Anthropology Archive

Cultural Issues in Mexican American Pregnancy and Prenatal Care

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For many women of Mexican origin, beliefs about pregnancy have centered on the traditions of parteras (midwives). Parteras' ideas about pregnancy and childbirth include food taboos and restrictions on activities that are often followed as part of the management of pregnancy. Ideas of "hot" and "cold" conditions and treatments are also important: conditions must be balanced to restore health. Pregnant women are "hot" and must avoid hot foods and hot treatment conditions or neutralize these conditions by taking cool substances. The postpartum woman is in a cold state and must be maintained in a warm state and fed hot (or temperate) foods to ensure the flow of milk; if the milk becomes cold, it could harm the baby. Restrictions for forty days of convalescence are also derived from parteras' traditional practices.

Cultural values affect teen pregnancy rates and prenatal care. About half of all Hispanics born in the United States in recent decades were to single mothers, a phenomenon reflecting cultural values and social circumstances. The relevance of cultural factors in addressing pregnancy risks among Mexican Americans include cultural values concerning children; negative attitudes toward and an ignorance of contraception; the value and status of parenthood; low levels of parental communication with children regarding sex, pregnancy, and contraception; low levels of the use of contraceptives; and social factors affecting access to sex education (Brindis, 1992).

The cultural value placed on children reinforces keeping a pregnancy even outside of marriage. Machismo and high mortality among male youth reinforces a mentality in which having a baby is a sign of manhood or womanhood and a means of intergenerational continuity. The lack of sex education reflects both social and cultural factors. Problems arise in sex education because of low levels of parental communication regarding sex, pregnancy, and contraception and early school dropout. Early school dropout means that sex education is not obtained. Public health information from health service agencies is often ineffective because of language barriers, cultural conflicts in learning and instructional styles, and barriers presented by a lack of legal residency. The avoidance of teenage pregnancy requires the involvement of cultural institutions, especially the family and church. Because many Hispanics drop out before finishing high school, where sex education is provided, parents must be encouraged to take a central role in the sex education processes. This requires a broader education to assist parents in developing communication skills and relevant knowledge through life education programs that are culturally relevant and sensitive (Brindis, 1992). Communication with parents about sexual matters basis from which people make decisions. Consequently, ethnomedical models are essential to the formulation of culturally relevant programs that address critical divergences from biomedical beliefs. For instance, traditional beliefs about pregnancy and fertility may increase risk during pregnancy (Snow, 1993). Pregnancy taboos—prohibitions on behavior during pregnancy—are found throughout the world. Many cultures view pregnant appears to inhibit teen pregnancy, as does involvement with the church, which tends to delay first sexual intercourse.

Cultural factors affect prenatal care, a significant factor in maternal and neonatal health. The utilization of prenatal health services by Mexican Americans is much lower than that of other groups (Moore and Hepworth, 1994). Mexican Americans were less likely than non-Hispanic whites to initiate first-trimester care, obtain prenatal care, and make postnatal visits for well-baby care. These differences are present even when Mexican Americans have the same access to services. Predictors of service use included satisfaction with care, lack of transportation problems, and higher social support, advice, and assistance. Low use of care is also affected by income, ineligibility for services, and cultural and language barriers to service satisfaction (Brindis, 1992).

Research on the prenatal beliefs, practices, and patterns of health utilization provide a basis from which to develop prenatal care education for low-income Mexican women (Alcalay, Ghee, and Scrimshaw, 1993). Researchers assessed the effectiveness of mass media campaigns in promoting the use of health care services and identified appropriate communication patterns and messages. This provided the basis for designing an intervention that addressed pregnancy-related problems and the appropriate health behaviors. The pregnancy education project used communication interventions based on a variety of persuasion theories that emphasized the personal relevance of messages, attitude changes, and new role models.

A significant barrier to prenatal care is a belief that it is unnecessary if a woman feels well. Women need to know the necessity of prenatal checkups even if they feel well. Information from practitioners does not provide adequate knowledge about appropriate weight gain, the need for iron supplements, the signs of risks during pregnancy, or supplemental dietary needs. Dissatisfaction is a barrier to care. Women's care-seeking behavior is also inhibited by the lack of their husband's approval for leaving the house and the inability of a man to accompany his wife because of having to work. Traditional sex roles and objections by husbands to another man looking at his wife's private areas are barriers to routine gynecological exams. The hospital and clinical situations where many providers examine the women also make them feel uncomfortable, and they avoid care. Because of the socialization for modesty emphasized in Mexican culture, women may feel particularly strong shame and embarrassment during gynecological or obstetrical exams or in discussing sexual or reproductive issues. Examinations that involve nudity or other lack of personal privacy may result in termination of the doctor-patient relationship. Health care providers sensitive to these cultural factors can adapt by providing greater privacy or by using female personnel for interviews and examinations.

women as being in a vulnerable state or posing a threat to others by her so-called abnormal condition. Understanding cultural taboos regarding pregnancy is important in ensuring the well-being of mother and child. Pregnancy taboos can be in a woman's favor (e.g., reducing fatty foods or foods with high risks of disease) or may negatively affect the mother and neonate (e.g., food restrictions that deprive them of protein or vitamins).

Birth and Delivery Processes In modern societies, birth processes are managed by biomedical institutions. But traditional beliefs and practices concerning childbirth persist. Knowledge of these practices is important for pregnancy, labor, and delivery classes because women use their own cultural beliefs in adapting to medical settings. Traditional practices of birthing while squatting lead women to abandon the gurney and stirrups and seek an area to squat; occasionally, women in a biomedical setting who are following their tradition's norms by seeking a private area in which to squat are discovered in custodians' closets or in stairwells. Cultural norms regarding the expression of pain are relevant to understanding delivering mothers, their expressions during labor, and the relevance of pain medication or other interventions.

Cultural elements of the biomedical obstetrical practices may conflict with cultural norms about modesty. Perineal shaving and routine episiotomies reflect cultural practices of biomedicine rather than scientifically established procedures. Cultural beliefs about who should be the birth attendant may conflict with American norms. Without the recognition of cultural patterns, outreach and marketing strategies may be to no avail (such as recruiting Hispanic men to attend birthing classes to learn to be labor assistants for their wives). Understanding cultural expectations is crucial to the correct assessment of the meaning of others' involvement or lack thereof. A man's failure to participate in the birthing process, or even be at the hospital, may reflect cultural expectations rather than a lack of interest in the mother and child. Support for the mother and her newborn also varies widely, ranging from conditions under which others accept full responsibility for the mother-infant dyad to those where mothers may find little, if any, relief from ordinary responsibilities and little assistance for the care of her newborn.

Differences in delivery expectations between biomedicine and the general culture have contributed to a burgeoning of alternative birthing practices, a popular uprising against biomedicine. The development of modern obstetrical practices led to the adoption of the lithotomic position, with the mother on her back with her feet up in the air in stirrups. While not conducive to natural labor processes, this was convenient for the physician's control. The role of culture in birthing practices is evidenced in the changes in the biomedical approach in the recent development of alternative birth centers and the rein-traduction of the nurse-midwife.

Postpartum Taboos Culture shapes a variety of postpartum behaviors affecting the health of newborns and mothers. Cultures have both formal and informal norms regarding the behavior of women following birth, including restrictions on activity and foods to protect the mother and newborn. Seclusion is a frequent source of protection, reducing exposure to infectious disease, providing rest and relief from ordinary work, and encouraging breast-feeding, mother-infant bonding, and healing. Many cultures require new mothers to rest for a month or forty days. Cultural beliefs about activity, diet, seclusion, purification, sex, and protection can favor or prejudice the well-being of mother and newborn. For instance, African Americans often introduce solid food in the first month, a practice considered to be harmful for newborns. Of particular importance are beliefs regarding exposure to temperature extremes, bathing, activity, diet, clothing, and a variety