Contrary to appearances, Tey is not sick. The young girl is simply following an ancestral tradition linked to the event she experienced three weeks ago: the birth of her daughter. “This is what we do in Cambodia,” she says. “After the delivery, we wear hot clothes from head to toe and stay warm at home for at least one month – more if we can. It’s not easy, especially now, but if I don’t protect my body against the cold and the wind, I will suffer from headaches or health problems in the future.
”Such beliefs and practices are widespread among Cambodian mothers, regardless of their economic or social status. Rooted in Chinese medicine, the Cambodian vision of maternal health is based on the necessity of restoring the ‘hot’ state of the mother, who is believed to have lost her heat during the delivery, suddenly left in a weak state after the birth. Any failure to immediately regenerate the mother’s heat in the following weeks exposes her to direct or future health problems known in Cambodia as toa.
“In Cambodia, people name the postpartum period sor sai kchey, which literally means ‘weak blood vessels’,” explains Dr Ly Cheng Huy, director of Ponleu Sokhapheap, a Cambodian NGO that specialises in health information. “Young mothers are considered as being sick, and they endure dozens of traditional ‘heating’ practices which generally are medical nonsenses. For instance, staying in bed in a sweaty environment, with no shower or bath for days after delivery, can be a source of microbes and infections. The imposition of ‘hot’ food diets – lots of salt, lots of pepper, almost no fruit – is also a custom leading to maternal malnutrition. Every family has its own magic recipe, and the number of fanciful beliefs is infinite.”
As a gynaecologist at Phnom Penh’s Clinic and Maternity Chetra, Dr Weygand Thaihoa is a day-to-day observer of the beliefs that surround birth in his country. “Superstitions are very heavy after the delivery, but they start on the first day of pregnancy,” he says. “Some are harmless, like not drinking coffee when you are pregnant to avoid ‘dark-skinned’ babies or not bathing at night to keep the baby ‘small’. But many others are clearly harmful. For instance, many pregnant women refuse to sleep on their left side – a good position for the vena cava that carries blood to the heart – because they fear that the baby will have a ‘flat’ face or nose. Others avoid drinking milk, an important source of vitamin D and calcium, because they think that it will make the baby ‘fat’ and hard to deliver. These beliefs can be detrimental, but many are way more dangerous, like those related to the virtues of alcohol consumption and fire to restore mother’s health.”
Booze ‘n’ birth
Alcohol consumption among pregnant women is a real problem in Cambodia. Despite its well-known effects on the foetus, many women still believe that drinking beer during the last months of pregnancy will ‘lighten’ the baby’s skin. In the countryside, some even drink rice wine in order to have ‘smaller’ babies – premature ones, actually – that are easier to deliver. Yet, while being problematic, antenatal drinking remains quite limited in comparison to post-delivery consumption aimed at heating the body.
“After my first baby, I drank about six litres of rice wine in less than two months,” says Mao, a young mother of two. “My mother-in-law told me that the more wine I could drink, the better my health and my skin would be. She said that drinking wine was more effective than the medication from the hospital.”
According to health experts, it is not uncommon for women to drink up to ten litres of rice wine in the month following the delivery, even when they breastfeed the newborn. “The toxicity of such a massive ingestion is of course colossal, both for mother and child,” says Dr Thaihoa. “Ante- and postnatal alcohol use lead to a withdrawal syndrome for the baby and inhibits its cognitive development. As for the mother, many suffer from liver problems or paraesthesia – the ‘pins and needles’ feeling – due to the alcohol abuse. Many are simply drunk for weeks and, since there’s no quality control of the wine produced, severe intoxications are frequent.”
In rural areas, a stunning custom continues to exacerbate the drinking problem. Ang pleung is a roasting practice where the mother has to sleep above a fire for a period ranging from three days to one month, depending on the money available to buy the charcoal.
“Ang pleung is still widely practiced in the countryside as a way to heat the mother after the delivery,” says Ly Cheng Huy. “This is of course a very dangerous custom leading to many skin burns, aggravated infections and increased alcohol consumption. Ang pleung is a vicious circle: the fire accelerates the dehydration, leading the mother to drink more wine, which in turn increases the dehydration process. A few years ago, I heard that a woman had drunk 50 litres of rice wine during her three-week ang pleung. This is just madness.”
Few women reject rice wine during ang pleung. But Vy is one of them. The 27-year-old, who recently gave birth to a boy, decided to drink only herbal tea during her three-day roasting. “Actually, I wouldn’t have done ang pleung either if my mother had not encouraged me to do so,” she admits, her face reddened by the coal and her pyjamas soaked with sweat. “She convinced me that ang pleung would help me recover and relax my muscles, and it is nice to have my family and my neighbours taking good care of me. Ang pleung requires a lot of attention from relatives.”
Mothers and traditional healers play a pivotal role in the maintenance of traditional practices in Cambodia. “Thanks to information campaigns and greater accessibility to healthcare, dangerous customs like ang pleung or prenatal wine drinking [have] almost disappeared in Phnom Penh. But in rural areas, where many women deliver at home, mothers and traditional healers are still considered the true experts,” says Chan Theary, director of RACHA, a leading reproductive and child health NGO in the country. “That’s why we work with them to change some habits, while respecting cultural values to avoid any clash. We also bring with us local mothers and children who did not endure dangerous practices to show that they are perfectly healthy. This kind of peer-to-peer approach gives good results.
“Of course, changing ancient beliefs takes time, but we [have seen] positive results. The situation was much more critical ten years ago. Maternal mortality has been halved in the last five years, but traditional practices remain a major health problem in the country. There is still a lot of work to be done.”