17.Maternal Health of Hispanic Women
The first national study of pregnancy-related deaths in Hispanic women in the United States by the Centers for Disease Control and Prevention (CDC) found that pregnancy-related deaths occur more frequently in Hispanic women than in non-Hispanic white women. Because Hispanic women have a higher risk of death associated with pregnancy than non-Hispanic white women, more research and surveillance are needed to determine the medical and non-medical factors that contribute to the problem, according to the study's authors. "Pregnancy-Related Mortality in Hispanic Women in the United States," released in the November 1999 issue of Obstetrics & Gynecology, is based on a review of all reported pregnancy-related deaths occurring between 1979 and 1992 in states reporting Hispanic origin for each year of the study. Following are key findings: Over the14-year study period, 623 of the 3,777 pregnancy-related deaths in the U.S. were of women of Hispanic origin. The pregnancy-related mortality ratio was 10.3 deaths per 100,000 live births for Hispanic women during the 14-year period, compared with 6.0 deaths for non-Hispanic white women and 25.1 deaths for non-Hispanic black women. Among U.S.-born Hispanic women for the years 1987-1992, pregnancy-related mortality ratios varied slightly among subgroups: Mexican (8.1 deaths per 100,000 live births); Puerto Rican (8.7); and Cuban (7.2). Among foreign-born Hispanic women for the same period, ratios among subgroups were: Mexican (9.9); Puerto Rican (13.5); and Cuban (9.6).
Source: Health departments from the 50 states, the District of Columbia, and New York City reported deaths to CDC through the Pregnancy Mortality Surveillance System (PMSS). For each year of the study, only data from those states that collected Hispanic origin information was used. Pregnancy-related mortality ratios are reported as the number of pregnancy related deaths per 100,000 live births. PMSS is part of an ongoing collaboration between CDC, the American College of Obstetricians and Gynecologists, and state health departments to monitor trends and examine ways to identify and prevent pregnancy-related deaths. Folic Acid Knowledge and Use Among Hispanic Womenn The Centers for Disease Control and Prevention (CDC), the National
Council on Folic Acid n
Hispanic/Latina women have a risk 1.5 to 3 times higher than
non-Hispanic white women for n
Hispanic/Latina women have lower blood folate levels, and are less likely
to consume foods n
Hispanic/Latina women are less likely to have heard about folic acid, to
know it can prevent Preventing Alcohol-Exposed Pregnancies Among Hispanic Womenn Studies show an association between prenatal exposure to alcohol and
increased risk for fetal n One in 30 pregnant and one in eight nonpregnant women report binge
drinking ( > 5 alcoholic n In 2000, Hispanic/Latina women represented 14% of
reproductive-aged women (15-44 n Monitoring rates of prenatal alcohol use among Hispanic/Latina women
is extremely
v
Maternal Health Risks of Immigrant Women From Latin America
On the other hand, Latina mothers do suffer increased risk of certain health conditions that may adversely affect their own health and/or a current or future pregnancy. On average, Latinas have some of the highest birth and fertility rates, begin childbearing at early ages, and are most likely to have four or more children (Giachello, 1994). All of these factors put a Latina woman at higher risk of maternal mortality and morbidity, while possibly endangering the health of her infant. According to a recent article on research done by the CDC, for Hispanic women with three or more live births, the risk of pregnancy-related death increased (Hopkins, et al, 1999). Also, both foreign-born and U.S.-born Hispanics suffer a higher rate of maternal mortality than non-Hispanic whites. From 1979 to 1992, the pregnancy-related mortality ratio was 10.3 deaths per 100,000 live births for Hispanic women, while non-Hispanic white women had 6.0 deaths (Hopkins, et al, 1999). Furthermore, between 1987-1992, foreign-born Hispanic women had higher maternal mortality ratios (MMR) than U.S.-born Hispanic women, and yet 60% of all Hispanic live births were to foreign-born Hispanic women and 40% were to U.S.-born Hispanic women. While differences in MMRs between immigrant and native Hispanic women varied across subgroups, the foreign-born consistently had higher MMRs: Mexican (9.9 deaths per 100,000 live births among foreign-born Hispanic women; versus 8.1 among U.S.-born Hispanic women); Puerto Rican (13.5 among the foreign-born, versus 8.7 among U.S.-born); and Cuban (9.6 versus 7.2). Thus, although foreign-born Latinas benefit from a lower incidence of infant mortality and of low birthweight, evidence suggests that they are at increased risk of maternal mortality. Further research should investigate whether faults in data collection or misclassification are the cause, or if other factors linked specifically to foreign-born Hispanic women, such as cultural norms of pregnancy and childbirth, might be responsible for the higher rates of maternal mortality among this group. Though foreign-born Latinas typically have better birth outcomes, such as healthy birthweight, there are factors that continue to be a threat for them. In those Latin American countries wrought with civil and political strife, a great proportion of the population lives in poverty and may be at greater risk of nutritional deficiencies. This is particularly the case among refugees and asylees from this region. Nutritional deficiencies can threaten the healthy development of the fetus as well as the health of the mother. For example, folate, iron, vitamin A, and iodine are micronutrients crucial for the proper development of the fetus, yet many Hispanics are deficient in these (Carter-Pokras, 1994). Aggravating these deficiencies are various parasitic diseases endemic to this region. These diseases can cause severe and chronic diarrhea, leading to mal-absorption of these necessary nutrients. Some parasitic diseases, such as malaria and hookworm, can also cause anemia or worsen pre-existing iron-deficiency anemia, thereby further endangering the life of the mother and fetus. Severe anemia can cause cardiac failure in pregnant women, and low birth weight, asphyxia, or stillbirth in newborns (WHO, 1994). Screening for these endemic diseases and nutritional deficiencies should be part of prenatal testing for immigrants from Latin America. Another prenatal practice that can affect birth outcomes is entry into prenatal
care. Educational levels have been implicated as a determinant of prenatal care utilization.
In 1990, Latinos were less likely to have completed 12 or more
years of education (46%) than white American mothers (85%) (Giachello, 1994). In
fact, "groups more likely to have delayed or no PNC [prenatal care] during
1989-1997 included non-Hispanic blacks, Hispanics, women aged <20 years,
women with <12 years of education, and multiparous women" (CDC, 2000;
Singh & Yu, 1996). Many immigrant women, including those from Latin America,
often fall into one or more of these categories. Participation and timing of
entry into prenatal care was in fact found to be lower among foreign-born
Hispanic groups. For instance, in 1990, 14% of foreign-born Latino mothers had
late or no prenatal care versus only 9% of US-born Latino mothers and 5% of
white American mothers (Giachello, 1994). Specifically, this was the case among
Mexican mothers (15% of foreign-born Mexican mothers had late or no prenatal
care versus only 9% of US-born Mexicanas), as well as Central and South American
mothers (11% of foreign-born versus 8% of US-born) (Giachello, 1994; Ventura,
1993). Recent immigrants and undocumented immigrants tend to initiate prenatal
care after the first trimester (Chavez, Cornelius, and Jones, 1985; Taylor, Ko,
& Pan, 1999), while immigrant women who have been residing in the U.S. for
longer periods of time begin prenatal care earlier (Taylor, Ko, & Pan,
1999). This discrepancy appears to illustrate some positive effects of
acculturation. Further research should determine if health education and
promotion programs targeted at this population subgroup; improved socioeconomic
status; changes in cultural beliefs and practices; better understanding of the
U.S. health care system; change in immigrant status; or other factors are
directly responsible for these positive changes in the health behavior of Latina
mothers.
Certain health risks and conditions among Hispanic women can add risk to
their pregnancy. For example, Hispanics are at higher risk for type II diabetes.
In one study, a 4.8-fold excess of diabetes prevalence was found among Latinas
versus white women (Bernal & Perez-Stable, 1994; Hamman, Marshall, Baxter,
et al, 1989). On average, Latinos have a high risk (3 times greater risk than
whites) for developing diabetes. The developing baby is also in danger when its
mother has diabetes. Fetal and perinatal deaths are 3-8 times more prevalent in
pregnancies of diabetic mothers, and there is a greater risk for congenital
malformations in children (Giachello, 1994; "Report of the National
Institutes of Health," 1992). Gestational diabetes in pregnant Latina women
is 2-3 times more prevalent than in non-Hispanics (Taylor, Ko, & Pan, 1999;
Council on Scientific Affairs, 1991; Ginzburg, 1991). Furthermore, 25% of women
who have gestational diabetes will develop diabetes mellitus after pregnancy (Giachello,
1994; "Report of the National Institutes of Health," 1992). This
outcome can then continue to threaten future pregnancies. Inconsistent and infrequent gynecological visits are another risk to childbearing Latinas. Even those Latinas who have heard of Pap smears are less likely to have them regularly because they do not feel that they are necessary, especially if they are bearing children and/or are married (Chiang, 2000; Gutierrez-Ramirez, Burciaga Valdez, & Carter-Pokras, 1994; Harlan, Bernstein, Kessler, 1991). Many believe that when they are already having children and are married, they are no longer at risk. Yet, cervical cancer rates are higher in Latinas than whites. For instance, incidence is 2-3 times higher in Mexican and Puerto Rican women than in whites (En Accion, 1993; Suarez & Ramirez, 1999). The rates are also higher for immigrant women than for US-born Latinas (Gutierrez-Ramirez, Burciaga Valdez, & Carter-Pokras, 1994). Without regular gynecological check-ups, Latinas are not only at higher risk of late detection and treatment of cervical cancer, which can eventually affect fertility, but also of various sexually transmitted infections (STIs). In fact, certain strains of human papillomavirus (HPV), an STI, have been implicated in the development of precancerous and cancerous conditions of the cervix (Thomas, 1997). Diagnosis of chlamydia and gonorrhea can only be made through tests performed in a clinical setting. In fact, these STIs often have no symptoms, so regular check-ups for sexually active women are crucial. Thus, regular Pap smears are not only critical in the detection of precancerous conditions of the cervix, but also in diagnosing STIs. Similar to visits to the gynecologist, Latinas are also unlikely to seek STI screening or treatment in general unless symptoms are noticeable or cause pain (Giachello, 1994). Chlamydia, however, often poses no symptoms; but in women, it can cause pelvic inflammatory disease, potentially fatal ectopic pregnancy, and infertility. Pregnant women with this infection are also at risk for spontaneous abortion and stillbirth. Chlamydia is also associated with conjunctivitis in infants born to infected mothers. In general, however, infants born to mothers with any STI are at risk for blindness, mental retardation, and death (Giachello, 1994). In addition, rates of primary and secondary syphilis for all Latino groups combined are disproportionately high (13 times that of whites) (Carter-Pokras, 1994; Moran, et al, 1989). According to the CDC, the southern U.S. faces the highest rates of chlamydia, gonorrhea, and syphilis (CDC, unknown publication date). Since Latino immigrants tend to settle in southern areas of the U.S., this demographic profile of these diseases is specifically relevant to Latinas (see Geographic Distribution in the U.S.). Furthermore, if exposed, women with chlamydia and gonorrhea are more likely to
become infected with HIV/AIDS. Eighty percent of the women infected with HIV in the
United States are of childbearing age (Giachello, 1994; Nichols,
1991). Of all women in the U.S. with AIDS, 20% are Latino (CDC, 1993; Giachello,
1994). This can have a tremendous impact on the health of future generations
with the 30-50% probability that HIV will be transmitted perinatally.
These maternal health risk factors in immigrant women from Latin America,
along with the maternal health beliefs identified in the previous section, can
help HCPs improve their services and program planning and development. This
combination of information can help HCPs understand the influence of culture on
immigrant health, and help them to show sensitivity to and knowledge of the
patient’s country of origin, health culture, and other related beliefs and
practices. HCPs can hope to bridge the cultural gap that may prevent immigrant
women from seeking needed preventive and curative care in a health care system
that is unfamiliar to them; ensure patient compliance with recommended treatment
(Falvo, 1994); improve the success of health education and health
promotion/disease prevention programs that target immigrant audiences; and
thereby, ultimately improve the health status of minority women in the U.S. Copyright American Public Health Association. v Maternal & Reproductive Health BeliefsThere are several maternal health beliefs and practices that are common to Hispanic culture. For instance, pregnant Latinas have been found to attach a safety pin to the front of their underwear (sometimes 2 safety pins in the form of a cross) (Taylor, Ko, & Pan, 1999). It is believed that by doing this, she can protect her fetus from developing a cleft lip or palate. This is particularly the case during an eclipse, which is said to cause a cleft lip or palate (Taylor, Ko, & Pan, 1999; Villaruel and Ortiz de Montellano, 1992). This belief originated with the Aztecs, who believed that an eclipse resulted from a "bite" being taken out of the moon, and thus, if a pregnant woman witnessed this, her baby would have a "bite" taken out of its mouth. Also, during pregnancy, Latinas commonly avoid cutting their hair because they believe that this will "cut" the vision of the developing baby (Taylor, Ko, & Pan, 1999). Recalling the Hispanic belief in the "hot-cold" theory of disease, pregnant Latinas typically avoid foods and medications that are considered "hot," believing that by doing this, the infant will not fall ill to a hot illness, such as a skin rash (Taylor, Ko, & Pan, 1999). Moreover, satisfying food cravings of expectant women takes on a different level of meaning in Hispanic culture. It is believed that los antojos (cravings) of a pregnant Latina must be satisfied or else the "baby may be born with characteristics of the particular food; for example, the infant may have strawberry spots if the mother craves strawberries but does not or cannot consume them during her pregnancy" (Burk, Wieser, and Keegan, 1995; Taylor, Ko, & Pan, 1999). Asian-Pacific Islanders also follow this tradition for similar reasons (see Asia health culture sketch). During childbirth, heat is thought to be lost, so different diets are adopted. Thus, during
the postpartum period, Latina mothers try to restore the lost heat by consuming hot
foods. They also avoid cold foods because they believe that these will prevent the uterus
from expelling blood and other body impurities after birth. Similarly, cold foods are
avoided during menstruation so as not to impede complete emptying of menstrual blood from
the uterus (Taylor, Ko, & Pan, 1999). Forbidding certain foods after giving birth may
prevent the mother from getting some of the most nutritious foods she needs. Understanding
that a mother's food preferences after childbirth may be culturally influenced, the health
care professional should ascertain the kinds of food that she is consuming to ensure that she
is receiving the essential nutrients as her body recovers from the pregnancy.
Other practices believed to restore heat to the mother after giving birth include
physical confinement to protect her from cold and bathing restrictions sometimes even for
several weeks (Queensland Health Information Network, 1998).
Another postpartum practice common to Latin American culture is la
cuarantena. La cuarantena is the 40-day postpartum period during
which the woman is to rest and adjust to having a new infant. It is a time of
special bonding between the mother and the newborn, and family members help
around the house attentively so that the mother can have this special time
without the added stress of doing housework (Giachello, 1994). During la
cuarantena, family members also prepare purgantes (home remedies) for
the mother that are said to help her body eliminate impurities from the birth
that would otherwise lead to health problems (Giachello, 1994). Symptoms and
conditions such as postpartum depression will occur if these purgantes
are not taken, and it would have been said that her body’s impurities went to
her head ("La purga se le fue a la cabeza."). Latinas are less likely to use family planning services than whites and
African-Americans (Bloom, 1981; Darroch Forrest & Singh, 1990; Garcia,
Sanceda-Gonzalez, & Giachello, 1985; Giachello, 1994; Mosher & Horn,
1988). This may be attributed to religious beliefs, since much of Latin America
is Roman Catholic, and therefore, use of contraception is a controversial issue.
Despite this, contraceptive use is prevalent. However, a common folk belief held
by Hispanics is that the use of certain contraceptives like the birth control
pill will lessen menstrual flow, and thus, cause retention of impurities that
will ultimately lead to health problems (Queensland Health Information Network,
1998). Also, it has been found that Latinas typically avoid using the diaphragm
as a contraceptive method. This has been linked to unfamiliarity with
reproductive anatomy, and a shyness and even embarrassment at the idea of
touching their genitalia (Taylor, Ko, & Pan, 1999).
v Understanding the Health Culture of Recent Immigrants to the
United States: A
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Examples of Cultural Beliefs Held by Certain Immigrant Groups |
||
|
Immigrant Group |
Timing |
Cultural Belief/Practice |
|
Latin American; |
General |
Health care decision-making centers |
|
Asian; African |
on the family as a whole. Often individual needs are secondary to family needs. Family is strong support system. Patient autonomy and patient confidentiality are often culturally irrelevant. |
|
|
Latin American; Asian; some African |
Prenatal |
Food cravings of a pregnant woman should be satisfied because they are thought to be the cravings of the baby. If cravings are left unsatisfied, the baby might take on certain unpleasant personality and/or physical traits, perhaps characteristic of the food (Burk, Wieser, and Keegan, 1995; Geissler, et al, 1999; Taylor, Ko, & Pan, 1999). |
|
Latin American; Asian; African |
Prenatal; Postpartum |
“Hot-cold” theory of illness. Pregnancy, for most cultures, is considered a “hot” condition (exception: Chinese believe it is a “cold” condition [Taylor, Ko, & Pan, 1999]). To maintain health and balance, pregnant woman is restricted to “cold” foods (Chinese, “hot” foods). After childbirth, heat is believed to be lost, so “hot” foods are encouraged to help the new mother recuperate. Categorization of “hot” and “cold” for illnesses, medications, and foods does not necessarily relate to the literal meaning of hot and cold. These classifications are instead defined by culture, tradition, and personal experiences over time. |
|
Latin American |
Prenatal |
Women avoid cutting their hair while pregnant. It is believed that cutting the hair will result in cutting the vision of the baby (Taylor, Ko, & Pan, 1999). |
|
Asian |
Postpartum |
Mother and newborn should not have visitors who are in mourning, are widows, or have deceased children. Belief is that a visit by such persons will bring bad luck (Assanand, Dias, Richardson, & Waxler-Morrison, 1990). |
|
African |
Prenatal |
Geophagia, or the ingestion of soil, chalk, or clay, is not uncommon during pregnancy. Not only is it considered appetizing and the craving of the developing baby, but soil is a symbol of female fertility (Geissler, et al, 1999; Jacobson-Whidding & van Beek, 1990). |
|
Examples of Epidemiological Data Affecting the Health of Childbearing Women |
|
|
Immigrant Group |
Epidemiology/ Health Indicator/ Maternal Health Risk |
|
Latin American |
Foreign-born are more likely than US-born Hispanics to die of pregnancy-related causes (Hopkins, et al, 1999). |
|
Guatemalan
|
Syphilis prevalence = 298/100,000 population (CRLP, 1997) (U.S. population = 3.2/100,000 population, 1996-1997) (CDC, undated) |
|
Gonorrhea prevalence = 1670/100,000 population (CRLP, 1997)(U.S. population = 123/100,000 population, 1996-1997) (CDC, undated) |
|
|
Asian
|
75% of the world’s chronically infected with Hepatitis B are in Asia (Hann, 1994; Takada, Ford, & Lloyd, 1998). |
|
Largest new sexually transmitted infections (STIs) worldwide in 1995 occurred in South and Southeast Asia (45.6%) (Gerbase, Rowley, & Mertens, 1998). |
|
|
Indian (Asian) |
Lifetime risk of maternal death = 1 in 37 women, where 1/3000 is considered a low risk of dying of pregnancy and childbirth and 1/100 is considered a high risk (WHO/WB, 1997). |
|
African |
Of all women of reproductive age, the World Health Organization estimates that 3-5 million are HIV-positive, with about 80% of them living in Sub-Saharan Africa (Chin, Remenyi, Morrison, Bulatao, 1992; Koblinsky, 1995). |
|
Somali |
MMR = 1600 (per 100,000 live births) (1990) (UNICEF, 2000). |
Examples of Proposed Links Between Epidemiological Data and Cultural Beliefs/Practices; and Associated Health Risks to Pregnant Women and Infants
|
Immigrant Group |
Latin American |
|
Cultural Belief/Practices |
Often feel no need for Pap smears and gynecological exams, especially when already married and having children (Chiang, 2000; Gutierrez-Ramirez, Burciaga Valdez, & Carter-Pokras, 1994; Harlan, Bernstein, Kessler, 1991). Belief is that when they are already having children, they are no longer at risk. |
|
Epidemiology/ Health Indicator |
Cervical cancer rates are higher in Latinos than whites. For instance, incidence is 2-3 times higher in Mexican and Puerto Rican women than in whites (En Accion, 1993; Suarez & Ramirez, 1999). The rates are also higher for immigrant women than for US-born Latino women (Gutierrez-Ramirez, Burciaga Valdez, & Carter-Pokras, 1994). |
|
Health Risks to the Mother |
Cervical cancer; incompetent uterus; hysterectomy; infertility; mortality. |
|
Health Risks to the Infant |
Possibly human papillomavirus (HPV) in throat (if exposed during vaginal delivery and if HPV is present). |
|
Immigrant Group |
Guatemalan |
|
Cultural Belief/Practices |
In 1995, only 26% of all women of reproductive age in Guatemala used modern methods of contraception, with only 2.2% using condoms (PAHO, 1998). Attitudes of male partners toward contraceptives often “nonsupportive, resistive, or controlling,” further hindering women’s family planning practices (Callister &Vega, 1998). |
|
Epidemiology/ Health Indicator |
Rate for gonorrhea in Guatemala is 1670/ 100,000 population (CRLP, 1997), versus a rate of 123/ 100,000 population for the U.S. as a whole, 1996-1997 (CDC, undated). |
|
Health Risks to the Mother |
Chronic pelvic inflammatory disease (PID); endometriosis; infertility. |
|
Health Risks to the Infant |
Ophthalmia neonatorium (if exposed during vaginal delivery); low birthweight. |
|
Immigrant Group |
Asian |
|
Cultural Belief/Practices |
De-worming pills and other biomedical/Western medi-cations may not be taken properly because of the belief that these create too much “heat” and may cause a miscarriage (DeSantis, 1998; Dinh, Ganesan, Waxler-Morrison, 1990; Nichter & Nichter, 1996; O’Connor, 1998). |
|
Epidemiology/ Health Indicator |
Helminthic diseases, including tapeworm, roundworm, and hookworm infections, are endemic in Asia and other parts of the world (Georgiev, 1999; Nishimura & Hung, 1997). |
|
Health Risks to |
Anemia; diarrhea; altered appetite/ anorexia; malabsorption of necessary nutrients for pregnancy and general health. |
|
Health Risks to the Infant |
Possible developmental problems due to nutritional deficiencies; repercussions of maternal anemia in severe cases, such as low birth weight, premature birth, poor fetal growth, asphyxia, and stillbirth. |
|
Immigrant Group |
Indian (Asian) |
|
Cultural Belief/Practices |
Iron-rich foods during pregnancy are often avoided because they are thought to be “hot” and may therefore cause miscarriage, as it contradicts the prescribed food for pregnant women as associated with the “hot-cold” theory of illness (DeSantis, 1998; Kendall, 1987; Landerman, 1987; Nichter & Nichter, 1996). |
|
Epidemiology/Health Indicator |
Iron-deficiency anemia (IDA) occurs in about 50% of all women in India and in >70% of pregnant women in India (ISTI, 1996). |
|
Health Risks to the Mother |
Lowered resistance to infection; other maternal morbidities associated with concurrent obstetric complications, including hemorrhage and shock; maternal mortality. |
|
Health Risks to the Infant |
Low birthweight; premature birth; poor fetal growth; asphyxia; stillbirth. |
|
Immigrant Group |
African |
|
Cultural Belief/Practices |
Belief that condoms can get lodged in the abdominal cavity and result in obstruction, infection, or cancer (DeSantis, 1998; Helman, 1994). |
|
Epidemiology/ Health Indicator |
Of all HIV/AIDS infected people worldwide, 63% live in Sub-Saharan Africa (NomadNet, 2000). |
|
About 90% of all HIV cases in Sub-Saharan Africa are transmitted through heterosexual contact (NomadNet, 2000; World Bank Group, undated). |
|
|
About 3-5 million women of reproductive age worldwide are HIV-positive, with about 80% of them living in Sub-Saharan Africa (Chin, Remenyi, Morrison, Bulatao, 1992; Koblinsky, 1995). |
|
|
Health Risks to the Mother |
HIV/AIDS; immunosuppression & increased susceptibility to other illnesses; mortality. |
|
Health Risks to the Infant |
Congenital HIV/AIDS; increased susceptibility to other illnesses; mortality. |
|
Immigrant Group |
Somali |
|
Cultural Belief/Practices |
Belief that without infibulation, a woman’s health and fertility weakens, among other reasons for FC/FGM (Ntiri, 1993). Some believe in reducing prenatal food intake to limit the baby size and ensure an easier birth (Calder, Brown, & Rae, 1993). |
|
Epidemiology/Health Indicator |
Female circumcision/female genital mutilation (FC/FGM) is performed on over 98% of the female population, with infibulation as the most common type (Arbesman, Kahler, & Buck, 1993; Dirie & Lindmark, 1991; El Dareer, 1983). |
|
Health Risks to the Mother |
Tetanus; chronic pelvic infection; urinary tract infection; infertility; incontinence; difficulty urinating. During birth: severe perineal lacerations, obstructed labor, and uterine rupture. |
|
Health Risks to the Infant |
Severe asphyxia; brain damage; developmental problems; stillbirth; mortality. |
Lessons for Health Care Professionals From Knowledge of Cultural Beliefs or Immigrant Experiences
|
Culture or Immigrant Experience |
American Health Care Professional |
|
Sexual abuse is prevalent among some Southeast Asian and African refugees. This makes pelvic exams traumatic and difficult, and may lead to low rates of regular Pap smears and gynecological exams. |
Not all immigrants have the same immigration history or the same reasons for migrating to the U.S., and patients usually do not openly discuss their refugee experiences. Therefore, the HCP should go beyond race/ethnicity and recognize the possibility that their patient might have undergone traumatic experiences as refugees. |
|
Religious beliefs and/or sexual taboos in some cultures can result in a lack of basic knowledge of reproductive anatomy. |
HCP should not assume that all women, even well-educated immigrant women, have a basic knowledge of reproductive health and anatomy. |
|
“Hot-cold” theory of illness is prevalent across many cultures throughout the world. |
According to this theory, women may follow specific diets for certain health conditions, including pregnancy. Knowing this theory, the HCP can anticipate possible deviations from prescribed diets and treatments. The HCP can then ascertain the specific dietary beliefs and practices observed by a given patient. |
|
For many cultures, there is strong extended family support and interdependency among members of a family. Usually during health care decisions and other major decisions, the issue is discussed as a family and the decision defers to the needs of the family over those of the individual. |
It is important for HCPs to respect the essential role that family members play in a patient’s care. Western concepts of patient autonomy and patient confidentiality are often culturally irrelevant to many immigrants. Inviting and addressing the opinions and concerns of family members can be quite helpful. |
|
Many Asian cultures believe it to be important to be stoic, believing that suffering is a part of life (Uba, 1992). Moreover, there is a great deal of reverence toward physicians. Thus, many Asian immigrants often remain quiet, respectfully answering the HCP’s questions and accepting the HCP’s advice without asking questions (Assanand, Dias, Richardson, & Waxler-Morrison, 1990; Takada, Ford, & Lloyd, 1998). In fact, asking questions may be considered a sign of disrespect, which is why Asians may refrain from doing so (Miller, 1995; Takada, Ford, & Lloyd, 1998). |
Even if patients seem to agree with what was discussed during an appointment, they may not follow the HCP’s recommendations if they lacked confidence and trust in the HCP (Assanand, Dias, Richardson, & Waxler-Morrison, 1990). In fact, they may not complain or ask questions, but they also may not return for their next visit (Mattson, 1995). This can cause problems when managing pregnancy-related illnesses and complications. Some Asians, and individuals from other cultures as well, believe that unless they are given some tangible form of medication, they do not feel that the HCP has really done anything. Subsequently, they may lose confidence in the HCP’s knowledge and abilities. Missing future follow-up appointments can also result from having the patient wait too long for her appointment or from asking her to return a number of times for follow-up (Mattson, 1995). |
|
Copyright
American Public Health Association |
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