In this research, the inclusion and exclusion criteria have been divided into two sections, according to the two sets of literature. One was epidemiological and the other was women’s experiences of cultural practices. The inclusion criteria for the epidemiological scenario were: only reports emphasizing the status of maternal and newborn health; the effects of safe motherhood strategies in relation to the achievement of the MDGs, and English-language sources. The inclusion criteria of cultural practices during childbirth and the postnatal period were: cultural perspectives related to childbirth and postnatal care practices in Bangladesh, literature published between September 2000 (MDGs launched 6 to 8 September on this year) and December 2017, English-language sources. The exclusion criteria were: literature in languages other than English, studies conducted outside Bangladesh, literature published before the MDGs targets were set in 2000.

An integrative literature search was conducted using a number of databases, including ProQuest, PubMed, CINAHL, Sociological Abstract, and Google Scholar. The search strategy had been based on searching for several primary key terms relevant to the research question, aims and objectives, including safe motherhood, postnatal care, MDGs, newborn care, maternal mortality, TBAs, cultural practice in childbirth and Bangladesh.

A total of 856 journal articles, relevant reports and studies were identified from the database search as potentially useful for this research. After screening the titles, abstracts, duplication and studies not written in English, a total of 142 articles were selected for the eligibility of this literature review. Studies were further rejected (n = 47) if they were not available in full-text or if the studies were published before 2000 as the MDGs launched on this year. Lastly, following the screening of the full-text and guided by the relevance of the studies against the inclusion criteria, a total of 27 studies were selected for final review. Among these 27 studies, a total of five reports were used for the epidemiological section. These reports highlighted the major changes and progress that took place in Bangladesh’s epidemiological scenario. Importantly, these reports did not consider cultural issues and practices that affect women’s behaviour and early postnatal care practices. Therefore, excluding the studies that were used in epidemiological section, a total of 22 articles were selected for this review of cultural practices of Bangladesh (Figure 1).

In this research, we used the Australian National Health and Medical Research Council’s recommended framework for assessing the quality of papers included in the review (National Health and Medical Research Council [NHMRC], 2009). Table 1 presents the grading criteria used to assess the level of evidence of each study, in line with NHMRC guidelines (Table 1). Additionally, we developed a summary table of the reviewed studies (Table 2). The components of the summary table included the author’s name, title, year, study locations, methods, sample size, key concerns and key findings.

Food taboos are common in pregnancy and the postnatal period in Bangladesh (Darmstadt et al., 2006; Choudhury & Ahmed, 2011, Ara et al., 2013; Sarker et al., 2016). These are affected by cultural beliefs and practices. Rural women generally believed that eating certain types of food during pregnancy and the postnatal period were harmful to both mothers and their babies (Darmstadt et al., 2006). During the postnatal period, especially the period of seclusion,¹ different foods were restricted, thus depriving women of sufficient nutrition (Choudhury & Ahmed, 2011; Darmstadt et al., 2006). Many foods were thought to be inappropriate during lactation (Choudhury & Ahmed, 2011). Darmstadt et al. (2006) found that bananas with seeds, eggs and leafy vegetables were prohibited during the postnatal period. Beef and Hilsa fish were thought to dry up the milk of a lactating mother, and to possibly cause postpartum diarrhoea. Food restrictions deprive women from benefiting from these protein-rich foods, which are needed by pregnant and postpartum women (Edhborg et al., 2015), thus risking malnourishment.

Birth preparedness is vital for safe childbirth. Researchers identified some reasons for this, which were socially and culturally oriented (Darmstadt et al., 2006; Sultana, 2010). For example, Darmstadt et al. (2006) found that cultural beliefs regarding pregnancy and childbirth were different where childbirth was considered a natural event with many social and religious ramifications, rather than when it was thought of as a medical event. They found that in rural areas, many pregnant women had to work hard until the time of childbirth, and sometimes they gave birth at home or outside without preparation or an SBA. They also found unwillingness to prepare for childbirth. Most women did not even contact a dai in advance because they believed it would take more time to give birth if news of the impending birth spread among many people (Darmstadt et al., 2006) . Choudhury and Ahmed (2011) identified poverty and traditional beliefs and rituals as a hindrance that delayed and sometimes stopped women from preparing for childbirth.

The practice of childbirth at home is very common in Bangladesh (Khan & Islam, 2006; Sarker et al., 2016). Research shows that rural women continue to give birth at home because it is a known environment, and because of the opportunity to have close ones nearby (Chowdhury et al., 2003; Sarker et al., 2016). Sixty-two percent of births occurred at home in 2014 (NIPORT, 2016), and a dai is the first choice for most rural people (Afsana & Rashid, 2009; Sarker et al., 2016). Sometimes, women’s mothers, relatives or neighbours help them during childbirth (Tasnim et al., 2010). Family members such as husbands, mothers-in-law and fathers-in-law give their opinions on where women will give birth to their babies, and they mostly prefer natural births at home, assisted by dais because of traditional views, religious beliefs, poor transportation, lack of awareness, fear of caesarean sections and lack of female doctors in healthcare facilities (Khan & Islam, 2006; Parkhurst et al., 2006; Sarker et al., 2016; Varghese, 2007). Preference for male doctors is very low in rural areas.

The period after childbirth is considered a vulnerable time for new mothers and babies (Moran et al., 2009; Rahman et al., 2011). Rural people think that women are impure (napak) or polluted after birth, as a result of the birthing process (Blum et al., 2006). For this reason, they practice seclusion after childbirth, where they stay in a single room with their baby from fear of being attacked by evil spirits (Tarafder & Sultan, 2014). Food cooked by a newly birthed woman is considered dangerous, and women are not even permitted to touch ingredients for meal preparation (Choudhury & Ahmed, 2011). Because of this belief in impurity, some people felt encouraged to bathe the baby immediately, as they believed a baby’s pollution could be removed by bathing (Moran et al., 2009).

Traditional practices outlined by researchers include those relating to cutting the umbilical cord and caring for the umbilical cord stump, bathing and breastfeeding (Darmstadt et al., 2006; NIPORT, 2016). Other traditional and cultural practices regarding newborn care can be observed, particularly in rural Bangladesh. For example, a harmful cord-cutting practice is followed, where instruments such as contaminated razor blades are used, because some women are still unaware of the importance of using hygienic equipment to prevent infections (Darmstadt et al., 2006; Islam et al., 2015; Moran et al., 2009) . Applying heat massage (shek dewa) to the umbilical stump and surrounding area is almost universally practiced among women in rural Bangladesh, as it is considered a common part of home-based newborn care (Moran et al., 2009). The most common substances used on the cord are turmeric and boric powder (Andrews & Dalal, 2011; Moran et al., 2009).

Breastfeeding is recommended for improving babies’ nutrition and development, and to help build immunity from common infections. Despite the nutritional value of breast milk, it has been observed that some mothers delay the practice of breastfeeding for up to three days after childbirth (Haider et al., 2010). While the practice of pre-lacteal feeding is not recommended because of the risk of gastrointestinal infection, about 27% of women give other liquids to their babies (NIPORT, 2016). Studies have shown that some cultural practices encourage pre-lacteal feeding, which goes against the WHO’s recommendations for optimal breastfeeding (Sundaram et al., 2016). Additionally, there is a belief that colostrum is dirty milk because of its thick consistency, and it is thought to cause diarrhoea, abdominal pain and contain evil spirits (Darmstadt et al., 2006). As a result, rural women delay the early initiation of breast feeding, first putting honey or sugar water in their babies’ mouths instead of breast milk (Haider et al., 2010; Moran et al., 2009). However, it has been found that the feeding of colostrum has increased, and 51% of mothers initiate breastfeeding within an hour of birth (NIPORT, 2016).