. (2005) [4] Thailand (UPIC) 30 (all women - most had recently given birth; a few were currently pregnant) In-depth interviews Phenomenology To understand women’s traditional beliefs and practices regarding pregnancy and childbirth among women in Northern Thailand, including the role of a traditional midwife. Herbal medicines Pregnancy, labour and birth Mothers or women and men of older generations; mor mon, a magical healer or older man who has knowledge about magical cures and healing
Mogawane et al. (2015) [64] South Africa (UPIC) 15 (all currently pregnant women) Unstructured one-on-one interviews Qualitative, explorative, descriptive, and contextual research design Investigate the Indigenous [medical] practices of pregnant women attending the Dilokong hospital, Limpopo Province, South Africa Herbal medicines Pregnancy, labour and birth Traditional African Healers, TBAs, also community elders and church leaders
Ngomane & Mulaudzi (2012) [57] South Africa (UPIC) 12 (all currently pregnant women) Unstructured in-depth interviews Narrative analysis To explore and describe the Indigenous beliefs and practices that influence late antenatal clinic attendance by pregnant women Herbal medicines Pregnancy, labour and birth TBAs and family members
Obermeyer (2000) [46] Morocco (LMIC) 151 (including 126 postnatal women; 20 modern (biomedical) health care providers; 5 traditional birth attendants) Semi-structured in-depth interviews and observation in homes and clinics Ethnography Model the ethnophysiology and symbolism of pregnancy and birth in Morocco and what this implies for women’s maternal health; understand women’s health care and decision-making actions regarding birth Herbal medicines and vitamin supplements Pregnancy, labour and birth Traditional midwives and traditional healers
Okafor et al. (2014) [8] Nigeria (LMIC) 25 (all women who had delivered a baby in the previous 2 years) Focus group discussions No theory stated except Framework Method used to analyse data Discover rural women’s preferred choice of health care provider for pregnancy and delivery services in Lagos, Nigeria; inform maternal health care services for rural Nigerian women Herbal medicines Pregnancy, labour and birth TBAs
Rice (2000) [44] Australia (HIC) 33 (including 27 women; three shamans; two medicine women; one magic healer) In-depth interviews and participant observation Ethnography To examine cultural beliefs and practices related to the 30 day confinement period after birth in Hmong society for Hmong women now residing in Australia. Also to discuss traditional and changing patterns of childbearing for these women in their new social environment. Herbal medicines Breastfeeding and the postpartum month Shared cultural knowledge; Medicine Women, Shamans, Traditional Hmong healers.
Rutakumwa & Krogman (2007) [59] Uganda (LIC) 63 (all rural women living in Uganda) Semi-structured interviews Not stated, except constant comparative method of analysis to develop descriptive categories Identify rural Ugandan women’s perspectives on their own health problems, their solutions and coping strategies, and their recommendations for improving services to suit their health needs. Herbal medicines Pregnancy Shared cultural knowledge, older female family members, TBAs.
Sim et al. (2014) [55] Australia (HIC) 20 (women all currently breastfeeding, or who had breastfed in previous 12 months; all had used herbal galactagogues) In-depth, semi-structured interviews Thematic analysis - transcripts were analysed using descriptive and qualitative approaches Understand women’s perspectives and attitudes towards using herbal galactagogues during breastfeeding; understand women’s choices in using alternative medicine to promote breastfeeding; identify factors that influence their decision-making. Herbal medicines Breastfeeding Internet and social-media based mothers’ groups, family and friends, trusted HCPS [biomedical HCPs, and CAM HCPs, and Lactation Consultants]
Thwala et al. (2011) [47] Swaziland (LMIC) 15 (all women with at least 1 child, the youngest less than 2 years old) Unstructured interviews Ethnography Describe the values, beliefs and childbirth practices of rural Swazi women in pregnancy, labour and the postpartum period. Herbal medicines Pregnancy Shared cultural traditions, Traditional African Healers, mothers-in-law.
Waiswa et al. (2008) [45] Uganda (LIC) 10 focus group discussions with mothers under 30 years of age, older mothers including grandmothers, fathers and childminders [but no exact number given for each FGD]; 6 key informant interviews with 6 health workers and 4 TBAs Focus group discussions and in depth key informant interviews Latent thematic content analysis Assess the acceptability of Millennium Development Goals to reduce infant and maternal mortality in rural Ugandan communities; identify acceptable factors and barriers and to ante and postnatal care. Herbal medicines Pregnancy Shared cultural traditions and practices; TBAs.
Warriner et al. (2014) [63] United Kingdom (HIC) 10 (all currently pregnant women) In-depth interviews Not stated just thematic analysis used in analysis of transcripts To investigate over the counter [OTC] use of complementary medicines and pharmaceutical medications in pregnancy, the role of others in influencing women’s choice to use CMPs, and how issues of choice and control influence women’s use of OTC CMPs and pharmaceuticals in pregnancy. Vitamin and mineral supplements, homoeopathic remedies and herbal medicines available over the counter Pregnancy Homoeopaths, doctors and midwives, other pregnant women.
Westfall (2003a) [40] Herbal healing Canada (HIC) 33 (27 currently pregnant women, of whom 26 used herbal medicines in pregnancy; 6 mentors including herbalists, authors and midwives) In-depth interviews Thematic analysis To give voice to women’s self-prescription of herbal medicines in pregnancy; understand women’s perceptions of the roles and safety of herbal medicine use in pregnancy, and the choice to use herbal medicine in pregnancy. Herbal medicines Pregnancy Own knowledge, own intuition, and trusted sources including books, friends, family members, biomedical HCP maternity care providers, CAM HCPs (herbalists), herbal shops, and the internet. Six mentors were listed by participants – these were midwives and childbirth educators and herbalists
Westfall (2003b) [10] Galactagogue herbs Canada (HIC) 23 (women, all currently breastfeeding; 14 had used herbal galactagogues) In-depth interviews Thematic analysis To discuss the potential value of five galactagogue herbs used by breastfeeding women, including the women’s own observations, historical use, safety and efficacy; inform future research. Herbal medicines Breastfeeding Midwives, friends, mothers, public health nurse, doula.
Westfall (2004) [41] Anti-emetic herbs in pregnancy Canada (HIC) 27 (all currently pregnant; 20 had nausea and vomiting of pregnancy, and of these 10 had used herbal medicines to treat) In-depth interviews Thematic analysis Discuss the details of the herbal medicines used by women to treat pregnancy-induced nausea and vomiting. Herbal medicines Pregnancy Herbalists
Wilkinson & Callister (2010) [48] Ghana (LMIC) 24 (all pregnant women; some HCP quotes also included) In-depth interviews and participant observation Ethnography with the Health Belief Model Describe the perceptions of childbirth held by Ghanaian women; inform health policy makers and health care providers to insure women receive clinically safe and culturally sensitive care. Herbal medicines and vitamins Pregnancy Herbalists, biomedical midwives
Wulandari & Whelan (2011) [53] Indonesia (Bali) (LMIC) 18 (all currently pregnant women) In-depth interviews Content analysis Explore the beliefs, attitudes and behaviours of pregnant women in Bali, Indonesia Herbal medicines and iron tablets Pregnancy Shared cultural knowledge, family members
Yeo et al. (2000) [49] USA (HIC) 22 (11 couples - 11 women and their 11 husbands in were interviewed in pregnancy and then postnatally) In-depth interviews Ethnography Examine Japanese couple’s perceptions and experiences of prenatal care and childbirth in Michigan, USA; explore implications for providing culturally competent care. Pre and postnatal vitamins Pregnancy and breastfeeding Shared cultural knowledge, doctors, family and friends.
Young & Ali (2005) [50] Tanzania (Zanzibar) (LIC) 52 (including 25 mothers; 27 health care workers including 4 government health officials; 3 biomedical doctors; 2 maternity ward nurses; 4 health aides; 2 pharmacists; 3 three TBAs; 1 diviner/healer; 3 traditional medicine makers; 5 employees at private pharmacies) Informal conversations, in-depth interviews, focus group discussions and participant observation Ethnography Using ethnography as the basis, to describe traditional (non-biomedical) treatments for maternal iron deficiency anaemia in Zanzibar; describe women’s choices in choosing treatments; inform health planners of these choices so that and culturally appropriate care can be provided, with the aim to reduce maternal anaemia. Traditional iron remedies and iron tablets Pregnancy and the postpartum month Iron tablets – hospital and nurses; Traditional remedies – traditional healers
  1. TBAs Traditional Birth Assistants or Attendants, Biomedical HCPs biomedically trained health care practitioners - nurses, midwives, doctors and obstetricians; CAM HCPs Western complementary medicine health care practitioners including naturopaths and herbalists trained in Western Herbal Medicine
  2. aLIC low income economy, LMIC lower middle income economy, UPIC upper middle income economy, HIC high income economy according to The World Bank Classifications [33], based on 2015 gross national income per capita
  3. b Complementary medicine type discussed in the paper, as identified by the first author (LAJB)
  4. c For the purposes of this review and analysis of the identified studies, the first author (LAJB) conceptualised the continuum of childbearing from pregnancy, birth, the early postpartum period, longer postpartum period and breastfeeding as separate but related stages