Traditional Postpartum Rituals
of India, North Africa, and the Middle East:

Seclusion,  Henna, & 40 Day Homecare

by Catherine Cartwright Jones
2002
Kent State University, Medical Anthropology


Hennaing a woman after she gives birth is a traditional way to deter disease, depression, and poor bonding
with her infant. The action of applying henna to a mother after childbirth, particularly to her feet, keeps her
from getting up to resume housework.  A woman who has henna paste on her feet must let a friend or relative
help her care for older children, tend the baby, cook and clean! This allows her to regain her strength and
bond with her new baby. She is also comforted by having friends who care about her well-being, and is helped
to feel pretty again. It’s a comfort to have feet beautified when you haven’t seen them for several months.









The countries that have these traditions have very low rates of postpartum depression. Non-western
societies have postpartum rituals within the popular expression of their religions that directly address the
needs of a mother in the 8-week period after birth. These ritual actions serve to support her physically and
emotionally after birth, and reintegrate her into the community after recovery.  Henna traditions within
popular religion practices of Islam, Sephardic Judaism, Hinduism, and Coptic Christianity are part of the
management system for postpartum depression in India, North Africa and the Middle East. Henna is becoming
more widely available in western countries at present due to the popularization of henna body art in
western pop culture (Maira S, 2000), and henna’s association with beautification and protection from evil are
comforting.

Henna’s requirement that a woman be still for several hours during and after application insures
that a mother will rest and allow others to take care of her! During the weeks after ornate henna
patterns are applied, a woman is culturally allowed to not do household tasks that would spoil the
beauty of the stains. This increases the likelihood that she will rest properly to regain her strength
after giving birth.

A woman goes through a social status change when she becomes a mother, and her relationship
with her husband, other family members, and social group is changed. Caring for and nursing a
neonate requires much from woman’s physical and emotional resources. These stresses added
to the precipitous fall in estrogen and progesterone levels following birth, coupled with the
elevation of prolactin in the first week postpartum are believed to give rise to irritability, mood
changes, tearfulness, guilt, anxiety, fatigue and feelings of inadequacy. In extreme cases, the
symptoms of postpartum psychosis include agitation, confusion, hallucinations, fatigue, delirium
and diminished thinking (Stern and Kruckman, 1983). Though women universally experience the
biological processes of the postpartum adjustment, they conceive of these changes through their
social and religious constructs (Kleinman, 1978; and Cosminsky, 1977).

When rituals are performed to relieve the woman of the stresses of social reintegration, childcare and fatigue,
theconceptualized demons of postpartum depression may be averted as the biological adjustments
are buffered. Henna is frequently used within performance of rituals actions in North Africa, the
Middle East and South Asia to deter the evil eye.

Western neonatal practice screens for postpartum depression, recognizes that it exists in several
degrees of severity, that it is a clinically recognizable affective disorder, and that there are
statistically predisposing socio-economic factors. Traditional cultures recognize that a woman is
in a fragile, stressed state after giving birth, and that timely assistance from ritual actions of
popular religion helps the mother reintegrate into society. In contrast, western medicine
conceptualizes postpartum depression as a psychobiological phenomenon to be addressed by
medication rather than a socio-magical phenomenon to be addressed by ritual performance.

Indian Traditions

Postpartum practices in Rajasthan are typical of those throughout rural regions in India.  In rural Rajasthan,
ritual actions surrounding childbirth include henna applications and rangoli during late pregnancy, well before
birth (called a 'blessingway' in native american tradition). A woman in the eighth month of her first pregnancy
has an Athawansa ceremony. She is rubbed with scented oils, bathed in perfumed water, and ornamented
with henna, on her hands, feet, up to the wrist and ankle, in a manner similar to her wedding henna. She is
dressed in new clothing and ornaments. She is seated on a cauki, ceremonial wooden seat. Women friends
and family fill her lap (god) with sweets, fruit, and a coconut. This ritual is "The Filling of the Lap."Women
ornament the floor with rangoli called “Athvansa-ko-cowk” (Saksena 1979:121).











The patterns used are acknowledged to bring health, protection and luck to the new mother and her
child by inviting the aid of supernatural forces. Primiparous women are statistically most at risk
for postpartum depression, and prenatal screenings for depression are often carried out in
western medicine at this period (Stern and Kruckman, 1983). The eighth month ritual may serve to
establish the woman’s “social safety net” within her community, who will help her through birth
and reintegrate her after childbirth.












At birthing, the mother is ornamented with henna before being escorted out of the delivery room.
After the woman has given birth, she must have all of her fingernails and toenails hennaed in a
ceremony known as Jalva Pujani, as henna is considered a medium for purging the pollution
incurred from the process of giving birth (Saksena 1978, 75). If she is not properly hennaed at
this time, she is considered at risk of not recovering from birth.

For the first 9 days after birth, the woman is secluded and attended to by female relatives. The Rajasthani
enforced rest, physical and emotional support during the establishment of maternal bonding and lactation may
be crucial in preventing or relieving postpartum depression, and are similar to those observed in Nepal
which are also considered to manage postpartum stress (Upreti, 1979) ...In most of the tribal groups, women
were hennaed, and ornamented with kohl (a traditional black makeup made of antimony) and swak, (a
traditional dark lip stain made of walnut root) as if they were brides before they go into labor.











These not only deterred malicious spirits, but also prepared the woman for the possibility of dying in
childbirth. If a woman died in childbirth, she was believed to enter paradise as a bride, and should be
appropriately adorned (Westermarck II, 1926, 383). A woman who died in childbirth was believed
to have no punishment after death (Legey, 1926: 119). Women in western maternity clinics are
well supported medically to prevent death in childbirth, but no attention is given to her potential
entrance into afterlife.

North African Traditions

An Amazigh woman who gave birth to twins was regarded as full of baraka, or blessedness, and
those who visited her after birth would kiss her hand and address her as lalla, “my lady”. If a
woman gave birth to triplets she was regarded as holy. Even an ordinary birth was believed to
have baraka (Westermarck I, 1926, 47). Though birth is regarded as a wonderful event, an
immigrant woman in a western hospital maternity ward is unlikely to feel very special. If she gives
birth to twins or triplets, they are swiftly removed to a neonatal intensive care unit for monitoring
and health support, and treated as a medical emergency rather than being celebrated. Multiple
births in the have a high statistical correlation with impaired maternal bonding and postpartum
depression in western pediatrics (Stern and Kruckman 1983).

The midwife attending the birth in North Africa took care to assure the woman that malicious
supernatural spirits were dispelled. This was accomplished with henna, incense, amulets, and
ritual actions. In Moroccan Jewish households, a magic circle was drawn in the air around the
laboring woman with a large sword to deter evil spirits. At the moment of birth in Amazigh
Morocco, the mother was kept covered, with only the midwife can attending her, so the “evil eye”
could not catch sight of her genital organs and cause her harm (Legey, 1926: 124). A laboring
woman was therefore in a secure and familiar place, undistracted, accompanied only by one
trusted helper. Several strangers peering between her legs, bright lights, and machines
surround a woman in a western obstetric ward.

An Amazigh woman was repeatedly ornamented with henna during the seven days after birth, as
well as having her eyes rimmed with kohl. She was kept secluded, and only the midwife was
allowed to attend her behind her curtain. This was seen as a safeguarding the mother against
malicious spirits and witchcraft that would cause her illness, depression and death (Westermarck
II, 1926, 385). The effect of these ritual actions was to allow the mother to rest and be cared for
by an experienced attendant during the 10 day period required for her estrogen, progesterone
and prolactin levels to stabilize and for her to recover her strength (Stern and Kruckman 1983), as
well as being comforted by ritual actions familiar from her wedding. Neither mother nor child were
washed with water during this period, but were cleaned with oil and henna. At each application of
henna, the woman would have to remain still for several hours, resting, and allowing others to
take care of household tasks, ensuring that she would regain her strength quickly.

On the seventh day after birth, the child was washed and named. In Andjra, the midwife again adorned
the mother with henna, and dressed her in clean clothing. The child was also hennaed on the
head, neck, navel, feet and fingernails, in its armpits and between the legs, all in an effort to avert
malicious spirits. The mother was dressed with slippers on her feet, and her head was covered,
leaving only eyes, nose and mouth uncovered, so that witchcraft or malicious spirits would not
cause her mental or physical illness. The mother still abstained from work at this time, though
she directed household tasks. Women in the house trilled a zgrit several times at the birth of a
son, fewer at the birth of a daughter (Westermarck II, 1926: 386 – 94) to dispel evil spirits.
At the seventh day and days following, the family put on as extensive celebration as could be
afforded. Female relatives who visited during this period assisted household tasks so the mother
could continue to rest. Music and feasting was arranged to celebrate the birth, and the mother
was dressed in fine clothing, hennaed, harquuesed, her hair dressed in fragrant oil and rosewater
as if she were a bride.

She was given the heart and fat of the sacrificed animal to eat,  one of the few times that a woman was
guaranteed abundant calories and protein. Again, elaborate henna ensured that the mother would rest for
several hours during and after the application. She would be excused from household chores for the
following weeks to keep her henna stains beautiful, so the henna encouraged continued rest and
recovery.















For forty days after giving birth, the woman was regarded as in a delicate state of transition. The phrase often
spoken was that “her grave is open”. Marital intercourse was not resumed until forty days after birth in most
of the communities, though a man could return to sleeping by his wife after the seventh day. For forty days, if
not longer, the child was never left alone, lest malicious spirits come and steal it, exchanging it for
their own (Westermarck II, 1929: 398-9). During this period, maternal bonding was not impaired
by separation as is common in western medical obstetric practice.

A woman suffering postpartum depression may assert, “The child is not my own, or I am afraid of my baby.”
(Brockington et al, 2001: 136 - 8). The North African ritual actions managed the risk of postpartum psychosis by
keeping mother and child together, supported and undistracted during the 40-day period when
depression is most likely to appear. If a depression or psychosis did develop and woman felt that
her child had been stolen and replaced by a supernaturally evil creature, (medical literature notes
postpartum psychoses can take the form of the mother believing the child to be evil or malicious
(Brockington et al, 2001)) rituals were be performed to retrieve the natural child so maternal
bonding could be re-established. The infant believed to be a changeling, a mebeddel, had to be
taken back to the jnun, supernatural spirits, and exchanged for the human child. The mother took
the evil creature to a cemetery, looked for a demolished tomb, and put the changeling child there,
with an offering of meat for the jnun. She withdrew, to avoid contact with the spirits as they came
to collect the meat. As soon as the child cried, she reclaimed it, and washed it with holy water,
and exclaimed, “I have taken my own child, not that of the Other People” (Legey, 1926: 154 – 5).
Thus the postnatal ritual actions acted to buffer depression, and offered an option for reinstating
maternal bonding in the instance of psychosis.

Performance of postpartum rituals, particularly those which include henna, for South Asian,
Middle Eastern and North African women during the forty days after birth may reduce their high
levels of depression in their host countries to levels found in their indigenous countries. It is
notable that these rituals are performed to provide physical and emotional assistance, and enable
the woman to recuperate and bond with her infant through the period wherein the woman is most
at risk for postpartum depression due to hormonal adjustment. In particular, the henna
applications during this period require a woman to rest quietly for hours during the process, and
abstain from household tasks that would spoil the patterns for three or four weeks following.
















This enforcement of inactivity ensures that a woman will rest during the period of hormonal
stabilization and bond with her infant. If ritual performance can achieve similar reduction in
depression to SSRIs, and does not directly interfere with medical practice, then religious pluralism
may be practical medical policy.

Women recently immigrated into western countries have up to 10 times the incidence of
postpartum depression in comparison to their peers in their native non-western countries and in
comparison to women acculturated to the west (Bashiri and Spielvogel, 1999). New mothers in
non-western cultures display few symptoms of postpartum depression; some sociologists believe
that the women may be so well supported by their postpartum rituals within their countries of
origin this affective disorder is nearly eliminated (Stern and Kruckman, 1983). Other studies
demonstrate that the physical and emotional stresses following childbirth are well identified and
managed by ritual in the indigenous community, so that the experience of depression is
minimized (Pillsbury, 1978). Immigrant women’s lack of access to their postpartum rituals in their
host country has been proposed as a cause of this elevation in psychiatric morbidity (Lee et al,
1998; Moon Park and Dimigen 1995).

In North Africa, women who feel they are suffering from postnatal illness seek help from a traditional healer
rather than from a physician (Cox, 1983), and such preference is common in other countries. The women feel
that their needs for postpartum reorientation and support are better met by popular religious ritual rather
than formal religion or western medical practice. When they are immigrants into a western country, the formal
religion may be available, but performance of appropriate popular religious rituals for childbirth may be
impossible do to lack of knowledgeable practitioners and implements for performance.

Western Medical and Popular Religious Ritual Approaches to Birth and Postpartum Depression

Western doctors understand that their patients are religiously and ethnically diverse, but they are
selective about which religious/medical actions they are willing to tolerate or perform. Western
neonatal practice is willing to perform male circumcision, but not female circumcision. A priest
may be admitted into a hospital setting to bless a child, but a large group of women loudly trilling
a zgrit to bless a child (Westermarck 1926, II, 375) might be unwelcome. A woman may be able
to order kosher or vegetarian food for her hospital stay, but not exotic foods required by popular
religious ritual in her country of origin. Women in obstetric wards receive flowers from a florist,
but are usually discouraged from decorating their bedposts with traditional textiles to deter evil
spirits, as only sterilized bedding and autoclaved instruments are permitted. An obstetrical room
will be cleansed with antibacterial spray, but anti-smoking regulations may be interpreted to
prohibit cleansing incensing with gum-sandarach, which rural Moroccan women believe to excite
fear in malevolent spirits (Westermarck 1926, II, 382).

A woman going into surgery is required to remove all jewelry, even if that includes amulets and talismans that
she feels are crucial to insure a safe delivery. Western physicians often mistake henna for skin disease, and
may dismiss other traditional postnatal rituals as unhygienic or medically useless. If performance of postnatal
rituals can be demonstrated to significantly reduce maternal psychiatric morbidity incidence in immigrant
women, they are NOT medically useless!

In addition, there is concern that selective seratonin reuptake inhibitors prescribed by physicians to
depressed mothers are found in their breast milk. The long-term effect of antidepressants consumed by
infants through breast milk has not been assessed for possible side effects, though it is noted to cause sleep
disturbance (Schmidt, Olesen, Jensen, 2000). A mother may be asked to choose between breastfeeding and
depression if a western doctor offers her only SSRIs to assist her postpartum depression. If
performance of traditional postpartum rituals could reduce depression to levels achieved with
medication, such a choice might be avoided.

An immigrant woman may thus be unable to access the rituals she regards as necessary for purifying and
reintegrating her into society after giving birth. This has been considered contribute to the elevated and
prolonged postpartum depressions observed among immigrant women (Williams and Charmichael, 1985). The
immigrant’s lack of the usual support network to perform popular religious rituals following birth has been
associated with the elevated maternal psychiatric morbidity in their host countries (Upadhyaya et al, 1989,
Watson and Evans, 1986)

References:

Al-Majed S A, Harakati M S, “The Effect of Henna Paste on Oxygen Satureation Reading Obtained by Pulse
Oximetry” Tropical and Geographical Medicine 46 #1, 1994, p 38 – 9
Barnett B, Matthey S, Gyaneshwar R, “Screening for Postnatal Depression in Women of Non-English
Speaking Background” Archives of Women’s Mental Health, 2: 67-74, 1999
Bashiri N, Spielvogel A M, “Postpartum Depression: a Cross-Cultural Perspective” Psychiatry Update, Elsevier
Science Inc, 1999, 82 - 87
Brockington I F, Oates J, George S, Turner D, Vostanis P, Sullivan M, Loh C, Murdoch C; “A Screening
Questionnaire for Mother-Infant Bonding Disorders” Archives of Women’s Mental Health 2001, 3: 133 - 40
Cosminsky S, “Childbirth and Midwifery on a Guatemalan Finca” Medical Anthropology 1, 69 - 104, 1977
Cox J L, “Postnatal Depression: a Comparison of Scottish and African Women” Social Psychiatry, 1983, 18, 25 -
28
Ghubash, R. Abou-Salen MT, “Postpartum Psychiatric Illness in Arab Culture: Prevalence and Psychosocial
Correlates” British Journal of Psychiatry, 171: 65-68, 1997
Kleinman A, “Culture, Illness and Care – Clinical Lessons from Anthropological and Cross-Cultural
Research” Annals of Internal Medicine, 88, 251-258, 1978
Lee, Yip, Chiu, Chan, Chau, Leung, Chung, “Validation of the Chinese Version of the Edinburgh Depression
Scale” British Journal of Psychiatry, 172: 433-437, 1998
Legey, Francoise; “The Folklore of Morocco” George Allen and Unwin Ltd. London, 1926
Maira, S, “Henna and Hip Hop, the Politics of Cultural Production and the Work of Cultural Studies”
The Johns Hopkins University Press, JAAS, 2000, 329-369
Malville J.M, Singh RPB, “Visual Astronomy in the Mythology and Ritual of India: the sun Temples of
Varanasi Pergamon, Vistas in Astronomy, Vol 39, pp 431 – 49, 1995 Elsevier Science Ltd, Great Britain
Moon Park E-H, Dimigen G, “A Cross-Cultural Comparison: Postnatal Depression in Korean and Scottish
Mothers.” Psychhologia 38: 199-207, 1995
Pillsbury BLK,” “Doing the Month”: Confinement and Convalesence of Chinese Women after Childbirth”
Social Science in Medicine, 12: 11-12, 1978
Saksena, Jogendra, "Art of Rajasthan, Henna and Floor Decorations" Sundeep Prakashan, Delhi, India, 1979
Schmidt K, Olesen O, Jensen P., “Citalopram and Breast-Feeding: Serum Concentraation and Side Effects
in the Infant” Society of Biological Psychiatry, 47:164-165, 2000
Shoeb I H and Hassan G A, “Postpartum Psychosis in the Assir Region of Saudi Arabia”
British Journal of Psychiatry, 1990, 157, 427 - 43
Stern G, Kruckman L, “Multi-Disciplinary Perspectives on Postpartum Depression: An Anthropological
Critique” Social Science in Medicine, 17: 1027 – 1041, 1983
Upadhyaya A, Creed CF, Upadhyaya M, “Psychiatric Morbidity Among Mothers Attending a Well Baby
Clinic: a Cross-Cultural Comparison” Acta Psychiatr Scand 81: 148-151, 1989
Upreti NS, “A Study of the Family Support System: Child Bearing and Child Rearing Rituals in Kathmandu,
Nepal” Unpublished Dissertation, University of Wisconsin, Madison, Wisconsin, 1979
Watson E, Evans SJW, “An Example of Cross-Cultural Measurement of Psychological Symptoms in
Postpartum Mothers” Social Science in Medicine 23: 869-874, 1986
Williams H, Carmichael A, “Depression in Mothers in a Multi-Ethnic Urban Industrial Municipality in
Melbourne”Journal of Child Psychological Psychiatry 26: 277-288, 1985
Westermarck, Edward, “Ritual and Belief in Morocco, Vols. I &II” Macmillan and Company, Limited, London,
1926

Rangoli, also known as Mandana, Alpona and Kolam, are designs executed by women using rice flour,
turmeric, spices, flowers, or henna on domestic floors and walls. The designs are auspicious and have
ritual significance for the occasion. They purify the domestic space, honor and invite the presence of a
deity. In the case of birth patterns, the soul of the child is welcomed with these patterns and directed to the
proper place.

Bishmillah allahu akbar ‘ala ----In the name of God, God who is Great ---(the name of the child) ben
(son) or bent (daughter) – (of so and so)

Zgrit: a North African and Middle Eastern loud, shrill celebratory ritual exaltation done by women. The
sound is made by loudly singing a high note while flicking the tongue back and forth across the upper front
teeth. The Zgrit is intended to frighten away evil spirits. Women in an Amazigh house trill a zgrit seven
times at the birth of a son, three times at the birth of a daughter.