Fisher Judith A, Bowman Marjorie, Thomas Tessie
Department of Family Practice and Community Medicine, University of Pennsylvania, Philadelphia 19104, USA.
J Am Board Fam Pract. 2003 Mar-Apr;16(2):151-5. doi: 10.3122/jabfm.16.2.151.
In 1998 ethnic minorities comprised 28% of the US population, and India is the third most common country of origin for immigrants. Many recently immigrated South Asian Indian patients are seen in health care settings in the United States. To deliver health care effectively to these patients, it is helpful for physicians to understand common cultural beliefs and practices of South Asian Indian patients.
Two illustrative cases are reported. One author's observations of the care of pregnant and parturient women in India and similar experiences in our own office spurred a literature search of the cultural behaviors surrounding sexuality, fertility, and childbirth. A literature search was conducted in Index Medicus, Grateful Med, and the catalogue of the University of Pennsylvania Arts and Sciences library, using the terms "Indian," "South Asian," "male and female gender roles," "gynecology in third world," "sexuality," "sexual health," "women's health," "women's health education," "obstetrical practices/India," and "female roles/India."
Issues surrounding sexuality and childbirth that arise during the US physician-South Asian Indian patient encounter might not correspond to the commonly held knowledge, beliefs, and behaviors of the US health care system. Common cultural beliefs and behaviors of South Asian Indian patients around sexuality and childbirth experience include the role of the individual patient's duty to society, the patient's sense of place in society, lack of formal sexual education, prearranged marriages, importance of the birth of the first child, little premarital contraceptive education, dominance of the husband in contraceptive decisions, and predominant role of women and lack of role for men (including the husband) in the childbirth process.
Lack of understanding of the Indian cultural mores surrounding sexual education, sexual behavior, and the childbirth experiences can form barriers to Indian immigrants in need of health care. These misunderstandings can also lead to patient dissatisfaction with the health provider and health system, underutilization of health services, and poorer health outcomes for Indian immigrants and their families. For this reason, it is important to teach cultural issues during undergraduate, graduate, and continuing medical education.
1998年，少数民族占美国人口的28%，印度是美国移民的第三大来源国。在美国的医疗环境中可以见到许多最近移民来的南亚印度裔患者。为了有效地为这些患者提供医疗服务，医生了解南亚印度裔患者的常见文化信仰和习俗会有所帮助。
报告了两个说明性案例。一位作者对印度孕妇和产妇护理的观察以及在我们自己办公室的类似经历促使我们对围绕性行为、生育和分娩的文化行为进行文献检索。使用“印度”“南亚”“男女角色”“第三世界的妇科”“性行为”“性健康”“妇女健康”“妇女健康教育”“印度的产科实践”和“印度的女性角色”等术语在《医学索引》《医学在线》以及宾夕法尼亚大学文理学院图书馆目录中进行了文献检索。
在美国医生与南亚印度裔患者接触过程中出现的围绕性行为和分娩的问题可能与美国医疗系统的普遍认知、信仰和行为不一致。南亚印度裔患者在性行为和分娩经历方面的常见文化信仰和行为包括个体患者对社会的责任、患者在社会中的地位感、缺乏正规性教育、包办婚姻、头胎出生的重要性、婚前避孕教育不足、丈夫在避孕决策中的主导地位以及女性在分娩过程中的主要作用和男性（包括丈夫）的次要作用。
对围绕性教育、性行为和分娩经历的印度文化习俗缺乏了解可能会给需要医疗服务的印度移民造成障碍。这些误解还可能导致患者对医疗服务提供者和医疗系统不满、医疗服务利用不足以及印度移民及其家庭的健康状况较差。因此，在本科、研究生和继续医学教育期间教授文化问题很重要。
