CHAPTER ONE:

GENERAL INTRODUCTION1.1.                                                                                                                   Introduction

The process of childbirth is a traumatic event and the early postpartum period is a trying period with increased demands on the woman who is recovering from the process of childbirth. These will comprise, adjusting to the role of the mother through breastfeeding and other aspects of care of the baby and dealing with the sexual needs of the partner. However, several studies estimate that the average time to resumption of sexual activity range from 5 to 8 weeks after delivery (Signorello et al, 2001) while literatures on factors influencing the resumption of sexual activity during the postpartum period are inconsistent (Odar et al, 2003). Nonetheless, cultural beliefs and practices, with associated obstetric outcome of pregnancy have been the most common factors influencing the timing of resumption of sexual activity during the postparum period. In terms of obstetric factors, older women and those with uncomplicated vaginal births are most unlikely to resume sexual activity early compared to the younger women and those who had sutured tears and caeserian sections (Rogers et al, 2009). With regards to the cultural beliefs on timing to resumption of sexual activity after birth, African women tend to follow established community norms and traditions on making decisions that influence resumption of sexual activity after birth (Desgrees and Brou, 2005). This is evidenced by the study carried out by Kola et al (2014) in Ogbomoso  (Nigeria )that the resumption of sexual activity after birth should be after weaning the child or when the child is old enough to walk.

Resumption of sexual activity is a key concept to be addressed during the postpartum period but in Africa, it appears to be a subject of taboo and secrecy (Tamale et al, 2003). In many societies of Africa, prolonged postpartum sexual abstinence is a strong cultural practice. Research indicate that resumption is often prescribed by the needs of the baby, the partner, age of the mother, marital status and cultural beliefs. This. Women are often forced to recommence sexual activity after childbirth to maintain intimacy and fulfill their partners’ desires. This however results in conflict between the women and their partners as regards to abstinence and timing to resumption of sexual activity after delivery1.2.                                                                                                                                                                                                                                                                        Background

Understanding and promoting healthy female sexuality is an important component of providing care for the woman especially given the transitions of the postpartum period. Postpartum sexual problems are thought to be commonly; superficial and deep dyspareunia, vaginal dryness or insufficient lubrication, vaginal tightness, vaginal looseness and discharge, loss of sexual desire and bleeding or irritation after sexual intercourse (Signorello et al, 2001).  Many doctors recommend waiting for four to six weeks before resuming sex, to allow the cervix to close, bleeding (known as lochia) to stop, and tears to heal(Mayo clinic, 2008). A study of women in Turkey found that 42% resumed sexual intercourse within six weeks of giving birth (Geckil  and Sahim, 2009). The American and British studies by Connolly et al (2005) found that at six weeks, 57% of women had resumed sexual intercourse,82–85% had by three months, and 89–90% had by six months. Sexual intercourse was resumed by two-thirds of Ugandan women within six months of childbirth, (Odar et al, 2003)and among Chinese women, 52% had resumed sex by two months and 95% had by six months (Wang and Qin, 2003).

All African societies possess and are far from loosing their specific models and practices relating to pregnancy and childbirth. Given the scientific and technical progress which has marked the 20th century, most developing countries are characterized by medical pluralism with both the traditional and biomedical systems operating. Cameroon with a multiplicity of ethnic groups just like other developing countries consider matters on sexual activity to be a subject of taboo and secrecy (Tamale et al 2003).

According to the National Institute of Health (2006,) mode of delivery has no measurable impact on sexual function during postpartum period. This is evidenced by the data on mode of delivery and postpartum sexual function (Leeman and Rogers,2012) which were found to be conflicting and inconsistent in quality. However, little is known about the factors that may be associated with poor postpartum sexual function. It is also important to note that postpartum sexual abstinence until the child is weaned from breast milk is a deeply rooted practice in different african cultures (Grudzinskas et al, 1984). This was common in the yesteryears where polygamy was common and postpartum women lived in homes separate from their husbands so as to have time to cater for their babies. Nowadays, with the avenue of different cultural and religious practices, monogamy seem to be the order of the day and so sexual activity tends to be resumed earlier. Nevertheless, some socio-cultural beliefs are beneficial but the reasons advanced are usually unfounded while others are apparently harmful. Furthermore, men have greater influence in the control and initiation of sexual activity in our environment compared to more developed countries (Susu et al 1996).

All african societies possess and are far from losing their specific models and practices relating to pregnancy and childbirth. Given the scientific and technical progress which has marked the 20th century, most developing countries are characterised by medical pluralism with both the traditional and biomedical systems operating. Cameroon with a multiplicity of ethnic groups just like other developing countries consider matters on sexual activity to be a subject of taboo and secrecy (Tamale et al 2003).

Postpartum sexual health and sexual problems which are common had received little attention from researchers and are often not discussed by clinicians during the prenatal and postpartum care but the focus is mainly on postpartum contraception even though such discussions should be part of a complete obstetric care (Grudzinskas,1984). It is in the view of these that this study has been designed to establish the present sexual practices among our postpartum women on when to resume sexual activity and the socio-cultural beliefs of sexuality in the postpartum period.

1.3.                                                                                                                                                                                                                                                                        Statement of problem

The resumption of sexual activity during postpartum varies from the developed to the developing countries. In Africa, there is nonconformity as to when to resume sexual activity during the postpartum period coupled with social beliefs and gender based influence on making the decision. Moreover, women go through different types of delivery and this may have an influence on their health and postpartum. It would appear that no particular time has been set on when a woman is supposed to resume sexual activity during postpartum. It is in this light that the researcher wishes to carry out a cross-sectional descriptive study on socio-cultural beliefs on resumption of sexual activity.

1.4.                                                                                                                                                                                                                                                                        Research Questions

• What factors determine the resumption of sexual activity in the postpartum period?
• What are the socio-cultural beliefs regarding sexuality in the postpartum period?
• What are the challenges faced by the postpartum woman in the resumption of sexual activity?

1.5.                                                                                                                                                                                                                                                                        Research objective

1.4.1.     General objective

The aim of this research was to investigate the socio-cultural beliefs on the postpartum resumption of sexual activity.

1.4.2.     Objectives

• To evaluate the factors determining the resumption of sexual activity in the postpartum period
• To assess the socio-cultural beliefs concerning sexuality in the postpartum period
• To determine the challenges faced by postpartum women in resuming sexual activity