Abstract
Examination is an important primary health care service for pregnant women. Such examinations are the most common health care services among pregnant women. Many women undergo gynecological examinations during their pregnancy. There are many reasons for performing gynecological examination, which include “pregnancy diagnosis, gynecological screening and as a measure in the differential diagnosis” (Brand, Walker, Hargreaves and Rosenbach, 2010).
However, some studies have established unique cultural issues that prevent women from gaining access to gynecological examinations. For instance, Brand and other researchers (2010) noted that doctors confronted cultural practices that opposed MHC (maternal and child health) best practices. One study indicated that cultural beliefs did not allow doctors to examine pregnant women. This research focuses on cultural beliefs and doctors’ examination of pregnant women and shows implications for health care providers.
Introduction
Culture is a way of life among a given population. Consequently, effects of cultural issues on the provision of primary health care services have affected both patients and care providers. Therefore, many studies have suggested that good health care providers should learn about cultural issues among patients they serve. It is important to note that we have wide variations among existing cultures. Consequently, it is necessary for health care providers to understand general health beliefs among cultural groups they serve.
Gynecological examination is necessary to identify undesirable outcomes of pregnancies. Antenatal care (ANC) has been effective in detecting problems associated with pregnancies. Such examinations are necessary means of reducing maternal mortality and allowing pregnant women to gain access to many forms of health care services. Health examinations enable women to have information that can improve their health status and those of their unborn babies (Agus and Horiuchi, 2012). At the same time, ANC provides opportunities for women to identify potential dangers and seek immediate medical assistance from health care providers. In developed countries, women have embraced ANC and gynecological examination due to lack of cultural barriers. Therefore, the numbers of women seeking such health care services are high. On the other hand, women who uphold their traditional beliefs may not seek health care providers during their pregnancies. Such cultural practices are unique to given regions, but have the same consequences i.e., they limit chances of women gaining access to MHC best practices.
Unique Cultural Issue: a doctor should not examine pregnant woman
Not many studies have concentrated on cultural beliefs that assert ‘a doctor should not examine a pregnant woman’. However, Brand and fellow researchers (2010) noted that there were cultural practices that did not allow doctors to examine pregnant women in one of their studies. According to these authors, such cultural beliefs contradicted MCH best practices. These researchers wanted to note the level of cultural competence among health care providers. The study groups consisted of Vietnamese, Sudanese, Hispanic, Latinos, and Hmong. The claim that a ‘doctor could not examine pregnant woman’ was among the cultural practices in the study groups that barred doctors from demonstrating the level of their cultural competence. Such beliefs about doctors’ examinations of pregnant women vary from culture to culture.
In Indonesia, traditional beliefs still have strong influences on provisions of ANC services to pregnant women (Agus, Horiuchi and Porter, 2012). Tradition and religious beliefs dominate women’s beliefs about advanced health care services. As a result, it is extremely difficult to change their mindsets about recent developments in health care services. The dependence on traditional birth attendants (TBA) was common than the use of midwives. Pregnant women in Indonesian villages believed that following “traditional beliefs often led to a safe and healthy pregnancy” (Agus et al., 2012). Therefore, it is fundamental for health care providers to understand complexities of the local culture and its influences on health care services. This can lead to an effective improvement in the health status of pregnant women.
Scholars have identified traditional beliefs as the main challenges to the provision of modern health care services among some communities, especially indigenous populations. Agus and Horiuchi (2010) found out that traditional beliefs had direct links to preferences of TBAs among pregnant women. These authors noted that preferences for TBAs indicated “tradition, interpersonal skill, special care, and respect for local customs” (Agus and Horiuchi, 2012) as core reasons for their usages.
Among Somali mothers in the US, traditional beliefs prohibited them from discussing reproductive health or sex with their daughters. On the other hand, some daughters are willing to discuss such matters with their mothers. Consequently, there is a communication gap. Such a lack of communication has led to unsafe reproductive health among Somali immigrants in the US. Communication gaps in communications have restricted communication between Somali women and their primary health care providers (Pavlish, Noor and Brandt, 2010). This suggests that it would be difficult for a doctor to conduct any examination on pregnant Somali women. Such studies have provided valuable data for understanding health care experiences among Somali women of Minnesota. Immigrants in different areas have different experiences with regard to health care services because of diversity that exists among different groups.
Some studies have looked at doctors’ examinations of women from perspectives of women. A number of women considered such intimate examinations as sources of potential awkwardness, concern, and discomfort. At the same time, doctors also expressed their discomfort with regard to such examinations. They cited issues of possible court cases and patients’ lack of confidence with the results. Consequently, some doctors have avoided such examinations by asserting that women do not like such examinations. Issues of possible legal cases against doctors together with cultural beliefs have discouraged doctors from conducting pelvic examination among women from different cultural backgrounds. Moreover, women have also indicated their preferences for doctors in such situations. For instance, some women have shown preferences to female doctors. Women felt comfortable with other female doctors during examinations. At the same time, such women also cited religious beliefs as the main reason for preferring female doctors. Cultural objections and the fear of consulting and discussing sensitive matters with male doctors also contributed to women’s preferences for female doctors. On the other hand, there were also women who preferred male doctors to female doctors to conduct their pelvic examinations. Such women felt that male doctors offered great opportunities for learning about reproductive health. In addition, such women also noted that they could communicate freely with male doctors. It is interesting to note that women who preferred male doctors to female doctors did not attribute their decisions to cultural or religious beliefs. This is contrary among women who preferred female doctors.
Given such unique cultural issues in the provision of primary health care services to women from various cultural backgrounds, we have to understand the importance of cultures in health care services, its effects on health care outcomes, and influences on health behaviors among target groups.
We have to note that the concept of culture differs across different groups. In this context, we have to consider factors that affect cultural beliefs like language, values, religion, communications, race, ethnicity, traditions, and other social elements within group setups. Within the perspective of health behavior, culture relates to shared practices, beliefs, and values. For instance, cultural beliefs, which claim that doctors should not examine pregnant women, were common among women who Brand and his colleagues encountered in studies. These are cultural beliefs that have direct impacts on health behaviors. As a result, such cultural beliefs influence adoption, acceptance, and usages of health care services among women.
Health care providers must recognize that cultural beliefs have valid explanations based on their influences on health outcomes. In this regard, it is necessary for health care providers to go beyond nationality or racial identity when dealing with people from other cultures because such factors alone do not provide accurate reflections of beliefs and attitudes towards advanced health care services. Therefore, it is necessary to focus on individual cultural traits in order to understand cultural beliefs within a group.
Policymakers must base their attempts of reducing health care disparities on cultural factors like beliefs, practices, and attitudes. Such approaches can reduce the health gap in the provision of health care services to minority groups.
Some studies have shown that current health care services have misalignment with regard to current ANC provisions. Such health care services have not accounted for both social and cultural beliefs of women they serve. As a result, they are often at odd with cultural beliefs of communities. This has led to low utilization of such care facilities among minority groups.
In many cases, the global approaches to implementation of health care services assume that women will readily accept high quality services or MCH best practices. However, this is not the case because many women prefer TBAs to health care providers. Therefore, such strategies cannot develop ANC services because of cultural beliefs, which most of these initiatives do not take into account. Consequently, it is fundamental to understand cultural and social backgrounds of target populations when implementing health care services for pregnant women.
From such observations, matching cultural beliefs of pregnant women with health care services can enhance acceptance, adoption, and usages of ANC services. This approach will facilitate communications between doctors and pregnant women. Availability of health care information to pregnant women shall enable such women understand why doctors should examine pregnant women. In fact, documented results from past studies have demonstrated that belief systems, cultural elements, religious beliefs, experiences in life, and other social factors have significant impacts on ways in which people understand information. Therefore, any attempts of developing health care campaigns for a particular group must account for such factors.
Cultural Competence
Policymakers in health care sectors have noted the importance of cultural beliefs in the provision of primary health care services to various cultural groups. They believe that developing cultural competence of the target group can be a potential approach of reducing disparities in the provision of health care services among various ethnic groups. Health care policymakers have reacted by developing cultural competence initiatives that can address cultural beliefs in the provision of health care services. However, such cultural competence cannot apply in another setting because of cultural variations among groups. In the US, three factors have facilitated the need to develop cultural competence of health care providers. First, the population has become diverse, and health care providers cater for many people with different cultural and social beliefs. In addition, language issues have also affected communications between the patient and doctors. There are unfamiliar beliefs among such diverse populations, which may influence how patients respond to doctors’ recommendations. For instance, Pavlish and colleagues reported that Somali women had “discordant health beliefs that resulted in divergent expectations regarding treatment and healthcare interactions” (Pavlish et al., 2010). Consequently, there were unmet needs in patients and health care providers. Such frustrations led to negative perceptions about the quality of health care.
Second, studies have demonstrated that effective communication resulted in patients’ satisfaction, compliance with the doctors’ recommendations, and positive health care results. Therefore, poor health outcomes were possible in cases where health care providers and patients could not handle different beliefs during their interactions. It is also necessary to note that certain cultural barriers and beliefs affect the public too. Finally, studies have emphasized the significance of patient-centered treatment with cultural competence approaches.
Many study participants have noted that a managed care can encourage cultural competence through collaboration. At the same time, the realization about impacts of cultural competence on health care provisions can promote the development of effective intervention strategies. However, developing effective cultural competence among health care providers has faced some challenges. For instance, many health care providers do not get adequate training on cultural awareness about their clients. As a result, many of them learn on the job. Generally, studies concluded that cultural competence was an effective approach of handling cultural beliefs that cause disparities in provisions of health care services among pregnant women and other members of society.
Summary (conclusion and implication)
Pregnancy tests provide unique chances for women to understand their health status. Health behaviors among pregnant women have significant effects on women and their unborn babies. However, studies have shown that some cultural beliefs do not allow doctors to examine pregnant women despite the fact that such health care services rely on best practices of MHC. Based on these observations, other studies have shown that health care policymakers do not account for cultural beliefs when developing health care policies for minority groups or other groups with different cultures. In fact, women failed to adopt and utilize such services because of their belief systems. Therefore, health care providers must account for cultural beliefs for effective provision of health care services to pregnant women.
From other women’s perspectives, they choose doctors to examine them based on sex. Women who chose female doctors noted influences of cultural and religion beliefs. Conversely, women who preferred male doctors’ examinations claimed that they could get information and learn about reproductive health. However, this group did not refer to culture or religious beliefs. We can note how cultural beliefs influence the choice of care providers.
Experts have noted the relevance of cultural competence among health care providers. They claim that future health care workers should learn cultural competence in order to cater for different patient populations. Cultural competence should aim at improving communication between health care providers and patients. In this context, health care provider must acknowledge the importance of cultural beliefs and health behaviors. Thus, care provider must develop cultural skills and avoid stereotypical approaches because of diversities in order improve the provision of health care services.
References
Agus, Y., and Horiuchi, S. (2012). Factors influencing the use of antenatal care in rural West Sumatra, Indonesia. BMC Pregnancy Childbirth, 12(9), 1-8.
Agus, Y., Horiuchi, S., and Porter, S. (2012). Rural Indonesia women’s traditional beliefs about antenatal care. BMC Research Notes, 5(589), 1-8.
Brand, A., Walker, D., Hargreaves, M., and Rosenbach, M. (2010). Intermediate Outcomes, Strategies, and Challenges of Eight Healthy Start Projects. Maternal Child Health Journal, 14(5), 654–665.
Pavlish, C., Noor, S., and Brandt, J. (2010). Somali Immigrant Women and the American Health Care System: Discordant Beliefs, Divergent Expectations, and Silent Worries. Social Science & Medicine, 71(2), 353–361.