Approximately 89.5 per cent (6835/7631) of mothers reported giving an oil massage immediately after the first bath, which occurred within 12 h of birth for 95 per cent of enrolled newborns. Twelve percent (956/7951) of newborns received an application of mustard oil to the umbilical stump immediately after the cord was cut, and 77.9 per cent received one or more cord applications of mustard oil during the neonatal period.
The practice of full-body massage with mustard oil to newborns is overwhelmingly prevalent in the study population, and the behavior persists across all ethnic, religious, cultural, or socioeconomic strata. Approximately 99.7 per cent (8553/8573) of newborns received some form of massage with mustard oil in the first 14 days of life, while almost 90 per cent (7610/8469) of babies were first massaged within 6 h of delivery. Mustard oil was usually applied two or three times a day (80 per cent, 6861/8540), and 99.1 per cent (8462/8540) of those reporting using mustard oil stated that it was used at least once a day. The most common reasons given for applying mustard oil to the skin of newborns are shown in .
Reasons for giving neonatal oil massage, by season
Informal interviews and focus group discussions
Mustard oil is commonly used both for cooking and body massage. The newborn’s mother almost always gives the massage, but grandmothers (maternal and paternal) are also often involved. FGD3 and FGD4 included mention of a specific sub-caste (‘chamain’) that is associated with giving oil massage (this caste is also associated with assisting during delivery). Often persons from this caste are called to the house to do the massage in exchange for a small amount of money, cloth, or food. Participants were in agreement that these persons ‘never bring their own oil’, but will use ‘whatever oil is in the house’. Before giving an oil massage to a newborn infant, the baby is either washed (hill communities) or not washed (terai communities). Almost all participants in all FGDs stated that the oil must be prepared properly before use. Only very rarely will a newborn be massaged with oil that has not been heated, even during the hot season. A small amount of oil (approximately 15–30 ml) is usually heated, placed in a small finger bowl, and mixed with small pieces of garlic and spices (e.g. fenugreek, nutmeg, cloves, and caraway seed).
The entire body is massaged, often with considerable force. Women from FGD3 commented that the whole process is quite difficult for the babies, noting, ‘they [the babies] always cry a lot because the massage is very strong’. One person suggested that persons of terai origin ‘usually will use more force and stretch the babies’ legs and arms more during the massage’. Women from FGD2 and FGD3 (terai) felt strongly that mustard oil should not be put in the eyes of the child during massage, as this ‘would make the baby cry’, ‘would hurt’, ‘is not our tradition, makes the eyes red’, ‘makes the eyes swollen’, or ‘would make eyesight very weak’. On the other hand, women from FGD1 and FGD4 (groups of hill region origin) and other informal groups included the eyes (‘helps the baby make tears’), the nose (‘keeps the nose from drying out’, ‘makes breathing easier’), and the mouth as locations where small drops of oil should be placed at the end of the massage. Participants from the Muslim community suggested that putting some small drops in the nose (‘prevents cough’) and ears (‘gets the dirt out’) would be beneficial.
After the massage, the baby is wrapped in a cloth and either placed in the morning sun for a short while, or placed near a fire inside the house, with the former more likely in communities from terai origin and the latter being more prevalent in the cold season. Almost everyone suggested that for newborns, it was important to do the massage at least twice a day, and in the cold season, perhaps even more frequently. There was less agreement on whether the sweating of the baby when placed in the sun after massage was beneficial or harmful. Possible benefits included ‘it gets the cold out of the baby’, ‘it cleans the skin of the baby’, and the ‘heat and sweat makes the baby’s bones strong’, while potential harmful consequences included ‘it causes weakness’ and ‘sweat is not good for babies’. Women in the Muslim group commented that although the sweating is bad for the babies, the benefits of the sun outweigh the potential harm.
During both focus groups and informal discussions, the quality of the mustard oil was mentioned as a key factor. It was stressed that for babies, pure oil must be used because non-pure mustard oil could be very harmful to the baby’s skin. There was some disagreement on good sources of pure mustard oil. For example, while some people favored a local producer or small-scale businessman over the commercially available packets (‘there are many chemicals added to this’), others argued that the local business people sometimes also ‘mix cheap oil into the good oil, and sell it at a high price’. A number of people mentioned that when a baby is born, a good source of pure oil would be set aside in a special container, and not ‘wasted on cooking’ or massages for older children or adults. Apparently, the price has less to do with quality than the level of ‘trust’ associated with the place of purchase or production.
Some characteristics other than point of purchase that could be used to determine the quality of the oil included smell, taste, color, thickness, and appearance upon heating (‘if there are many bubbles when heating, the oil is not good’). Also, the stickiness of the oil after application was an important indicator of its quality. If the child’s skin is sticky (‘like gum’) 1 or 2 days after application, then the quality is ‘very bad’. Participants in FGD1 stressed that the cleanliness of the oil and the container in which it was stored, or even the hands that used the oil, could be important factors in changing oil from pure to non-pure, while in the Muslim group, there was little indication that factors in the household could affect the purity of the oil.
Sunflower seed oil is not often thought of as useful for massage, and is rarely used in this way, largely due to the more widespread availability of mustard oil. Those that had used sunflower seed oil suggested that it was less greasy (positive), but that it did not have a very nice smell or taste (negative). Opportunity was given during the discussion groups to try massaging sunflower seed oil into the skin of a newborn. Participants from FGD1 were very eager to try another oil, noting that the color of the oil (gold vs. clear) was not a concern for them, nor was smell, taste, or degree of oiliness; all factors that are significantly different between the two oils. Other participants (FGD2) were more hesitant about substituting mustard with sunflower seed oil, noting that the thinner consistency and smell of sunflower seed oil were associated with non-pure mustard oil. Smell was initially an important factor for Muslim women (FGD3), but they were willing to try sunflower seed oil for massage ‘if it is good for the baby’. After trying out the sunflower seed oil, participants suggested it was as easy to apply to the skin as mustard oil, and stated, ‘the oil is just as oily as mustard oil’, or ‘it went straight into the baby’s skin and [therefore] is good for the baby’. Participants suggested that the baby’s skin did not remain oily for long when using the sunflower oil, noting, ‘Less dust and dirt sticks to the [baby’s] skin’. Some participants mentioned that they would discontinue using a substitute oil if the child became ‘cold’ or ‘sick’, developed a skin infection because of the substitute oil, or if ‘it did anything harmful’ to the baby. A woman from the Muslim FGD commented, ‘After 1 week, we will know if it is good oil’.