Strategies for incorporating indigenous placenta disposal methods in public healthcare: A Delphi study in Tshwane District, Gauteng, South Africa

Background: Indigenous placenta disposal strategies are essential to bridge clinical protocols with indigenous worldviews, allowing for safe and respectful handling without compromising health standards. Using Appreciative Inquiry in the Dream and Design phases, stakeholders collaboratively developed draft strategies that honour indigenous values while aligning with clinical protocols. These strategies further need inputs from a wider group of stakeholders to ensure that they fit both hospital rules and indigenous traditions. Aim: To refine and validate the draft strategies that incorporate indigenous placenta disposal methods for women birthing in the Tshwane District, Gauteng, South Africa. Setting: The Delphi process was conducted remotely with subject-matter experts based in Gauteng province, South Africa. Methods: Three iterative rounds of feedback using a modified e-Delphi technique were employed to ensure reliability. Twenty homogeneous experts were recruited to enrich validity. Of these, 14 participated in rounds one and two, while 10 participated in round three. For anonymity, questionnaires which included a 4-point Likert scale with five principles were sent through blind emails to the expert for them to rank the draft strategies. The consensus was set at 70% and the draft strategies that experts agreed on were repeated in the next rounds for further ranking until consensus was reached. Results: Five strategies that focused on fostering collaboration between midwives and indigenous women, infection prevention and control on indigenous placenta disposal, the development of culturally competent policies and guidelines in the healthcare facilities, the provision of culture competency training and awareness on cultural maternal care were refined and validated. Conclusion: These strategies may facilitate the safe indigenous placenta disposal while creating a harmonious space between midwives and indigenous women. Contribution: This study underscores the convergence of cultural values, healthcare policy, and sustainability, advancing culturally competent care by integrating Indigenous practices within contemporary medical frameworks.