In this study, we assessed use of herbal medicines and their determinants among mothers who delivered in the preceding two years and who were attending RMCH clinics in health facility settings in Tanzania. The findings show that more than 60% of the women used herbs during the most recent pregnancy or delivery. The significant predictors of use were distance to the nearest health facility, women’s perception of herbal safety and whether the health care provider discouraged use of herbal medicines or not during antenatal visits.
The results of the present study ranges between 20–80% as reported in other related studies [6, 9, 13, 21, 22]. Furthermore, these findings are in agreement with other studies elsewhere, which confirm dramatic increment in the use of herbal medicines in pregnant women. The possible reason for the observed high usage of herbs could be due to easy availability, their perceived safety and rapid increase in promotion of traditional medicines in the society as well as the media. It is common to see posters advertising traditional medicines and herbalists in various parts Tanzania.
A significant association has been documented between educational status of a woman and utilization of herbal remedies during pregnancy and delivery. For example, some studies in Africa suggest that women of low educational status as compared to those highly educated had a higher likelihood of using herbal remedies [13, 21, 22]. However, the current data do not support such an association. In addition, the education status of the mother did not have significant influence on the use of herbs in the most recent pregnancy or during delivery.
Plants used for herbal remedies are less expensive as compared to modern medicines and they have been culturally considered as an effective and acceptable option even when modern health facilities are available [24]. Some studies have associated use of herbs during pregnancy with lack of access to public health care [7]. Similar to observations by Mothupi, use of herbal medicines in this study is significantly associated with perceived beliefs about their safety and local availability [10].
In our study, women who resided far away (at least 5 km) to the nearest health facility had more than 10% adjusted prevalence ratio to use herbal medicines compared to women living closer to the health facilities. This may suggest that accessibility to public health care is an important attribute to using herbs during pregnancy, similar to observations elsewhere [3, 7, 13].
Medications and in particular herbs should be used with caution during pregnancy as could result in adverse effects. Apart from not having standard dosages, the pharmacology and potential toxicity of the plants used are still unclear [7]. The most important aspect is lack of awareness of pregnant women and the community about potential effects of using herbal medicines on the mother and the fetus. In the current study, less than half (48%) of the respondents were aware of the adverse effects of herbs in pregnancy and only a few of them were able to mention some of the major effects. In Ethiopia and Norway, only 14% and 12% respectively of pregnant women reported to have received health advice from healthcare workers on the use of herbs [22, 24]. Compared to women who were discouraged by health care providers against the use of herbs during pregnancy, significantly more women in the Tabora study who did not receive such advice used herbs (p < 0.01). This finding suggests that if women get appropriate information during pregnancy they will greatly avoid using the herbs.
Similar to studies in Ghana [14] and Ethiopia [13], oral route was the commonest means (64.9%) for taking herbs during pregnancy and labor in the Tabora study. In all these studies, women most often chewed or consumed herbs as a strong tea. On the contrary, findings in a related study in Kagera regional referral hospital, in rural north-western Tanzania revealed that only 22% of women reported using herbs orally [15]. However, the Kagera study looked at only women who used herbs for inducing abortion.
The main motive for using herbs in the current study was to shorten labor duration (38.9%). This finding is consistent with what was observed in studies in Ghana and Mwanza Tanzania, which revealed that 39% and 68% of women respectively took herbal medicines for shortening duration of labor and alleviate pains [6]. For many years, women used herbal medicines in pregnancy to help several conditions during delivery process. For example, Nigerian women use herbal medicine to prevent complications, such as pain and bleeding [12]. Similar to findings in Tabora, studies indicate that pregnant women in some communities use herbs for the purpose of accelerating labor, preventing antepartum and postpartum haemorrahage, increasing milk production, and aiding postpartum uterine involution [6, 12]. The grounds for the high usage of herbs could in addition be attributed to their easy accessibility, perceptions that they are safe and alleviate pain; as well as the general lack of awareness of the potential side effects [13, 25].
In the Tabora study, independent predictors of using herbs during the most recent pregnancy are distance to the nearest facility, perceived safety of the herbs and the stance of health care providers towards use of the herbs. The statistically significant association between perception of safety and use of herbal remedy during pregnancy is in line with the findings of various related studies elsewhere [4, 21, 26]. The studies indicate that women who perceive herbal remedies as safe use them more than those who have negative perception about the herbs.
This study has several potential limitations. First, although we assumed mothers gave birth within two years prior to the survey were likely to remember use of herbal medicines in their most recent pregnancy; we are unable to rule completely out the possibility of information bias due to individual’s ability to recall. If some of women were unable to remember, this bias could have contributed to the low estimates. Second, women were aware that use of herbal medicine during pregnancy was discouraged at each health facility. Therefore, due to social desirability bias, there is a possibility that some women concealed reporting use of herbal medicines, thus, leading to under-estimating the proportion of herbal use. Third, no research design is optimal for all purposes and since this was a cross-sectional study, it might have reservations with the generalizability of the findings. Fourth, there is possibility that the variables we considered as independent may not be exhaustive.