Huazhong University of Science & Technology (N. Liu, Sun, L. Liu, Yao, Chen); Hubei Maternal and Child Health Hospital (N. Liu); Southern Medical University (Mao)

"We have confirmed that traditional postpartum practices in both urban and rural community can be changed quickly by messages given by health professionals..."

This evaluation details the effect of a health and nutrition education intervention which focused on improving postpartum dietary quality and optimal health behaviours in China. According to Chinese traditions, the first 30 or 40 days postpartum - called the 'sitting month' or 'doing the month' - is recognised as a special time period for behaviour restrictions and a state of convalescence. Chinese women are advised to follow a specific set of food choices and health care practices. For example, the puerperal women should stay inside, with all windows in the room well sealed. Bathing and hair washing should be restricted, and foods such as fruits, vegetables, soybean products, and cold drinks should be avoided.

Several studies have indicated that the incidences of postpartum health problems are high, and that these problems could be related to the traditional and unscientific dietary and behaviour practices in the postpartum period. Available Chinese data also suggested that the incidences of constipation and hemorrhoids were associated with lack of exercise and a decreased intake of fruit and vegetables, and the risk of oral problems was associated with not brushing the teeth and excessive intake of sugar during the puerperium.

In order to understand whether these traditional postpartum practices are indeed potentially harmful for women's health, a randomised controlled trial was conducted in both urban and rural areas of Hubei between August 2003 and June 2004. A total of 302 women who attended the antenatal clinic during the third trimester with an uncomplicated pregnancy were recruited. Women randomised to the education intervention group received two two-hour prenatal education sessions and four postpartum counseling visits. A guidebook concerning postpartum nutrition and health care knowledge that was compiled by the research team was disseminated to the intervention group women after class. Participants in the control groups didn't receive the intervention but were exposed to the normal standard of care available during the delivery and postpartum period.

Women were followed up until 42 days postpartum. Outcome measures were nutrition and health knowledge, dietary behaviour, health behaviour, and health problems during the postpartum period:

• A nutrition and health knowledge test was performed for all the participants at the time of the recruitment; no significant differences were found between the intervention and control group in both areas before the intervention. The repeated test was performed at the last postpartum visit. Significantly more women in intervention groups responded correctly to the questions than those in the control groups. After the education sessions, most of the intervention group women knew that they could eat fruit and vegetables, brush teeth, or take a bath during the puerperium.
• Women in the intervention groups exhibited significantly greater improvement in overall dietary behaviours such as consumption of fruits, vegetables, soybean and soybean products than those in the control groups. Significantly higher mean Vitamin C, Vitamin A, and calcium intake were found in the intervention group as compared to the control group in urban area, but the intake of Vitamin C and calcium were still remarkably below the Recommended Nutrient Intake. Significantly more women in the intervention groups give up the traditional behaviour taboos (no bathing, no hair washing or teeth brushing).
• The incidence of constipation, leg cramp or joint pain, and prolonged lochia rubra was significantly lower in the intervention groups as compared with the control groups.

The study shows that health and nutrition education enabled the women to reject some of the unhealthy traditional postpartum practices and decrease the prevalence of postpartum health problems. The researchers "conclude that this intervention has potential for further adaptation and development to other areas in China. We suggest that other channels, perhaps television, magazines and internet could be added to the intervention. If well-designed, these medias could potentially add a lively, modern, colorful and attractive channel for the messages to reach the families. However, the face-to-face contact of health professionals and the health education guidebook are still recommended as additional effective communication channels, as these were welcomed by most of the women."

BMC Public Health 2009, Vol. 9.