Churches: God's Frontline Soldier for Improving Maternal and Child Health

Story 1

In one of the sessions, a young mother raised her hand and asked, “May I invite my mother-in-law to attend these sessions as well? Because if we follow what is being taught here and it differs from what our mothers-in-law believe, we might get scolded by them.” At the time, we were discussing exclusive breastfeeding. Based on our observations and the information gathered, the rate of exclusive breastfeeding was notably low. This appeared to be strongly linked to limited public understanding of its importance. Yet, the mother's question revealed something deeper: that maternal health practices are heavily influenced by the social structure in the community.

In the local cultural context, mothers-in-law play a dominant role, and daughters-in-law are expected to comply with their guidance. This includes decisions about what toddlers should eat, the activities of pregnant women, and even their dietary patterns. Thus, this situation is demonstrating the powerful influence of intergenerational dynamics on maternal and child health behavior.

This condition is closely tied to the sociocultural configuration in which mothers-in-law hold a central role in Nias tradition, particularly in marriage customs. In fact, the mother-in-law is often referred to as ina sowõli, which literally means “the purchasing mother.” Meanwhile, the daughter-in-law is called bõli gana’a, meaning “the gold purchase.”

Why is such a transactional term used? In practice, marriage in Nias resembles an asset exchange process. The bride’s family “offers” their daughter, while the groom’s family is expected to sacrifice their wealth, especially in the form of gold as dowry to “acquire” the bride. The mother-in-law, before her son’s marriage, is considered to have worked hard accumulating the family’s wealth and gold, which would later be paid to the bride’s family during the wedding. This is the cultural basis behind the naming of the daughter-in-law as bõli gana’a.

Therefore, it is unsurprising that the young mother felt she had no authority over her own child and even less over herself. Her perceived role in the family structure was subordinated to her mother-in-law’s authority.

Story 2

In another session, we encountered a mother who had already stopped exclusively breastfeeding her infant. Related to the previous account, this mother revealed something revealing: after childbirth; she had to return to work immediately to support her family; otherwise, she would be labeled as lazy and face reprimands from her mother-in-law.

This immediate return to labor post-delivery left her with no time to recover and posed long-term risks to her own health. More concerningly, her baby was left in the care of others, usually her mother-in-law, which opened the door to early substitution of exclusive breastfeeding with alternatives.

For many women in Nias, being seen as hardworking is considered far more important than seeking health services. Although traditional health practices are still observed, they are often more socially acceptable than missing work for medical care. Farming labor, especially, is strongly associated with securing the family's future.

In several areas we visited, local midwives had long given up on encouraging women to attend antenatal checkups. Many midwives expressed frustration, uncertain of how to even persuade mothers to attend basic health education sessions. Work and family obligations consistently took precedence. Adherence to cultural norms led many women to neglect their own health. These women are often the backbone of their families, working long and physically demanding hours on family land.

This deeply entrenched work ethic cannot be separated from the extreme poverty that has long afflicted Nias Island. People are forced to work harder, often through manual labor rooted in tradition. However, the burden falls disproportionately on women, reinforced by social expectations and cultural norms. As Zaluchu noted in his writings on the concept of dowry in Nias,² this is closely tied to the systemic weakening of women’s status. Similar to the myths surrounding Black women, as discussed in Kelly Brown Douglas’s essay ³ women in Nias—despite their vulnerable position—are mythologized as resilient figures who can immediately resume labor after childbirth.

Story 3

During one of our sessions, we distributed pre-test questionnaires. A pregnant woman seated in the front row remained completely silent. She accepted the paper and pen, but did not respond to any questions. We approached her and asked why she wasn’t engaging with the form. To our astonishment, we discovered that the woman was illiterate. Even more surprising was the fact that she was only 16 years old and already married.

Marriage in Nias is deeply steeped in tradition. From a young age, girls are taught to dream of happiness through marriage. This message is transmitted primarily through the teachings of their mothers. During fieldwork, the first author frequently heard mothers scolding their daughters with statements like: “Behave well and work hard so you’ll be happy when you get married.” Conversely, if a girl misbehaved, the mother might say: “You’ll regret it later—once you're married and still lazy, you’ll suffer under your mother-in-law’s anger. You must change your bad behavior now.”

Although not all mothers use these exact words, similar sentiments are often heard as advice given to young girls. Future happiness in married life is closely linked to present behavior. Girls are trained early to serve their families like washing clothes, fetching water, tending livestock, all are perceived as preparation for serving their future households. This transmission of norms is long-standing and tightly regulated, often under close supervision by their biological mothers.

Because family norms are the foundation of life in Nias, marriage is seen as the gateway to happiness. Love or romantic relationships are not seen as prerequisites. Arranged marriages remain common, especially in rural areas. Some women we met had never even met their prospective husbands before the wedding. Girls are told by their families that forming a family is their primary calling and must be acted upon swiftly. Unmarried or “late-married” women are considered a social disgrace. They are labeled as undesirable, and their families, especially their parents will bear the shame. As a result, early marriage is common, often at the expense of education, as exemplified by the participant mentioned earlier.