"My husband is my family." The culture of pregnancy disclosure and its implications on early pregnancy registration in a child nutrition intervention in rural Maharashtra, India.

Abstract Less than seventeen percent pregnant women in rural India had full antenatal check-ups. Early uptake to maternal and child healthcare services is strongly associated with cultural beliefs and practices around pregnancy and childbirth. This study aims to assess the cultural elements that influence women's behaviours of disclosure of their pregnancy in rural setting in Maharashtra state of India. We conducted 25 In-depth semi structured interviews with pregnant women and two focus groups with Community Health Workers in villages around Nagpur and Bhandara districts. The pregnant women were selected purposively with preference given to those who had a previous pregnancy. The audio recorded interviews were transcribed verbatim and translated into English. An inductive thematic approach was applied for data analysis. According to most respondents, they would only directly disclose their pregnancy to their husband and close relatives. Although, most pregnant women were hesitant towards nonrelatives discovering their pregnancy before completion of three months. The reasons behind delayed disclosure of pregnancy were fear of losing baby due to black magic, and casting of evil eyes by jealous neighbours and people with bad intentions. The Community Health Workers seconded these believes and mentioned that if pregnancy disclosed earlier, the foetus would remain incomplete (adhura). These superstitions prevented the women from availing benefits from the health facility at the earliest. The study identified several local beliefs and perceptions that hinders health care utilization of the women. Interventions that are tailored to the local cultural context can address these obstacles to increase the uptake of antenatal check-up early in pregnancy.