The role of South ASIAN grandmothers
Many grandmothers believed they play an important role in the familial hierarchy and saw themselves as a figure of wisdom and experience, often advising their daughters and/or daughters-in-law on matters regarding food, activity, and optimal maternal behaviours. Many also said their role was to help preserve the cultural values and traditions that have been upheld by previous generations. For example, one grandmother responded with “we keep our culture and religion (Participant 013)” when asked about the role she played within her family. Another grandmother said she takes responsibility in “teaching about culture and cooking” (Participant 007).
Furthermore, many grandmothers felt they maintain a very positive relationship with their grandchildren and enjoy taking an active role in their health and well-being. This relationship was associated with a great sense of fulfillment and purpose. For example one grandmother said, “I am always interested in my grandchildren’s growth, studies, and health. It’s my choice too. I love to take care of them (Participant 003).” Another grandmother said, “we have such an active role in their [our grandchildren’s] upbringing (Participant 002).” In some cases, taking an active role in the lives of their grandchildren result in them “worrying about whether they will do well” (Participant 001).
Attitudes toward advice-giving
Generally, the grandmothers’ attitudes towards giving advice can be categorized in three ways and may change depending on the situation: a) Enforcing: this style of giving advice is steadfast with the belief that it will be followed. Stemming from the perceived role of the grandmother as a figure of wisdom and experience, one who is responsible for taking care of the family through her actions and the advice she provides. For example, one grandmother said “We advise them on each matter and they do follow them (Participant 012)”; b) Intervenes when necessary: this style of giving advice is described as intervening only when the right opportunity arises. This stems from the belief that although the new mother will act in the best interest of the child, she may need guidance around certain behaviours. For example, one grandmother said, “That should be her choice as to what she wants to eat or drink, but as to what you want to advocate it’s different … Like iron … she should take supplements if she’s low on iron (Participant 004)”; c) Imparts when asked: This style is described as giving advice only when requested and not necessarily advising otherwise. Grandmothers who provide advice this way oftentimes acknowledge generational and intercultural differences in terms of child-rearing. For example, one grandmother said, “I normally don’t give advice because I don’t like to impose myself … But yes whenever she does need any advice I do want to share my advice and she follows it. At other times I just give a suggestion for her to weigh the pros and cons and then decide for herself (Participant 006).”
The health beliefs of grandmothers
Our data reveals that South Asian grandmothers garner their health perceptions from three main sources of knowledge: experiential (personal experience), medical-based, and community-based/cultural. Many also identified a distinction between what behaviours are considered optimal during the three main stages of the perinatal period. The pre-conception period was characterized to be reserved for healthy habit building; the pregnancy period was considered to be a time where the mother surrounds her mind and body in an enriched environment; the postnatal period was thought to include behaviours that support healing and restoration for both the mother and the newborn.
The preconception phase
To ensure optimal health, many grandmothers recommended that their daughters or daughters-in-law practice building healthy habits during the pre-conception period. With a special emphasis on mental health, nutrition, and physical activity, grandmothers believed that women should engage in stress reduction practices (e.g. yoga, meditation) and occupy themselves in a positive mental and physical state. For example, one grandmother said, “your mind should be healthy. You have to keep your mind peaceful (Participant 005).”
Grandmothers believed that keeping one’s mind at peace is an important step in taking care of others (including future children). Many emphasized the importance of moderation in one’s diet, implying that eating well is characterized by balance, instead of specific or extreme food restrictions. For example, one grandmother explained that it is important to have “moderation in everything. I don’t believe in extremes (Participant 008).” Another grandmother said, “It should be a well-balanced diet, not something in particular (Participant 009).” Many felt that during the pre-conception phase, eating all foods in moderation was important to building healthy habits.
Overall, the pre-conception period was considered to be a time where the body is being prepared for supporting the optimal growth of a baby. As a result, women should build health habits that are conducive to ensuring metal wellbeing, nutritious eating, and non-strenuous physical activity.
The pregnancy phase
Many grandmothers believed that in order to support the growth and delivery of a healthy baby, the pregnant woman has to reflect and surround herself in an ideal environment. This is best achieved by continuing to practice the healthy habits that were built during the pre-conception stage. An “Enriched Environment” was upheld by keeping positive relationships and support systems, maintaining healthy routines, nutritional enhancement, and moderate, non-strenuous exercise. The main reason that many grandmothers believed that an enriched environment was the key to optimal health during pregnancy was because of the belief that everything the pregnant woman surrounded herself with would be imprinted onto the baby growing inside of her, including thoughts and conversations that she may have. For example, two different grandmothers provided the following explanations:
“After the first three months I think the baby starts to hear what is going on in the family so it’s good to have good thoughts, read good books and listen to good music, and no fighting, you know the baby can tell when the mother’s upset. So psychologically try to have happy thoughts (Participant 004).”
“Mentally soothe yourself you know, listen to calming music. You know all of that is beneficial to the baby and I guess it’s all tied into the same theme. The mother is calm the baby is going to be calm. The mother eats right the child will eat right so it’s all like a tree giving forth good food (Participant 005).”
Maintaining an enriched environment was believed to primarily follow from the preservation of healthy habits. In addition to keeping one’s mind at peace, some grandmothers indicated that this period should include surrounding oneself with religious and intellectual stimuli like books and pictures, and also engaging in prayers and ceremonies. These activities are seen as important not only for the expecting mother’s own mental health, but for the well-being of the child. For example, one grandmother explained this: “Read good books, religious books … Read good novels and watch religious movies, or do prayer. Meditation (Participant 003).” Another participant said, “You can read books, visit spiritual institutions, listen to songs, radio, read newspapers, and talk to people (Participant 007).” Many grandmothers also spoke of the mother-child connection that exists, and the ways in which the mother’s own health and state of mind can influence the child in-utero. For this reason, maintaining a positive state of mind was seen as imperative to the health of the child, and many grandmothers spoke of different ways for the expecting mother to remain happy and stress-free. This often included being social, interacting with friends and family, and maintaining a sense of “normal” life and routine. Some grandmothers spoke of their own experience dealing with the stresses of pregnancy, and the importance of reaching out to support networks and asking for help when necessary.
There was an emphasis on nutritional enhancement in regards to adding special foods to the diet and replacing or replenishing vitamins. Many grandmothers believed that the pregnant woman eating particular foods would foster particular traits in the child in addition to informing his or her overall health and wellbeing. Smoking, drinking, and the use of drugs were generally seen as negative, both culturally and also due to the adverse health effects these substances can have. This viewpoint was generally extended to prescription medications during pregnancy, unless it is a last resort.
Consistent with the pre-conception period, light exercise was seen as important, especially in the management of excess weight gain. While food is seen as nourishing and healthy, there was still an understanding that the pregnancy period should not be one of gluttony and inactivity, and the mother must still remain healthy and active for herself and the baby. For example, two different grandmothers said, “she should not gain too much of weight. Staying healthy and active is important (Participant 016)” and that “she should exercise and do household work. Sleeping entire day is not good, walking is a good exercise (Participant 017).” Few grandmothers mentioned intentional, strenuous exercises such as weight bearing, running, or gym-related activities, and instead focused on walking. Some grandmothers also expressed concern regarding more rigorous activities, as they believe them to adversely affect the expecting mother’s health by increasing the risks of abortion. For example, one grandmother said she would recommend the following: “Walking. I wouldn’t do anything too strenuous in excess you know, no jogging or anything just walking on a treadmill or something (Participant 014).”
Post-partum phase
The postnatal period was described to be a time of healing and restoration for the mother and the baby. First and foremost, many grandmothers emphasized the importance of self-care during this period, ensuring that the mother regains both the physical and mental strength necessary to take care of the baby. This included activities such as getting adequate rest, eating well, taking soothing baths, listening to calming music, and maintaining a positive mental state. For example, one grandmother said, “she should look into her own self first and see what used to make her happy, what used to give her more satisfaction … Maybe read, hear good music, go out … Essentially you should love your own self and your own company. If you can manage to get that down you will never be sad (Participant 005).”
Many grandmothers mentioned that friends and family can play an important role during this period by offering their love and support for the mother and new baby. Raising the child was seen as a collective responsibility, and many grandmothers assumed an active role in this regard. Furthermore, the ongoing practical and emotional support was seen as imperative to the mother’s mental health, helping her during this period of stress and change. For example, one grandmother said, “I think that the mother needs somebody there every day for six weeks. My daughter is still taking antidepressants ‘til now, from the first baby … I don’t know how much care she had because you can’t interfere with certain things, and I don’t think she had the support like we had back home in our country, and I think she suffered because of that (Participant 008).”
Following this initial period of recovery and restoration, many grandmothers encouraged their daughters and daughters-in-law to start re-building healthy habits and re-integrating into the flow of normal life (re-build her routines). Many felt this included behaviours such as learning to maintain a work-home balance, eating healthy, and upholding a good social network. For example, one grandmother explained that, “in the first year she should gradually get back into her own routine life. The longer she waits, the harder it becomes (Participant 012).”
Furthermore, grandmothers expressed that the mother bonds with the child through co-sleeping, massages, stretching, and breastfeeding. For example one grandmother explained the importance of helping the baby stretch, “you cross their arms, you cross their legs, you have their legs touching their head, you know so it’s a stretching thing and the baby’s so relaxed they go to sleep (Participant 014).” Another grandmother said, “even now my daughter-in-law massages the back and the tummy, soothes, reads to them, lullabies (Participant 009).”
Breastfeeding was seen as important and often linked to reduced infection and sickness in the baby. It was generally believed that a child who was breastfed will be healthier. For example, one grandmother said, “for one thing, breastfeeding helps the baby have a healthy growth. Secondly it sort of builds a bond with the mother and the child. I know there’s a natural bond that comes with the mother and the child and a child gets more immunity. A [breastfed] child is healthier (Participant 010).”
Similar to the notion of imprinting, many believed that the baby can sense when the mother is anxious or sad, and therefore her mental state can have a profound effect on the child. Many grandmothers explained that the “mother-child connection” is imperative to avoid any stress or fighting that could influence the child’s temperament or impede the mother’s ability to take good care of the child. As opposed to food being almost exclusively seen as nourishing during pregnancy, there was a focus on avoiding certain foods that would cause distress in the baby through breastfeeding (referred to as Kirandhi foods), as well as ensuring an adequate diet pattern full of healthy, fresh foods.
Overall, the grandmothers believed that the preconception phase begins far before planning to have a child and includes behaviours that promote building healthy habits (particularly around nutrition, physical activity, and mental wellness). They believed the pregnancy phase should include behaviours that enrich the surrounding environment of the mother and child. After the child is born, the woman should focus her behviours around healing and restoration, including re-building healthy habits. It is important that a cyclical relationship exists between these phases, as many South Asian women have more than one child (See Fig. 1). See Additional file 2 for additional supporting raw data for each theme.
