Cultural Competency - Multicultural Health Generalizations: Reproductive Beliefs
Latino Maternal and Reproductive Health
- Maternal and Reproductive Health Beliefs
- Reproductive Health of Latinas in the U.S.
- Maternal and Child Health (last section - scroll down)
- Entre Parejas: An Exploration of Latino Perspectives Regarding Family Planning and Contraception.
Asian Maternal Health Beliefs
- In some Asian populations, it is believed that the fetus absorbs information and develops its personality, disposition and physical appearance in the womb.
- An expectant Asian mother may fear that unless she satisfies her food cravings, her baby will take on (physical) characteristics of the food she craves.
- Therefore, it may be helpful for the patient if healthcare providers accept her dietary choices, when medically appropriate.
- In certain Asian cultures, physical activity is advocated even up until birth. Thus, it may be difficult for some Asian women to accept or follow a healthcare provider's medical recommendation for bed rest.
- Expectant mothers may reunite with their parents in the country of origin to deliver the baby, especially during the first pregnancy.
Source: Asia: Health culture sketch. Maternal and reproductive health beliefs. (Online).
American Public Health Association. http://www.apha.org/ppp/red/asiabeliefs.htm (2002, Apr 4).
La cuarentena and Mexicans/Mexican-Americans
- La cuarentena is the 40-day postpartum period during which the mother is to rest and adjust to having a new infant.
- During this recuperation period, the mother is discouraged from getting out of bed for the first few hours after birth, unless she needs to use the bathroom. She is also discouraged from taking showers for several days.
- La cuarentena is also a time of special bonding between the mother and her newborn. Breastfeeding is one way of developing this bond.
- Although breastfeeding is more common among new Mexican immigrants, it is becoming increasingly popular among Mexicans/Mexican-Americans who have lived in the United States for an extended period of time.
- To provide for this mother-newborn bonding time, family members usually take care of household chores.
Sources: De Paula, T., Lagañá, K., & González-Ramírez, L. (1996). Mexican Americans. Culture and nursing care: A pocket guide. San Francisco: University of California.
Kemp, C. (2002). Hispanic health beliefs and practices: Mexican and Mexican-Americans (clinical notes). Hispanic Health. (Online).
http://www3.baylor.edu/~Charles_Kemp/hispanic_health.html (2002, May 6).
Maternal and reproductive health beliefs. (2002). (Online). American Public Health Association. http://www.apha.org/ppp/red/labeliefs.htm
(2002, Feb. 13).
African Women and Geophagia
- Geophagia is the consumption of soil, clay, or chalk.
- Geophagia is common among pregnant African women, particularly in Kenya and Ghana.
- Consumption of soil has been considered a craving of the developing fetus and a characteristic of pregnancy. It has also been used to alleviate morning sickness.
- Certain soils or clays are chosen depending on taste and/or cravings. For example, termite soil is preferred for its saltiness, and gray clay soil is preferred for its sweetness.
- Soil and clay consumption can cause nausea and diarrhea, while lead found in soil and clay may cause miscarriages and stillbirths.
- Although geophagia is not perceived as deviant behavior among pregnant African women, it may be perceived as a psychological disorder or possession by spirits if great amounts of soil are consumed.
Source: Africa: Maternal and reproductive health beliefs. American Public Health Association. (Online). http://www.apha.org/ppp/red/afrbeliefs.htm
(2002, Feb. 1).
Contraceptive Usage according to Islamic Practice
Contraceptive use is a topic about which some Muslims disagree. Many Muslim scholars approve of family planning because contraception is not expressly forbidden in the Qur'an. In fact, prolonged breastfeeding is encouraged by some scholars to delay conception. It is also recognized in the Qur'an that some friends of the Prophet practiced coitus interruptus. Therefore, it is reasoned that if contraception were inappropriate, it would have been expressly forbidden in the Qur'an (Libbus & Kridli, 1997, as cited in Lawrence, P. et al, 2001). However, other Muslim scholars believe that contraception is forbidden in Islam. The command to "procreate and abound in number" is cited as proof of this prohibition. Some scholars believe that children are God's gift and that procreation is the primary objective of marriage. These scholars would also argue that only God can decide the number of children that a couple will have (Libbus & Kridli, 1997, as cited in Lawrence, P. et al, 2001). This example of varying practices and beliefs within the same culture is a reminder that cultures are not homogeneous, and therefore, such generalizations can be used as a starting point to learn the practicing beliefs of each patient.
Source: Lawrence, P. and Rozmus, C., 2001. "Culturally Sensitive Care of the Muslim Patient." Journal of Transcultural Nursing 12, 3, 228-233.
Russian Pregnancy Practices
With some Russian patients, prenatal care is expected only when pregnant women feel that something is wrong. Pregnant women are often protected from bad news, since such news is believed to be harmful to the baby. Throughout the entire pregnancy term, expectant mothers are discouraged from skipping any steps when climbing or going down stairs, and lifting heavy objects for fear of losing the baby. During the last trimester, pregnant women are especially discouraged from lifting heavy objects, such as chairs or boxes, and from performing heavy exercise, such as jumping or jogging. These activities are believed to potentially harm the baby; for example, the umbilical cord may become wrapped around the baby, the baby might choke, move to breech position, or become past due. Being aware of potential Russian pregnancy practices can aid in providing culturally competent health care.
Source: Evanikoff, L. J. (1996). Russians. Culture and Nursing Care: A Pocket Guide . San Francisco: University of California.
Greek Fertility Beliefs and Practices
- In American Greek populations, limiting family size is stressed. The trend in Greece for smaller families has been noted since at least the turn of the century.
- In large part, this decrease has resulted from the desire of parents to provide adequately for their children and to have them educated so they can achieve professional status (Friedl, 1962).
- The method of limiting pregnancies has changed from control of gestation to control of conception.
- In Greece, abortions were not legal but were commonly performed by physicians. In the United States, a wide variety of birth control measures, such as intrauterine devices, birth control pills, and condoms are now used (Tripp-Reimer, 1982, as cited in Purnell, L. D., & Paulanka, B. J., 1998).
- The Greek Orthodox Church has issued encyclicals expressing strong disapproval of birth control; however, each local priest may interpret these differently. Although the attitude of the church is generally lenient and practical with regard to birth control, abortion is still regarded as murder.
- Furthermore, adoption is rare among Greeks, both in Greece and in the United States.
Source: Purnell, L. D., & Paulanka, B. J. (1998). Transcultural Health Care: A Culturally Competent Approach. Philadelphia, PA: F. A. Davis Company.
Muslim Birth Customs
Muslim birth customs are deeply symbolic and serve to remind new
parents that a fresh chapter is about to unfold. The following are only
four of many Muslim birth customs.
- Adhan - A call to prayer including two pronouncements:
- It is only proper that the first word a baby hears is the name of his creator, 'Allah'.
- Followed by the Declaration of Faith, 'There is no deity but Allah; Muhammad is the Messenger of Allah'.
- Both of these fundamental pronouncements serve as the pivot around which the life of a Muslim rotates, hence their symbolic significance at birth.
- The father whispers the Adhan into the baby's right ear,
serving as a reminder that the father also has a key responsibility in the months and years ahead. - Ideally, the Adhan should be completed as soon as possible after birth.
- Iqamah - A second call to prayer performed shortly after the Adhan; 'Our stay on earth is short' - the equivalent of the few minutes separating the Adhan from the Iqamah, 'so life then should be spent wisely and diligently, and not wasted'.
- Tahneek - Performed soon after birth and preferably before being fed, a small piece of softened date is gently rubbed onto the infant's upper palate.
- Where dates are not easily available, substitutes such as honey are used.
- A respected member of the family often performs this customwith the hope that some of his positive qualities will be imparted onto the infant.
- Taweez - A black string with a small pouch containing a prayer, tied around the baby's wrist or neck.
- This is particularly common among Muslims from the Indian subcontinent, with many believing that it protects the baby from ill health.
Source: Caring for Muslim patients: Birth customs: meaning and significance. Primary Care Online.
http:www.primarycareonline.co.uk/humaneffect/muslim/chap3.htm (disabled) (2003, Mar. 31).
Alternate sources:
Gathrad, AR, A. Sheikh. Muslim Birth Customs. Arch Dis Child Fetal Neonatal Ed 2001;84:F6-F8 (January). (Online). http://fn.bmjjournals.com/cgi/content/full/84/1/F6#SEC2
Amjad, Moiz. (2000, Dec. 18) General Muslim Customs & Traditions. Understanding Islam. (Online).
http://www.understanding-islam.com/related/text.asp?type=article&aid=
35&sscatid=177
Jewish Fertility Practices and Views toward Pregnancies
- Because children are considered a blessing, sterility is regarded as a curse.
- According to traditional Jewish law, a man may not abstain from procreation until he has children.
- Unless pregnancy jeopardizes the life or health of the mother, contraception is not looked on favorably among the ultra-Orthodox (Klein, 1992).
- To the Orthodox, it is important to know the mechanism of action of the birth control.
- The birth control pill does not result in any permanent sterilization, nor does it prevent semen from traveling its normal route. Therefore, use of this method is the least objectionable to most branches.
- Most religious denominations within Judaism accept the practice of artificial insemination if the donor is the husband of the woman being impregnated.
- Recognizing that Judaism's primary focus is the sanctity of life, it is important to identify when life begins. The fetus is not considered to be a living soul or person until it has been born. Birth is determined when the head or "greater part" is born (Klein, 1992). Until that time, it is merely part of the mother's body and has no independent identity.
- The newborn in traditional Judaism still does not have all the rights of a person and is not considered fully viable until 30 days after birth (Rosner, 1972).
- All branches of Judaism would favor abortion if the fetus endangers the mother's health (Bial, 1971).
- Random abortion is not permitted by the Orthodox branch because the fetus is a potential human being.
- Abortion would also be denied because it entails wounding oneself, which is not permitted, and it would place the mother in some danger.
Source: Purnell, L. D., & Paulanka, B. J. (1998). Transcultural Health Care: A Culturally Competent Approach. Philadelphia, PA: F. A. Davis Company.
Somali Postpartum Practices
- An herb called malmal could be applied to the newborn's umbilicus for the first 7 days of life.
- Newborn care could include warm water baths, sesame oil massages, and passive stretching of the baby's limbs.
- When a child is born, the mother and baby stay at home and indoors for 40 days, a period known as afatanbah.
- During this time, female relatives and friends visit the family
and help take care of the newborn and mother. This includes preparing special foods such as soup, porridge, and special teas. - Incense (myrrh) is burned twice a day in order to protect the baby
from the ordinary smells of the world, which are believed to have the potential of making the baby sick. - At the end of these 40 days, a celebration takes place at the home
of a friend or relative. This marks the first time the mother and baby
have left home since delivery. - A naming ceremony for the child is also commemorated. This usually occurs within the first 2-3 weeks of the baby's life or at the time of concluding the afatanbah celebration. These ceremonies are big family gatherings with lots of food and prayers.
Source: Lewis, T. Somali cultural profile. (Online). Ethnomed in collaboration
with the University of Washington Harborview Medical Center Comments.
http://www.ethnomed.org/ethnomed/cultures/somali/somali_cp.html#post_part
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