CHAPTER ONE

INTRODUCTION

BACKGROUND OF THE STUDY

Herbal medicine use among pregnant women is increasing in many low and high income countries due to their cost-effectiveness in treatment and ease of access. The World Health Organization (WHO) defined herbal medicines as “herbs, herbal materials, herbal preparations and finished herbal products that contain as active ingredients parts of plants, or other plant materials, or combinations” [WHO, 2016] . Although, herbal medicines may be produced from any part of the plant, they are commonly made from the leaves, roots, bark, seeds, and flowers [Bandaranayake et al, 2016] . The herbs are eaten, swallowed, drunk, inhaled, or applied to the skin [Akerele, 2013] . In spite of the great advances observed in modern medicine in recent decades, medicinal plants still play a key role in world health [Calixto, 2010] .

Herbal medicines can be purchased in bulk in the crude form or as refined pharmaceutical dosage forms such as capsules, tablets, concentrated extracts, teas, tinctures and decoctions. The use of herbal medicines play significant roles in the management of both minor and major illnesses [Barnes, 2013; Gardiner et al, 2017; Eisenberg et al, 2013] and has been influenced by patients’ dissatisfaction with conventional allopathic medicines in terms of effectiveness and/or safety, satisfaction with therapeutic outcome [Huxtable, 1990; Abbot & Ernst, 2017] , and the perception that herbal medicines are inherently safe. Some of the more complex reasons for preference of herbal medicines are associated with cultural and personal beliefs, philosophical views on life and health [Ernst & White, 2010] , as well as comparison of experiences between conventional healthcare professionals and complementary medicine practitioners [Astin, 2014] by patients. The use of herbal medicine has been on increase in many developing and industrialized countries [Furnharm, 2016; Ernst, 2013] . It is known that between 65 and 80% of the world’s population use herbal medicines as their primary form of health care [Eisenberg et al, 2014; WHO, 2017] . Patients who are likely to be at risk from adverse effects of herbal medicines include those who are already prone to difficulties from regularly prescribed medications namely foetus, infants and older children, the elderly, as well as pregnant and lactating women [Drew, 2017; Anonymous, 2013; Philipson & Anderson, 1984a; Philipson & Anderson, 1984b; Gold & Cates, 1980; Roulet et al, 2018; Saxe, 1987] . In developing nations most especially, regulation of sales, importation and manufacturing of herbal medicines are not subject to rigorous scrutiny in terms of safety and efficacy as is the case for conventional western/allopathic medicines [WHO, 2016] . Pregnant women use herbal medicines for a variety of reasons such as for pregnancy-associated disorders including nausea, vomiting, and labor enhancement [Henry & Crowther, 2010] , as well as for illnesses and diseases due to pregnancy such as fatigue, respiratory and skin issues, and nutritional benefits [Fakeye et al, 2011] .

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