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Year : 2018  |  Volume : 5  |  Issue : 1  |  Page : 4-5

Sociocultural beliefs and perceptions about cleft lip-palate and their implications in the management, outcome, and rehabilitation

Department of Plastic Surgery, KIMS; Department of Cosmetic and Plastic Surgery, Sampige Super Speciality Clinic, Hubli, Karnataka, India

Date of Web Publication8-Feb-2018

Correspondence Address:
Dr. S S Shirol
Sampige Super Speciality Clinic, 1st floor, Divate Complex, Near Court Circle, Club Road, Hubli
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jclpca.jclpca_41_17

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How to cite this article:
Shirol S S. Sociocultural beliefs and perceptions about cleft lip-palate and their implications in the management, outcome, and rehabilitation. J Cleft Lip Palate Craniofac Anomal 2018;5:4-5

How to cite this URL:
Shirol S S. Sociocultural beliefs and perceptions about cleft lip-palate and their implications in the management, outcome, and rehabilitation. J Cleft Lip Palate Craniofac Anomal [serial online] 2018 [cited 2019 Dec 8];5:4-5. Available from: http://www.jclpca.org/text.asp?2018/5/1/4/224902

Even in this 21st century with educational and cultural advances and in the era of omnipresent social media, where every birth is celebrated publicly online by photographs, birth of a child with craniofacial anomaly or cleft lip-palate causes an acute embarrassment, a sense of shock, shame, disbelief, and even a feeling of guilt,[1] among parents and the family members, who otherwise eagerly await the birth of a child as an occasion to celebrate. A child is many a times, especially in India, considered a gift of God, even is named after multitude of Gods! In the birth of a child with deformity, the celebratory mood turns into one of the depressive or anxiety moments and the event being branded as a curse on mother [2] or the child or a bad omen.[3]

As with any other medical treatment, cleft lip-palate correction, its prognosis, and rehabilitation are largely influenced by local sociocultural beliefs, prejudices, and often determine the need for consultation, and medical treatment. Negative perceptual prejudices are relatively high, especially among the rural populace of developing countries such as Africa,[2] India, and China. These prejudices affect the parental attachment with the child, leading to social discrimination, ridicule, stigmatization, abandonment of the child, increased chances of infanticide, and poor psychological growth of the child.[1],[3]

The social stigma associated with cleft lip-palate and craniofacial anomalies is a major obstacle for modern treatment;[3] financial constraints and low level of education being other factors. At places like rural areas of developing countries where prenatal diagnosis of cleft is not possible due to lack of facility, religious folklore, and traditional healers substitute the scientific basis of deformity.[2] The causation is seen through the lens of superstitious beliefs such as sins of the past life, holding sharp objects such as knife, scissors, and needles during solar eclipse, evil act by parents/grandparents, karma, reincarnation, curse on family, witchcraft, God's will, being punished for having looked at the face of child with deformity when pregnant, eating rabbit meat while pregnant, walking in hot sun or late night, adultery by mother, father having killed a strange animal, violations of religious laws, Djinn (evil spirits), black magic by jealous relatives, walking outdoors on an inauspicious day like Amavasya (new moon).[1],[3],[4],[5],[6],[7],[8]

On the other hand, some communities consider the cleft children as a gift of God, and the child being endowed with special or divine powers.[5],[7] The author has come across many children with bilateral cleft lip-palate and protruding premaxilla being treated like Lord Ganesha, hence avoiding the correctional procedures!

Though there has been a scientific multidisciplinary approach to the problem of clefts, involving plastic surgeons, pediatric surgeons, pediatricians, maxillofacial surgeons, orthodontists, and speech and language pathologists with well-established treatment protocols, traditional healers and religious/community leaders with their perceptual prejudices continue to hold their sway on the poorly educated populace. Better understanding of these regional variations in different countries and communities by the cleft team would improve the health-care delivery. Various practices such as branding child's abdomen, burying the child up to neck under hot sun,[5] performing extra prayers, and Tarveez are common among African Muslims. Giving charity, submitting themselves to God, burning and purification process such as burning wood, coconut, camphor, and ghee are reported among Hindu healers. Consulting person's astrological chart, sharing sorrow with others, fasting, and going on pilgrimages also have been reported in the literature.[5] Preventive measures such as avoiding holding any sharp objects and pregnant woman fasting during eclipses are practiced at many places in India.[5]

These superstitious beliefs are strongly rooted in the minds of people of developing countries and can only be uprooted with a better understanding of the sociocultural diversity and beliefs; with a systematic approach to the problem by education in a culturally sensitive manner,[9] involving the community in street play, group discussions, and using audio-visual aids. Educating parents about the causation of clefts during prenatal period often reduces the parental anxiety or depression, motivating them to seek an early treatment and in turn improves psychological and cosmetic results of cleft corrections.

  References Top

Mednick L, Snyder J, Schook C, Blood EA, Brown SE, Weatherley-White RC, et al. Causal attributions of cleft lip and palate across cultures. Cleft Palate Craniofac J 2013;50:655-61.  Back to cited text no. 1
Mandrano N. Beliefs and perceptions that impairs cleft care treatment in Madagascar: A Qualitative study during humanitarian mission. J Cleft Lip Palate Craniofacial Anomalies 2017;4:149-53.  Back to cited text no. 2
Oginni FO, Asuku ME, Oladele AO, Obuekwe ON, Nnabuko RE. Knowledge and cultural beliefs about the etiology and management of orofacial clefts in Nigeria's Major Ethnic Groups. Cleft Palate Craniofac J 2010;47:327-34.  Back to cited text no. 3
Bhattacharya S, Khanna V, Kohli R. Cleft lip: The historical perspective. Indian J Plast Surg 2009;42 Suppl:S4-8.  Back to cited text no. 4
Naram A, Makhijani SN, Naram D, Reddy SG, Reddy RR, Lalikos JF, et al. Perceptions of family members of children with cleft lip and palate in Hyderabad, India, and its rural outskirts regarding craniofacial anomalies: A pilot study. Cleft Palate Craniofac J 2013;50:e41-6.  Back to cited text no. 5
Ross E. A tale of two systems: Beliefs and practices of South African Muslim and Hindu traditional healers regarding cleft lip and palate. Cleft Palate Craniofac J 2007;44:642-8.  Back to cited text no. 6
Hutchinson K, Wellman MA, Noe DA, Kahn A. The psychosocial effects of cleft lip and palate in non-Anglo populations: A cross-cultural meta-analysis. Cleft Palate Craniofac J 2011;48:497-508.  Back to cited text no. 7
Nelson J, O'Leary C, Weinman J. Causal attributions in parents of babies with a cleft lip and/or palate and their association with psychological well-being. Cleft Palate Craniofac J 2009;46:425-34.  Back to cited text no. 8
Olasoji HO, Ugboko VI, Arotiba GT. Cultural and religious components in Nigerian parents' perceptions of the aetiology of cleft lip and palate: Implications for treatment and rehabilitation. Br J Oral Maxillofac Surg 2007;45:302-5.  Back to cited text no. 9


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