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Berkeley ETHSTD 196 - Management of Reproductive Health Among Women From the Indian Subcontinent

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Management of Reproductive Health Among Women From the Indian Subcontinent Bhumi Bhutani Abstract Women’s reproductive health issues are often overlooked in South Asian societies. Previous research indicates that unreliable sources, such as friends and family, are often used as a primary outlet by South Asian groups to answer questions about their reproductive health. Past observations made while working in an obstetrician’s practice show distinct differences in behavior, perception, knowledge, and attitude between South Asian women and Non-South Asian women. However, due to the recent acculturation of South Asians in the United States, there is limited information regarding the management of reproductive health among this group in the United States (Mukherjea 2003, pers. comm.). This study resembles a Knowledge, Attitude, and Practice (KAP) study that compares the management of reproductive health among South Asian women and Non-South Asian women. This question has been tested using a questionnaire which addresses the following topics: a) socio-economic status, b) contraceptive use, c) fertility, d) sexually transmitted diseases, reproductive tract infections, and e) source of information on reproductive health. Approximately 400 questionnaires were completed by South Asian women and Non-South Asian women located in obstetrician/gynecologist offices in the Bay Area of Northern California. Results indicate marked differences in how South Asian women manage their reproductive health when compared with non-South Asian women. South Asian women are often accompanied by their husbands on their visits to the OB/GYN. They also rely on their husbands as a prime source of information regarding their reproductive health, although they are more educated and come from high income groups. Differences between these two groups may indicate the need to provide reproductive health services in a manner that is sensitive to the socio-cultural needs of South Asians.Introduction Women’s sexuality issues are controversial in India’s South Asian societies. Not only is it difficult to discuss basic hygiene practices within a traditional South Asian family, but it is also incredibly hard to make South Asian women understand the importance of managing their own health. According to Dr. Nilima Parekhji, M.D., “Within South Asian families, women depend on their male counterparts to make decisions regarding the household and business aspects of family life.” In this process, many South Asian women also depend on their husbands to make choices regarding their own reproductive health. Because South Asian women are not in control of their own reproductive health they do not have as much autonomy and decision-making power regarding their reproductive well-being. As a result, “lack of control over accessibility to reproductive health services can adversely affect their general well-being” (Kamal, 2003. pers. comm). The International Conference on Population and Development (ICPD) defined reproductive health as the “state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its function and process” (Ramasumbban and Jejeebhoy, 2000). Prior to 1994, the United Nations’ focused on population control. It was only until the 1994 Cairo Conference, organized by the United Nations Fund for Population Activities (UNFPA), when the focal point shifted from population control to the management of reproductive health (Kamal, 2003. Pers. Comm). Since the ICPD conference, the governments of countries in the Indian subcontinent have done much to address reproductive health needs of the population (Kamal et al, 1997). Further research performed by the Population Council in Bangladesh studied the perceptions and attitudes of reproductive health care among Bangladeshi adolescents. Findings from the study show that adolescents turned to mostly unreliable sources for reproductive information (Kamal et al, 1997). Females traditionally turned to their grandmothers while males preferred electronic media sources (Kamal et al, 1997). From my own experiences working in an obstetrician’s private practice, I have observed distinct differences in behavior, perception, knowledge and attitude between South Asian and Non-South Asian women. The South Asian women who came to see the OB/GYN usually were accompanied by their husbands whereas the Non-South Asian women came alone. The South Asian patients were timid and hesitated when answering the OB/GYN’s questions regarding theirreproductive health. In comparison, the Non-South Asian women appeared much more confident, answered questions completely, and asked questions themselves. There is limited information regarding the reproductive health of South Asian women who reside in the United States because of the recent acculturation of this group in the United States (Mukherjea 2003, pers. comm.). However, primary observations and personal experience reveal that many South Asian American women also rely heavily on their husbands, fathers, and/or brothers in making decisions for them in regards to the household and work (Parekhji, 2004. Pers. Comm.). “Past studies have presented Indian women as lacking interest in sex, or being less sexually interested than men. There is little research examining Indian women’s views about sex and participation in sex research” (Boynton 2003). According to research on the knowledge, behavior and attitudes of college students in Delhi University, India, “female students seem to be rejecting traditional Indian repressive sexual standards of premarital and non-procreative sex and the gender differences are beginning to narrow. Despite their sexual awareness, students are highly ignorant about major reproductive health issues” (Sachdev 1998). Research done in this study also indicates that being male and married does not make them more knowledgeable about managing their reproductive health. Given these findings, past research has studied sexual behavior, attitudes, and perceptions among South Asian men and women in India, but overlooks how South Asian women manage their reproductive health in the United States. Due to a relatively small level of South Asian immigration and acculturation, this group has been overlooked (Mukerjea 2003, pers. comm.). My research question is how do South Asian


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Berkeley ETHSTD 196 - Management of Reproductive Health Among Women From the Indian Subcontinent

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