Blessing of the moon: cultural beliefs, birth timing and child health in Nepal

Abstract

In many South Asian contexts, specific dates are auspicious and inauspicious for health-related behaviours and outcomes. This study analysed the effect of lunar date-related auspicious beliefs in Nepal on childbirths and neonatal health outcomes. Using the daily birth records from a tertiary maternity hospital, we empirically examined whether births occurred disproportionally around full moon days. We found an average of 10.7 extra births on and before full moon days, with an average of 7.5 extra Caesarean deliveries on full moon days. We demonstrated that births occurring on or before the full moon day have poor neonatal health outcomes. However, a subsample analysis suggested better health outcomes for low-risk mothers and worse health outcomes for high-risk mothers. These findings suggest that low-risk mothers may move their deliveries to auspicious dates with fewer complications than high-risk mothers. The results emphasise the need for additional research to distinguish health service demand from supply influences on birth timing in Nepal.

Keywords:

• Cultural beliefs
• full moon days
• caesarean delivery
• birth shifting
• health outcomes

Acknowledgements

We are grateful to the Paropakar Maternity and Women’s Hospital in Kathmandu for providing access to their paper-based birth records. We thank Culture, Health and Sexuality’s editor and two anonymous reviewers for their helpful comments on earlier drafts of this paper. Any errors remain our own.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 “Astrologers Hold Sway over Nepal’s Political Leaders” (France24, December 5, 2017).

2 Vikram Sambat, the ancient Hindu calendar, has been the official calendar of Nepal since 1901. It runs 56.7 years ahead of the Gregorian calendar. The Vikram Sambat new year begins in mid-April and extends to mid-April the next year.

3 The Vikram Sambat calendar adjusts tropical solar days and sidereal years to create a civic solar calendar. This involves the deletion or repetition of lunar days according to intricate Vedic criteria and the inclusion of a leap lunar month every 2.7 years.

4 The register was tailored to an electronic form using the Open Data Kit (ODK) app. Trained enumerators collected data using ODK under the supervision of field supervisors and a data entry officer.

5 The control variables used were daily average temperature, rainfall, extreme weather events, holidays, and violent political events.

6 We checked linear, quadratic and cubic trends for birthdays across the cut-off; however, the estimated results are similar. We included first-order lag of birth counts to account for unobserved characteristics that may affect daily birth rates such as service arrangements and staffing.

7 The percentage reported in parentheses was obtained when the log number of births was used in equation 1(1) $${\mathit{Births}}_{dt}=\alpha +{\beta \mathit{BeforeFM}}_d+{\varphi }_{ym}+{\gamma }_d+{\theta }_{ld}+{\delta X}_{dt}+{\epsilon }_{dt}$$(1) and equation 2(2) $${\mathit{Births}}_{dt}=\alpha +{\beta }_1{\mathit{Before}}_d+{\beta }_2{\mathit{After}}_d+{\varphi }_{ym}+{\gamma }_d+{\theta }_{ld}+{\delta X}_{dt}+{\epsilon }_{dt}$$(2) . Logging the dependent variable allowed us to interpret the result as β∗100% change (increase/decrease) in births with the explanatory variable. We omitted the log numbers from Tables 1 and 2 for the sake of clarity.

8 Gestational age was based on women’s recall of her last menstruation. It is the duration between the delivery date and the first day of last menstruation. Note that the birth register does not include detailed screening tests (ultrasonography) to estimate gestational age clinically.

9 As of March 29, 2022, the Knoethe DataHub stated on its website that the total number of births for Nepal in 2020 was 5,621,200.

Additional information

Funding

This work was supported by Japan Society for the Promotion of Science (JSPS), Kakenhi under Grant JP19KK0044.