Traditional practices during the first 1000 days of life in Southest region of Türkiye: a qualitative study

Abstract

Background

Traditional practices during the first 1,000 days of life can shape caregiving behaviors and influence maternal and child health. This study aimed to identify and describe traditional practices related to pregnancy, childbirth, and early infant care, as well as to explore the reasons behind their adoption and the sources of information guiding them, from the perspectives of pregnant women and healthcare professionals in southeastern Turkey.

Method

The study included 34 pregnant women from antenatal clinics at two hospitals, alongside four focus group discussions, and 17 healthcare professionals from related units, supported by two focus groups. Data were collected through face-to-face interviews using structured demographic forms and semi-structured interview guides. Interviews were audio-recorded and analyzed thematically.

Results

Participants reported various traditional practices, such as withholding colostrum, tightly swaddling the infant, delaying bathing until the 40th day, making razor blade incisions for jaundice, applying salt or olive oil mixtures to the newborn, and using the “höllük” cradle (a traditional wooden cradle). These practices were largely transmitted through intergenerational advice, particularly from elder family members.

Conclusion

The study highlights a range of traditional practices that persist during the first 1,000 days of life, some of which may be potentially harmful. Antenatal counseling that includes family elders may help reduce harmful practices and promote safer caregiving behaviors.

Introduction

In southeastern communities, traditional practices play a central role in addressing health issues and are deeply embedded in the cultural fabric. These practices are shaped by the beliefs, values, communication styles, and behaviors of society [1]. They significantly influence caregiving behaviors during pregnancy, childbirth, the postnatal period, and infant care [2]. Given the diverse cultures and traditions across societies, traditional practices related to mother-infant care can vary widely between communities [3, 4].

While some practices positively impact maternal and infant health, others may be neutral or even harmful, causing physical, psychological, or social harm [5]. Therefore, it is essential to identify and support health-promoting practices while actively working to eliminate harmful ones [3]. The first 1,000 days of life, spanning from pregnancy to a child’s second birthday, are critical for establishing the foundation for lifelong health, growth, and development. During this period, the brain, body, and immune system undergo significant development [6]. Adopting proper care approaches during this crucial time can save the lives of both mothers and babies [3, 5]. Traditional practices can profoundly influence the survival and well-being of mothers and children. However, due to a lack of knowledge or adherence to harmful traditional practices, mothers may inadvertently jeopardize their infants’ health [7–9].

The literature highlights numerous traditional practices used before birth and throughout the first 1,000 days of life. Common examples include avoiding certain foods or consuming specific herbs during pregnancy, believing these practices to be beneficial, covering the baby with a yellow scarf to relieve jaundice, giving the baby sugary water, or cutting behind the baby’s ears. Other practices include hiding the umbilical cord at home or burying it in places such as schoolyards, mosques, or hospital gardens; staying home for 40 days postpartum; salting the baby; and tightly swaddling the infant [4, 10–12].

Harmful traditional practices can lead to severe health consequences. They may delay early diagnosis and treatment, hindering recovery and resulting in disabilities, illnesses, or even death. For example, cutting the back of a jaundiced baby’s ear or forehead with a razor blade may cause life-threatening infections; salting a newborn may lead to hypernatremia and death due to skin irritation; and swaddling can cause developmental hip dislocation [12, 13]. Therefore, healthcare professionals must support evidence-based beneficial practices while identifying and eliminating harmful ones to protect and improve infant health [3, 11]. However, cultural sensitivities and resource limitations may sometimes hinder healthcare professionals’ efforts, leading to the tacit acceptance of harmful practices.

This study employs the Health Belief Model and the Cultural Competence Framework to explain traditional health practices. The Health Belief Model provides a framework for understanding how individuals adopt and maintain health-related behaviors by examining their attitudes, beliefs, and perceptions of health risks and benefits. Meanwhile, the Cultural Competence Framework is instrumental in exploring how cultural beliefs and norms influence healthcare behaviors [14]. By integrating these frameworks, the study offers a comprehensive understanding of how traditional health practices are both personally and culturally constructed, shedding light on factors that shape maternal health behaviors during the first 1,000 days of life.

The first 1,000 days of life—from conception through pregnancy, birth, and up to a child’s second birthday—represent a biologically sensitive window during which optimal health, nutrition, and care are crucial for establishing the foundation for lifelong physical, cognitive, and emotional development. Scientific evidence has consistently shown that interventions during this period can significantly improve maternal and child survival, reduce the risk of chronic diseases later in life, and promote better educational and economic outcomes. The first 1,000 days of life is not only vital from a biomedical perspective but also highly influenced by cultural beliefs, traditional practices, and intergenerational knowledge. Many families rely on inherited customs and advice from elders when caring for pregnant women and infants. Some of these practices can be beneficial, reinforcing protective health behaviors, while others may pose risks to the health of the mother and child.

By focusing specifically on this timeframe, the study aims to explore the traditional methods used during pregnancy, breastfeeding, and infant care in the Şanlıurfa region of southeastern Turkey. Rather than evaluating the effects of these practices, the study focuses on exploring their cultural meanings, underlying reasons, and sources of information in order to inform future educational and preventive efforts targeting harmful traditions. The study hypothesizes that both beneficial and detrimental traditional practices coexist within this community.

It is hypothesized that both beneficial and harmful traditional practices were present in Şanlıurfa. Understanding the cultural context in which these practices occur allows health professionals to design respectful and effective education strategies that promote safe traditions while discouraging harmful ones. The findings will provide valuable insights for developing targeted interventions and educational programs to promote optimal caregiving practices, particularly in communities where traditional methods are commonly employed.

Methods

Study design and setting

This qualitative research was conducted between March and June 2023 in Şanlıurfa, a city with the highest birth rate in Türkiye. The research was carried out at two healthcare center: the Şanlıurfa Training and Research Hospital, and Viranşehir State Hospital Antenatal Clinics. Ethical approval was obtained from the Harran University Clinical Research Ethics Committee (Protocol no: 2023/03/17) along with local authorization from hospitals. Written consent was obtained from all participants.

Participants and sampling

The study involved two participant groups: pregnant women and healthcare personnel. Pregnant women attending antenatal visits were informed about the study and invited to participate voluntarily. Additionally, healthcare personnel, including midwives, nurses, and physicians responsible for the care of these pregnant women were recruited for the second group.

A total of 34 pregnant women participated in four focus group discussions (FGDs), while 17 healthcare personnel contributed through two FGDs, totaling six FGDs. Sampling was finalized based on thematic saturation, where no additional interviews were deemed likely to provide new insights. All authors unanimously agreed that further interviews were unlikely to provide additional insights.

Data collection

Data collection involved two stages.

Descriptive characteristics form

Pregnant women provided information on their age, occupation, education level, spouse’s education and occupation, family structure, number of children, whether the last pregnancy was planned, previous training on infant care, and sources of health information. Healthcare personnel shared their age, gender, marital status, profession, experience with baby care, and perspectives on traditional practices during pregnancy and breastfeeding. The data were collected by researchers through face-to-face interviews and recorded.

Semi-structured interviews

At the beginning of the FGDs, participants were informed that the interviews would be recorded. Participants were asked open-ended questions (Table 1) exploring traditional practices related to pregnancy, baby care, and breastfeeding with FGD. The questions focused on the purposes and perceived effects of these practices, sources of information, and the decision-makers regarding health practices. Healthcare personnel were specifically asked for recommendations to prevent harmful traditional practices.

Table 1.

Focus group discussion questions

(1) What are the traditional methods used in baby care? Can you tell us about the purposes and effects of these applications?

(2) What are the traditional methods used during pregnancy? Can you tell us about the purposes and effects of these applications?

(3) What are the traditional methods used during breastfeeding? Can you tell us about the purposes and effects of these applications? (4) What are the sources of information that provide suggestions about traditional methods?

(5) Whose suggestions are implemented in solving children’s health problems?

(6) What can be done to prevent the wrong traditional practices you have identified? (asked only to healthcare personnel)

FGDs were conducted in a private and comfortable environment to encourage candid responses. Audio recordings were made with participants’ consent, and non-verbal cues, such as facial expressions and body language, were documented as observational notes.

Data analysis

A phenomenological approach was adopted to explore participants’ lived experiences and perceptions of traditional practices. These discussions facilitated a dynamic exchange of perspectives, allowing participants to reflect on and articulate their collective experiences. The data were analyzed to identify recurring themes and deeper meanings, capturing the essence of how and why traditional methods are perceived and practiced within the group (Table 2).

Table 2.

The themes and sub-themes obtained from the qualitative analysis of the data

Themes	Sub-themes
Traditional Infant Feeding Practices	• Colostrum rejection due to color and delayed onset • Influence of mothers and mothers-in-law • Waiting for prayer time before feeding
Harmful Skin and Body Care Practices	• Salting the baby to prevent bad odor • Use of salt and olive oil mixtures • Duration of salting practices
Traditional Infant Handling Practices	• Tight swaddling for strength and health • Inclusion of arms and legs • Use of rope to secure the swaddle
Sources of Traditional Knowledge	• Advice from family elders (especially mothers/mothers-in-law) • Influence of community beliefs
Perceptions and Rationale Behind Practices	• Cultural beliefs about health and strength • Fear of illness or bad outcomes • Lack of awareness of medical evidence
Role of Healthcare Professionals	• Observations of traditional practices • Challenges in changing family-driven behaviors

Thematic analysis was used to identify recurring patterns and underlying meanings in the data. The analysis process included: (a) Audio-recorded interviews were transcribed verbatim and read multiple times to ensure familiarity with the data. (b) Initial coding was performed to categorize data, and themes were generated by grouping similar codes. (c) Themes were reviewed and refined through detailed analysis and interpretation by three researchers (BG, HYSA, and SSY).

Interview statements were reported in the form of quotes, in accordance with the categories and codes, and the participants were kept anonymous.

Trustworthiness

To maintain rigor, analytic triangulation was employed. Two coders independently verified categories and themes, resolving discrepancies through consensus.

Triangulation also included observational data from field notes and participant transcripts to address researcher reactivity and researcher bias. This included utilizing two sources of observational data—written notes on gestures (facial expressions) and non-verbal cues like laughter, coughing, or groaning—as well as transcripts of audit data.

An audit trail of the coding and analysis process was maintained for transparency.

Data management tools

MAXQDA 24 software was used for content analysis to systematically organize and interpret the qualitative data.

Descriptive statistics of participants’ sociodemographic data were analyzed using IBM SPSS for Windows Version 23.0. Results were presented as frequencies, percentages, and arithmetic means with standard deviations.

Results

Socio-demographic characteristics of the participants

The average age of the pregnant women participating in the study is 26.3 ± 4.1 years. 35.3% of pregnant women were defined as literate and 85.3% as housewives. 17.6% of pregnant women stated that they lived in large families and 76.5% received help from their mothers in child care. Pregnant women have an average of 2.6 ± 1.5 children. 67.6% of the pregnant women stated that their last pregnancy was planned, 64.7% stated that they had not received education on baby care during any of their pregnancies, and 58.8% received health-related information from their family elders (Table 3).

Table 3.

Demographic characteristics of mothers (n = 34)

Features		n	%
Mother’s Education Status	Literate Primary school Middle school High school University	12 9 5 4 4	35.3 26.5 14.7 11.8 11.8
Working Status	Housewife Working mother	29 5	85.3 14.6
Family Type	Core Family	28	82.4
Person Caring for the Child*	Mother Father Mother-in-law Relative Caregiver	26 10 7 5 1	76.5 29.4 20.6 14.7 2.9
Was the Last Pregnancy Planned?	Yes	23	67.6
Receiving Baby Care Training During Pregnancy	Yes	12	35.5
Primary health-care source	Doctors	34	100
	Family Elders	20	58.8
	Television	14	41.2
	Nurse-Midwife	11	32.4
	Social Media and Internet	11	32.4
	Pregnant schools	9	26.5
	Book	4	11.8

*Multiple response count percentage distribution

A total of 17 healthcare professionals, including 1 doctor, 3 nurses, 1 psychologist, 1 dietician and 11 midwives, working in the units where pregnant women are accepted in the two centers, were interviewed. The average age of healthcare professionals is 30.6 ± 5.0 years and four of them are male. 70.6% of healthcare professionals were married and had an average of 2.0 ± 1.0 children. 52.9% of healthcare professionals stated that traditional practices used in baby care are partially useful, 76.5% stated that traditional practices used during pregnancy and 52.9% during breastfeeding are not useful.

Traditional practices used during pregnancy and birth

Mothers reported several traditional practices used to alleviate discomfort during pregnancy and ensure safe delivery. Belly massages administered by others were commonly mentioned to alleviate pregnancy pain. Elders often advised against pulling the legs too close to the body, as this was believed to disrupt the baby’s birthing position. Additionally, some mothers believed that applying locks on pregnant women could prevent the baby from falling. Healthcare professionals confirmed observing these practices.

P4: “I had pain when I was pregnant. It was told me the baby had fallen down. I couldn’t walk. I went to a woman and she fixed it. My pain is gone. My mother-in-law took me there.”

H14: “There is a string in the shape of a circle for the mother, they tie it around her belly. They also have a knotted string made by a healer, which they wear around their waists. I encountered it in the delivery room. Before childbirth, the pregnant woman removed that circle without untying the knot. When the baby was born, they asked us to pass the baby through that circle for the baby to live. Several babies had died after birth. Since they started doing this procedure, babies haven’t been dying.”

H13: “There is a herb called Fatma Mother’s Hand. When a woman is about to give birth, they immerse it in water. As the leaves of these plants open in the water, the mother drinks the infused water. They believe they gain strength from this plant. We inform them about methods that may facilitate the birthing process. Mothers derive psychological strength from these practices. It’s akin to burning a Nazar bead. We do not discourage them from doing this because it does not cause any harm.”

Two healthcare professionals stated that they observed the use of the Fatma mother’s plant during normal birth to facilitate the birthing process. One healthcare professional emphasized that mothers eat eggs and molasses to regain strength after birth.

There are six distinct opinions on practices that mothers believe enhance their baby’s beauty. At the forefront is the practice of looking at pictures of beautiful people, noted by two mothers. Other practices mentioned by mothers include being mindful of their diet, gently pinching the baby’s cheeks, consuming apples or pears, looking in the mirror, and applying olive oil to the baby’s skin. Healthcare professionals offered four perspectives on this topic, with eating quince being highlighted as the most prominent. Other opinions included dietary considerations, cheek pinching, consuming apples or pears, using olive oil, and engaging in mirror gazing.

P33: “I squeeze my baby’s cheeks to make her have dimples. I look at a photo of someone with green eyes so that the baby will have colored eyes.”

Traditional beliefs regarding determining the baby’s gender involve the taste (bitter, sour, sweet) of consumed foods, the shape of the abdomen.

P33: “They gave me sweet foods to make the baby a male gender. They get angry when we eat sour during pregnancy. When your abdomen is a little bit forward, the baby becomes a girl. When it’s not obvious, they call the baby a boy.”

One healthcare professional stated that pregnant women put their hair on their faces with the idea that it would alleviate the pregnancy mask after birth.

Traditional practices regarding baby feeding

First milk: Eight of the pregnant women stated that they fed their babies with their first milk, while one did not. Ten healthcare professionals mentioned that they did not give the pregnant women’s first milk to the babies due to its color and the prolonged waiting period. They believed it could be harmful, a similar thought of the mothers and mothers-in-law. Three healthcare professionals noted that some mothers delayed breastfeeding until a specific prayer time, believing that initiating breastfeeding during a sacred moment would bring spiritual protection or blessings to the child.

P31: “We do not feed the baby with the first milk after birth for a week. They say that the first milk is not good for the baby. I will start breastfeeding for the first time in 3 weeks. I will give ready milk during that time.”

H9: “They think that colostrum is unhealthy due to its yellow color and so they milk it and throw away this milk.”

H1: “ Some mothers wait for 3 prayer times and then breastfeed. They think that if she waits for 3 prayer times, the baby will be a righteous child.”

H3: “Some mothers did not give their first milk to their babies. They discarded it, considering it harmful due to its yellow color. They perceive it as unclean and fear it may lead to a buildup of diseases in the body. Despite our explanations, some individuals persist in this practice, influenced by their surroundings.”

H14: “During a training session, I encountered a pregnant woman who mentioned that she did not give colostrum to any of her eight children. She believed it was not beneficial and feared it might cause skin rashes and gas due to its oily nature. However, after the training, she had a change of heart, expressing deep regret and acknowledging her mistake.”

According to pregnant women and healthcare professionals, sugar water was the first food given to the baby other than breast milk in the first three days. Some pregnant women gave honey to the baby before the first milk.

P12: “I do not think it is right to give sugary water to the baby. But my mother and mother-in-law gave it to my baby. They gave it despite my objections. They said, “We grew 10 babies with sugar water as first feed and nothing happened, you don’t know since this is the first baby”. So, I gave up on persisting against it.”

H12: “They feed the baby with sugar water after birth. They say they do this for jaundice. We provide education and say that only breast milk is sufficient for the first 6 months. But here they give babies too much sugar water.”

Foods that increase breast milk: Bulghur pilaf comes first among pregnant women’s beliefs about foods that increase breast milk. Health staff stated that mothers consume tea obtained from a regional plant and a mixture of molasses, butter and flour called “bulamaç” in order to increase their milk supply. According to 4 opinions from health staff, mothers do not bathe for 40 days after birth, and according to one of these opinions, it was determined that the purpose of this was not to affect or decrease the colostrum.

P9: “They believe that eating bulgur pilaf will increase milk production. They advise eating more food to increase milk supply and believe that consuming foods rich in vitamins will benefit the baby. They avoid bitter foods, fearing they will affect the baby’s health through breast milk. Sour foods are also avoided because they believe they can pass to the child through milk. They caution against drinking very hot tea to prevent burning the baby’s tongue. I’m sharing this because I’ve witnessed such occurrences.”

P14: “Since giving birth, mothers have been consuming milk-based items like ayran soup or rice pudding to boost lactation.”

P19: “I pay close attention to breastfeeding. I believe that bulgur helps increase milk production. I’m cautious about foods that could potentially harm the baby through breastfeeding. I don’t restrict my diet. We used to eat eggplant with its peel to prevent any negative effects on the child. I eat whatever I want.”

H1: “Some mothers breastfeed their babies only once a day, believing that one teaspoon of breast milk is sufficient. One mother refrained from breastfeeding because she believed her baby would remain silent even if they cried. This belief was reinforced by her mother-in-law, which is why she chose not to breastfeed.”

H3: “To increase milk supply, some individuals mix molasses, butter, and flour to make a paste and consume it. I have tried it myself and believe it’s effective.”

H5: “There is a plant known for increasing milk supply. It is boiled,and the tea is consumed.”

There were several beliefs observed among the opinions of healthcare professionals regarding traditional methods used during breastfeeding. Some believed that pregnant women should avoid drinking water to prevent bloating, fearing it might hinder breastfeeding. Another notion was that if a woman’s milk didn’t come immediately after birth, another woman should breastfeed the baby. Additionally, there was a practice of dipping pacifiers in chocolate, molasses, or tea before giving them to babies. Some mothers had been advised to avoid certain foods, such as meat, out of fear that they might harm the baby. Another belief was that placing an iron fork on the mother’s plate could help relieve the baby’s gas. Finally, there was the belief that breastfeeding served as a contraceptive method.

H10: “They say that a breastfeeding woman does not eat meat. They think it is unhealthy and harmful.”

H11: “When the baby is given to the mother first time, due to a belief the mother can not feed the baby with breastfeeding immediately, another woman feeds the baby with her breast milk. Women who do not have milk give their breasts to the baby and use it as a pacifier. They do this so that the baby gets used to breastfeeding and becomes silent.”

Traditional practices used in baby care

Umblical cord care: Pregnant women commonly reported the use of kohl (surma) for umbilical cord care, which is often believed to have antiseptic properties or to ward off evil influences. In contrast, healthcare professionals indicated that coins and ashes were more frequently applied—substances traditionally believed to aid in drying the cord or symbolizing protection and prosperity. Pregnant women stated that the fallen umbilical cord was buried in the mosque, while healthcare professional stated that it was buried in the ground. This divergence may be explained by differences in emphasis: while women may focus on the spiritual significance of the burial site, healthcare workers may prioritize the act itself over its symbolic placement.

P15: “They put ash and kohl on the umbilical cord of the baby to dry it quickly. I’m thinking of doing it too since my elders did and nothing happened, this practice may be true.”

H13: “They put money on the baby’s umbilical cord to prevent it from swelling following it falls. They leave ashes in the umbilical cord. We tell them to keep it clean is the best way to prevent the umbilicus from getting infected.”

Eye care: Applying eye rub and squeezing lemon were mentioned as eye care practices.

P4: “They wanted to squeeze lemon to make the baby’s eyes shine. I didn’t let him.”

H2: “They drop lemon and breast milk into the baby’s eyes to make the eyes bright.”

H3: “They apply kohl to make the baby have beautiful eyes and dark eyes. They also squeeze lemon.”

Jaundice: According to the comments of pregnant women and healthcare professional, the top two practices used by pregnant women when their baby is jaundiced; covering the baby with yellow cloth and cutting skin with a razor.

P21: “When my baby had jaundice, they cut behind my and the baby’s ears with a razor. They told him to cover him with a white blanket, make him sleep under white light, and make him drink mint water. After 1 week and 10 days, the jaundice disappeared.”

H8: “They cover the baby with a yellow cloth to prevent jaundice and cut the baby’s ears with a razor.”

Bathing: The timing of babies bathing ranged between the first week of birth to 40 days after birth. It was commonly reported by both pregnant women and healthcare professionals that waiting until the 40th day after birth was the most prevalent traditional practice for baby bathing. From the participants’ point of view, this practice is often rooted in beliefs about protecting the newborn from illness, cold, or the “evil eye” (nazar), and in some cases, it is tied to religious or spiritual notions of purification.

P15: “We did not bathe the baby until he turned 40 days. We didn’t wash the baby since we had concerns about falling the baby. But I think the baby should be bathed every day. 40 days should not be waited. But this is what our elders do. They did not provide training in the past regarding baby care. So, we did not know the correct approach.”

H9: “They do not bathe babies for 40 days. They do these practices because of transmitted previous experiences and believe that they were correct.”

Salting: Pregnant women and healthcare professionals highlighted that the primary reason for salting babies is to prevent them from developing an unpleasant odor. It was observed that some pregnant women applied a mixture of salt and olive oil to their babies for half an hour, while others opted to keep them salted for 1–2 hours. For many, this practice symbolizes purification or future hygiene, and may even be linked to broader cultural expectations around child rearing and social acceptance. This belief appears to be culturally rooted and passed down through generations as part of traditional newborn care rituals.

P6: “I applied salt to prevent the baby from developing a smell when they grow up, as advised by my mother-in-law. Personally, I doubt its effectiveness. Being bedridden after giving birth, I couldn’t argue with them. It’s hard to refute their beliefs, especially when they claim, “We did it this way, and everything turned out fine.” I feel powerless to oppose it.”

H13: “The baby is salted to prevent odor and sweating.”

Diaper rash: Mothers reported using baby powder and diaper rash cream to treat their babies’ rashes, while healthcare professionals mentioned that mothers also use sifted, untouched sand heated in a pan (known as ‘höllük’) for diaper rash treatment.

P27: “If there is a rash, I use powder or cream. I leave it clean the rash area.”

H14: “They cook sifted, untouched sand in a pan for diaper rash. They think of it like powder. They apply this to the area where there is a rash.”

Swaddling: 23 pregnant women stated that they tightly swaddled their babies, including their arms and legs. The primary reason cited by both pregnant women and healthcare professionals for swaddling was the desire for the baby to be strong and healthy. Moreover, both groups mentioned that the swaddle was sometimes secured with a rope, reflecting a customary approach believed to enhance the tightness and effectiveness of the wrapping.

P6: “I swaddled my baby and tied it with rope based on advice from people around me. They told me that swaddling strengthens the baby as they grow up.”

P27: “We swaddle our babies for up to 2–3 months, tying their hands to prevent them from getting startled. We use a rope for this purpose, but we make sure not to tie too tightly. This is a common practice for us.”

H16: “Mothers often adopt traditional baby care practices they learned from their own mothers, such as swaddling. As education levels rise, these practices tend to decline, but societal pressures, particularly from older generations and caregivers, often lead mothers to continue using these methods. Given the choice, many mothers would prefer modern approaches like using strollers.”

Evil eye: Pregnant women primarily use prayers and salt to protect their babies from the evil eye, as per their accounts. Healthcare professionals, on the other hand, mentioned that pregnant women mostly utilize amulets and evil eye beads for this purpose.

P34: “I also wear evil eye beads as a protection against the evil eye. Additionally, I place some salt in a bag and put it under the baby’s head to ward off evil eyes.”

H3: “They place evil eye beads on the baby’s hair to ward off the evil eye, or gold to prevent jaundice.”

Flushing: The puerperal infection that occurs after birth is commonly referred to colloquially as “red flushing,” “forty flushes,” or “puerperal fever”. One pregnant woman mentioned placing an iron under her baby’s head in the cradle to prevent it from flushing. Additionally, three healthcare professionals stated that they advised pregnant women not to bathe for 40 days to prevent flushing.

P28: “We place an iron under the baby’s head in the cradle for forty days.”

H2: “Mothers avoid bathing their babies for 40 days. They leave a knife and the baby’s father’s jacket to prevent the baby from developing a red flush.”

Giving strengthen to the baby: One pregnant woman mentioned that her baby’s belly was burned with a cigarette to increase the baby’s strength. Similarly, three healthcare professional stated that melted nylon was applied to the baby’s abdomen, a hot skewer was brought into contact with the skin, and a cigarette flame was applied to the baby’s back for the same purpose.

P5: “My mother-in-law wanted to burn the baby’s belly with a cigarette because the baby had gas. I did not allow it.”

H1: “They melt nylon and put drops on their stomachs because the baby is sick and has no appetite.”

Other traditional practices reported by mothers: Olive oil is commonly applied to the baby’s body to treat diaper rash and reduce fever. It is also given to children for constipation and used as a vitamin supplement. In cases of diarrheal diseases, dried pomegranate peel tea is administered. To reduce fever, lemon juice is squeezed into the baby’s sock. For treating wounds, camel urine is applied. During infancy, mothers rub the baby’s swollen breasts to reduce their size. Additionally, when their babies fall ill, mothers often seek advice from a religiously knowledgeable and trusted individual, typically a teacher.

Other traditional practices reported by healthcare professionals: These include tying a beret around the baby’s head to keep it tidy and having the grandmother or an elder spit into the baby’s mouth to supposedly make the baby resemble them. It is also a common practice to read the baby’s name during the call to prayer into their ear, as it is believed to foster good behavior. Lifting the baby’s palate to increase their appetite is another traditional method mentioned. Additionally, vaccine hesitancy was noted as a prevalent issue.

The sources of traditional practice information

Pregnant women reported receiving advice on traditional practices primarily from family members, especially their mothers and mothers-in-law, as well as trusted neighbors. Healthcare professionals indicated that they obtained information about these practices from similar sources, including family, trusted neighbors, and social media. Both groups agreed that mothers and mothers-in-law were the most influential sources of advice. Although healthcare professionals mentioned giving advice on traditional methods, pregnant women did not reference this. Despite six pregnant women expressing reluctance to follow traditional practices, they cited reasons such as respecting their elders’ advice, trusting their experience, and fearing negative consequences if they didn’t comply. Healthcare professionals noted that pregnant women often resorted to traditional practices out of fear, pressure, belief in their validity, and a desire to honor their mother-in-law’s wishes.

P18: “The adults dictate everything. I stopped swaddling my baby in the fourth month despite my mother-in-law’s disapproval. I didn’t listen because it was a hot summer.”

P28: “I follow the advice of my mother, mother-in-law, and elders. They have the wisdom of experience. They are the backbone of tradition.”

H14: “They mostly adhere to their mother-in-law’s instructions, often out of fear of displeasing their spouses.”

Information sources for solving babies’ health problems

Pregnant women rely on various sources for their babies’ health issues, including doctors, their immediate environment, family members and personal experiences. Healthcare professionals noted that pregnant women and mothers gather information from their surroundings, family, doctors, and trusted religious figures. While many pregnant women primarily seek advice from doctors, healthcare professionals emphasized that mothers-in-law play a central role in providing information. Additionally, one pregnant woman mentioned following doctors on social media for recommendations. Although healthcare professionals stated that pregnant women receive support from doctors for health concerns, this was not emphasized by the women themselves.

P27: “My mother-in-law is my main source of information. She lives in the same house as me. Even though she wouldn’t get angry if I didn’t follow her advice, I did it out of respect.”

H7: “Pregnant women often rely on people around them, including their mothers and mothers-in-law, for information. Sometimes, they don’t speak up for themselves, and their mothers-in-law speaks on their behalf.”

Solution proposal to prevent traditional practices

Healthcare professionals have proposed four suggestions to prevent traditional practices identified in the community. The primary recommendation involves providing education not only to pregnant women but also to their companions, family elders, the entire household and particularly the mother-in-law. Additional suggestions include minimizing the influence of mothers-in-law on pregnant women, distributing informative brochures to community members, and adopting a solution-oriented approach to address the underlying reasons for adherence to traditional practices.

H2: “In my opinion, educating mothers-in-law is essential. However, given that these practices are deeply ingrained in their culture, changing them will require time. It’s worth noting that even educated and cultured individuals can sometimes adopt incorrect practices. Fear of their mother-in-law greatly influences this dynamic.”

H13:“We offer training sessions for mothers. During these sessions, they often mention the significant influence of family elders. However, they tend to pay closer attention to the advice of doctors, as mentioned by nurses.”

Discussion

Our research revealed various traditional practices concerning pregnancy, breastfeeding and baby care (Table 4). While some of these practices pose no negative health impacts, others have the potential to harm both the mother and the baby. The study highlighted that during the first 1000 days of life, traditional practices influenced by the pressure from mothers and mothers-in-law were prevalent. These practices included discarding colostrum, delaying breastfeeding initiation, tightly swaddling the baby and using ropes, cutting the skin behind the ear in cases of jaundice, avoiding bathing the baby and mother for 40 days post-birth, and salting the baby. It is imperative to recognize and eradicate these harmful practices, often resorted to by mothers due to fear and pressure. Doing so is vital for ensuring the healthy growth and development of children, who represent the future of our society.

Table 4.

Traditional methods in pregnancy, infant feeding, and infant care: purposes and cultural beliefs

Period	Traditional Methods	Purposes and Effects
Pregnancy	Wearing a belt to support the abdomen	Reducing the risk of miscarriage and supporting a healthy delivery
	Avoiding certain foods	Protecting the health of the mother and baby
	Carrying cloves during frightening situations	Belief in protection for mother and baby
	Using prayers or charms for easier childbirth	Perceived to facilitate the birth process
Infant Feeding	Drinking fennel tea to increase breast milk	Enhancing breast milk production
	Consuming “lohusa şerbeti” (a traditional postpartum drink)	Supporting maternal health and milk production
	Discarding the first milk, considering it “spoiled”	Belief in protecting the baby’s health
Infant Care	Salt rubbing or swaddling the baby	Supporting healthy growth and shaping the baby’s body
	Hanging a blue bead for protection against the “evil eye”	Believed to ward off negative energy
	Placing a pillow under the baby’s head during sleep	Ensuring proper head shape
	Using gold bracelets or yellow cloth for jaundice	Traditional belief in treating jaundice
Sources of Information	Grandmothers, aunts, neighbors	Transmission of traditional knowledge
Harmful Practices	Improper handling of the umbilical cord, taking infants to unqualified practitioners	Risking the baby’s health
Prevention Methods	Educational programs, recommendations from healthcare professionals	Promoting informed parenting

Traditional practices used during pregnancy and birth

In the study, consistent with findings from existing literature, it was observed that some pregnant women employed practices such as tying a rope around their abdomen or attaching a small lock to the end of the rope to prevent the baby from falling during pregnancy. Similarly, in a study conducted in Tanzania, pregnant women were reported to use a similar method of tying a rope around their abdomen to prevent the baby from falling during pregnancy. Additionally, they utilized a mixture of cornflower and cold water to manage bleeding [10].

The participants mentioned that pregnant women resort to placing the Fatma mother’s hand plant in water and consuming this infusion to alleviate pain during labor, while also seeking advice from someone within their around to prevent miscarriage by employing a certain procedure on the mother during pregnancy. Previously, it was repoted that soaking the Fatma mother’s hand plant in water and then opening it would alleviate pain [15]. The literature reports various beverages, such as water, hibiscus leaf juice, Fatma mother’s hand plant consumption, cotton leaf, and ginger tea, as well as coffee, hot milk, and tea, being used to induce labor [16, 17]. However, a study conducted in Bangladesh revealed that herbal medicines believed to facilitate healthy childbirth could lead to severe and potentially fatal bleeding [18]. The full effects of consuming the Fatma mother’s hand plant, as reported by pregnant women in the study, remain unknown [19]. In a study by Çalbayram et al., similar practices were observed where pregnant women had their waists pulled and were hung from the ceiling by their feet to prevent stillbirth and increase the chances of conception [11]. It’s important to note that such practices may not only fail to assist the pregnant woman but could also pose risks to her well-being.

Traditional practices regarding baby feeding

In the study, pregnant women avoided giving colostrum due to its color, as they believed it might harm the baby and because of the influence of their mother and mother-in-law’s perceptions. It was also noted that some pregnant women delayed breastfeeding for up to 3 days or until three adhan times, opting instead to provide sugar water or honey before initiating breastfeeding. Similar practices of avoiding colostrum have been observed in other countries, as evidenced by studies conducted in Peru and various other locations [9–11, 16, 20]. However, colostrum holds significant nutritional value, aiding in intestinal maturation and providing antibodies against enteric pathogens. Both the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) emphasize the importance of initiating breastfeeding within the first hour after birth and exclusively breastfeeding for the first 6 months to prevent neonatal deaths [21].

Our findings underscore a lack of awareness among pregnant women regarding breastfeeding, breast milk, and colostrum. Inadequate prenatal care contributes to this deficiency in breastfeeding education, leading individuals to rely on traditional beliefs and practices passed down from previous generations. Research indicates that maternal education and proper prenatal care are positively correlated with early breastfeeding initiation and exclusive breastfeeding rates [22].

Traditional practices used in baby care

In our study, we found that substances like kohl, coins, and ash were employed to induce premature detachment of the baby’s umbilical cord. Across the globe, a wide array of materials—ranging from ointments, food items, and oils to herbs, spices, and even animal manure—are utilized to expedite the healing process of the umbilical cord [23–26]. These cord care practices exhibit significant diversity based on geographical location, cultural norms, and regional traditions. For instance, in southern Zambia, ash is utilized similarly to our findings for hastening the navel’s detachment. Other examples include Vaseline in Nigeria, turmeric in Bangladesh, butter in Ethiopia and saliva in Tanzania, all employed for umbilical care [27]. However, it’s crucial to note that inappropriate management of umbilical cord care may lead to infections, ultimately resulting in preventable neonatal deaths [23]. As a fundamental aspect of cord care, it is strongly advised to keep the cord open, clean, and dry [28].

In our study, it was observed that when babies suffered from jaundice, they were often wrapped in a yellow cloth, and the skin area behind their ears was sometimes nicked with a razor. These practices align with those reported in the literature, where mothers employ various methods to alleviate jaundice symptoms [12, 29]. For instance, a study from Nigeria revealed that mothers resorted to feeding their infants sugary foods and administering herbal teas to combat jaundice [30]. While practices like wrapping the baby in a yellow cloth or adding gold to bathwater, common among pregnant women to address jaundice, may not directly pose health threats, they can obscure jaundice symptoms and delay treatment [11]. Alarmingly, our findings indicate that potentially harmful practices persist, such as cutting the baby’s heel, forehead, or under the tongue with a razor, in an attempt to alleviate jaundice and bolster the baby’s immunity.

It was found that pregnant women persisted in this practice because they observed that both the baby and the mother were traditionally not washed until 40 days after birth, a custom they inherited from their mothers and surroundings. Pregnant women believed that adhering to this tradition would prevent flushing and maintain the effectiveness of breast milk. Similarly, a study by Pekyiğit et al. yielded similar findings, where babies were also bathed after 40 days [29]. In another study conducted in Malawi, it was discovered that premature newborns were not bathed until they reached nine months old [31]. However, abstaining from bathing for forty days can result in various infections due to poor hygiene practices [32].

In our study, it was found that babies were salted to prevent them from developing a sweaty odor as they grew up. A study conducted in Jordan revealed that half of the mothers bathed their infants with salt water under the belief that salting conferred health benefits and resulted in healthier individuals later in life [33]. Kuşlu and Koçak’s study found that salting remains a prevalent tradition among both Turkish and Syrian mothers [34]. However, salting the baby is a harmful practice that can lead to skin irritation and compromise the delicate integrity of the baby’s skin [12].

It was observed that cream, powder, and pan-cooked sand (höllük) were commonly used in the treatment of baby diaper rash. However, the application of höllük poses a significant risk of neonatal tetanus and can also lead to chronic lung diseases and cancer in both the mother and the baby due to its asbestos content [35]. Studies have consistently identified the use of höllük in diaper rash care [13, 36]. As diaper rash is typically caused by moisture and irritation, frequent diaper changes are considered one of the most effective preventive measures. Furthermore, it is important to note that relying solely on diaper rash cream may not be sufficient, and the use of powder can potentially block the baby’s respiratory tract, leading to respiratory issues [37, 38].

It has been observed that swaddling, encompassing both the arms and legs, remains a prevalent practice aimed at promoting the baby’s strength and health, often involving the use of ropes for tightening. However, traditional swaddling methods, which involve tightly wrapping the baby’s lower extremities, pose a risk of developmental hip dysplasia [39]. Similar studies in the literature indicate that babies are swaddled tightly to facilitate sleep, regulate temperature, prevent crooked legs, and enable easier carrying [40]. A study conducted in Iran revealed that mothers swaddle their babies to promote better sleep [41], while research in southeastern Turkey in 2009 found that tight swaddling was common practice to ensure smooth body contours [42]. Despite the passage of time, our research findings demonstrate the persistence of traditional swaddling techniques, which can potentially cause hip and knee issues. Instead of these practices, safe swaddling methods, which involve wrapping the arms without compromising hip movement, offer various benefits such as improved sleep, enhanced thermoregulation, reduced risk of sudden infant death syndrome, faster recovery from painful stimuli, and decreased crying in infants with brain damage [40]. Our research indicates that pregnant women and healthcare professionals are not familiar with safe swaddling techniques. Providing healthcare professional with information on safe swaddling would be the most effective way to disseminate this knowledge to mothers, thereby reducing the incidence of negative outcomes associated with tight swaddling in our society.

The sources of traditional practice information

In our study, it became evident that mothers and mothers-in-law were the primary sources of advice on traditional practices. While many pregnant women expressed reluctance towards these practices, their compliance stemmed from various factors such as living arrangements with their in-laws, fear of discord within the family, pressure, and a sense of deference to past experience. Consequently, they often refrained from challenging these customs. Interestingly, pregnant women with higher levels of education tended to distance themselves from traditional practices.

Our findings were in line with existing literature, which highlights the tension between modern medical practices and entrenched traditional care. This tension is exacerbated by the transmission of traditional knowledge from family elders, particularly mothers or mothers-in-law, and is reinforced by the patriarchal dynamics inherent within the family structure. These dynamics play a pivotal role in perpetuating harmful traditional practices [43–45].

Information sources for solving babies’ health problems

It was observed that pregnant women primarily receive advice on addressing health issues from doctors, as per their accounts, whereas healthcare professionals indicated that mothers-in-law were the main source of advice. Similar studies have also highlighted that mothers predominantly seek guidance from healthcare professionals and family elders when addressing health concerns [23, 34, 43].

The family structure plays a significant role in shaping societal beliefs, attitudes, and behaviors regarding health and disease. The challenging transition period of the first 1000 days of life, coupled with inadequate access to healthcare services, often leads mothers to seek solutions to health problems during this critical period or succumb to the pressures exerted by family elders, thereby resorting to traditional practices [43]. When a baby falls ill, relying solely on traditional practices after consulting with family elders can have detrimental effects on the baby’s health. In such instances, it is crucial to educate mothers about the importance of seeking medical attention for their babies before conditions worsen.

Solution proposal to prevent traditional practices

In this study, healthcare professionals recommended providing training to pregnant women, their companions, family elders, the entire family, and mothers-in-law to prevent traditional practices. This recommendation aligns with findings from the study by Buser et al., where midwives and nurses emphasized the importance of health education for grandmothers, noting its positive impact [46].

Traditional practices during the first 1000 days of life necessitate integrated health services and community-based approaches across all stages of infant care. Key stakeholders in neonatal health, including mothers, fathers, mothers-in-law, sisters-in-law, grandparents, traditional birth attendants, women’s groups, religious authorities, and legislative bodies, should be engaged in prenatal education efforts [8, 9, 47].

Strengths and limitations

A key strength of this study lies in its dual perspective: it integrates the views of both pregnant women and healthcare professionals, allowing for a more comprehensive understanding of traditional practices and their perceived purposes. This multidimensional approach enriched the analysis and interpretation of the data, offering valuable insights into the cultural norms influencing maternal and child care. Furthermore, focusing on the first 1000 days of life—recognized as a critical period for child development—strengthens the study’s relevance to maternal and child health.

However, several limitations should be acknowledged. First, the study was conducted in only two prenatal education centers within one region of Turkey, which may restrict the generalizability of the findings. Second, the data relied solely on participants’ self-reported accounts during interviews and focus groups. As such, some practices may not have been disclosed due to recall bias, social desirability, or discomfort in discussing sensitive topics. Third, the study aimed to describe traditional practices and their perceived purposes, but it did not assess the actual health outcomes associated with these practices. As such, no direct conclusions can be drawn about their clinical benefits or harms. Further research is needed to evaluate the real effects—positive or negative—of traditional practices using evidence-based methodologies. Such studies will be essential to guide culturally sensitive, yet medically sound, health education and intervention strategies.

Conclusion

This study explored traditional practices related to prenatal care, childbirth, and early newborn care from the perspectives of both pregnant women and healthcare professionals in southeastern Turkey. The findings reveal the continued use of various cultural practices, some of which may pose risks to maternal and neonatal health—such as delaying breastfeeding initiation, withholding colostrum, tightly swaddling infants, or applying substances like salt, olive oil, or coins to the umbilical cord. Although this study did not assess the clinical outcomes of such practices, it contributes to the understanding of their cultural underpinnings, motivations, and sources of information. The persistence of these practices highlights the critical need for culturally informed health education strategies that promote safe behaviors while respecting community beliefs. However, it is essential to recognize the complexity of cultural norms, familial expectations, and healthcare accessibility that influence the adoption of traditional practices [8, 9, 48]. Effective interventions must account for the broader sociocultural context—including traditional family structures, generational influences, and access to healthcare. Education is a key strategy, not only for pregnant women but also for companions, family elders, and healthcare providers. Encouraging respectful dialogue between healthcare professionals and community members, increasing awareness, and enhancing accessibility of evidence-based services will be essential steps toward improving maternal and newborn outcomes. Future research is needed to evaluate the actual health effects—both beneficial and harmful—of traditional practices to inform culturally sensitive policy and programming.

Abbreviations

FGD

Focus group discussion

P

Pregnant

H

Healthcare personnel

Author contributions

“HYSA, BG and SSY conceptualization; HYSA and SSY resources; HYSA, BG and SSY data curation; HYSA, BG and SSY formal analysis; SSY supervision; HYSA and BG funding acquisition; HYSA validation; HYSA and BG. investigation; HYSA visualization; HYSA and SSY methodology; HYSA and BG writing-original draft; HYSA and BG project administration; HYSA, BG and SSY writing-review and editing.”

Funding

This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

Data availability

Data can be requested from corresponding author ( [siyalcin@hacettepe.edu.tr](mailto: siyalcin@hacettepe.edu.tr) ).

Declarations

Ethics approval and consent to participate

Harran University Clinical Research Ethics Committee approved the study protocol (Protocol no: 2023/03/17). All methods were carried out in accordance with relevant guidelines and regulations along with ethical approval statement and informed consent to participation. The procedures used in this study adhere to the tenets of the Declaration of Helsinki. All participants were informed of the research and an informed written consent to participate was obtained from all of the participants.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.