NUR 112 (Decent Work Employment &
Transcultural Nursing)
STUDENT ANSWER SHEET
BS NURSING / FOURTH YEAR
Session # 15
LESSON TITLE: Transcultural Perspectives in
Childbearing
Materials: Handouts, Pen and Paper,
Books(optional), Notebook
LEARNING OUTCOMES:
At the end of the lesson, the nursing student can:
1. Analyze how culture influences the beliefs and
behaviors of the childbearing woman and her family
during pregnancy.
2. Recognize the childbearing beliefs and practices of
diverse cultures.
3. Examine the needs of women making alternative
lifestyle choices regarding childbirth and child rearing.
4. Explore how cultural ideologies of childbearing
populations can impact pregnancy outcomes.
References: Transcultural Concepts in Nursing
Care 7th Edition by Margaret A. Newman and
Joyceen S. Boyle
Overview of Cultural Belief Systems and Practices Related to Childbearing
• Pregnancy and childbirth practices in contemporary Western society have seen dramatic changes over the past
three decades. As global populations become increasingly mobile, we are seeing cultures converge, which calls
for a reorientation of our nursing skills and nursing behaviors.
• In light of global population shifts that are likely to continue for years to come, cultural beliefs regarding
childbearing and childrearing need to be examined to enable nurses to offer our patients culturally congruent care
throughout their pregnancy, birth, and the early postpartum.
• One aspect does remain static: Childbearing is universal and, as Chalmers (2013) notes, is a great leveler, as all
women who give birth do so in one of two ways. This is also a time of transition and social celebration of central
importance in any society, signaling a realignment of existing cultural roles and responsibilities, psychological and
physiologic states, and social relationships.
• Health disparities in the United States also play a role in increased maternal morbidity and maternal mortality,
although it is unclear to what extent. For example, African American women are nearly four times more likely to
die of pregnancy-related complications than White women. These rates and disparities have not improved in more
than 20 year
• Subcultures within the United States have very different practices, values, and beliefs about childbirth and the
roles of women, men, social support networks, and health care practitioners. One such subculture includes
proponents of the “back to nature” movement, who are often vegetarian, use lay midwives for home deliveries,
and practice herbal or naturopathic medicine.
• Other groups that might have distinct cultural practices include African Americans, American Indians, Hispanics,
Middle Eastern groups, Orthodox Jewish groups, Asians, and recent immigrants, among others.
• Additionally, religious background, regional variations, age, urban or rural background, sexual preference, and
other individual characteristics all might contribute to cultural differences in the experience of childbirth.
Fertility Control and Culture
• The professional literature lacks information specific to cultural beliefs and practices related to the control of
fertility. A woman’s fertility depends on several factors, including the likelihood of sterility, the probability of
conceiving, and of intrauterine mortality.
• In addition, the duration of a postpartum period, during which a woman is unlikely to ovulate or conceive,
influences fertility. These variables are further modified by cultural and social variables, including marriage and
residence patterns, diet, religion, the availability of abortion, the incidence of venereal disease, and the regulation
of birth intervals by cultural or artificial means, all of which are influenced by cultural norms, values, and traditions.
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Unintended Pregnancy
• In the United States, according to Finer and Zolna’s (2011) combined data study, 49% of pregnancies in 2006
were unintended—a slight increase from 48% in 2001. Among women aged 19 years and younger, more than
four out of five pregnancies were unintended. The proportion of pregnancies that were unintended was highest
among teens younger than age 15 years, at 98%.
• The largest increases in unintended pregnancy rates were among women with low education, low income, and
cohabiting women. Mosher, Jones, and Abma (2012) reported similar findings in data from the National Survey of
Family Growth, which indicated no significant decline in the overall proportion of unintended births between the
1982 and the 2006 to 2010 surveys.
• The proportion of births that were unintended did decline during these years among married, non-Hispanic White
women. Women more likely to experience unintended births included unmarried women, black women, women
who are socioeconomically disadvantaged, and those with less education.
• Consideration must also be given to what is influencing unintended pregnancy, which includes changes in social
mores sanctioning motherhood outside of marriage, contraception availability including abortion, earlier sexual
activity, and multiple partners.
Contraceptive Methods
• Commonly used methods of contraception in the United States include hormonal methods, intrauterine devices
(IUDs), permanent sterilization, and, to a lesser degree, barrier and “natural” methods. Natural methods of family
planning are based on the recognition of fertility through signs and symptoms and abstinence during periods of
fertility.
• The religious beliefs of some cultural groups might affect their use of fertility controls such as abortion or artificial
regulation of conception; for example, Roman Catholics might follow church edicts against artificial control of
conception, and Mormon families might follow their church’s teaching regarding the spiritual responsibility to have
large families and promote church growth (Andrews & Hanson, 2012).
• Negative outcomes of religious family planning teachings have recently been studied. Pritchard, Roberts, and
Pritchard (2013) analyzed WHO data from two continents sharing religious–cultural views on suicide and family
planning those being Western European Catholic and Latin American Catholic countries. He reported that in Latin
American female youth (15 to 24 years of age), less access to contraception contributed to unintended
pregnancies and higher suicide rates.
Religion and Fertility Control
• The influence of religious beliefs on birth control choices varies within and between groups, and adherence to
these beliefs may change over time. Cultural practices tend to arise from religious beliefs, which can influence
birth control choices.
• For example, the Hindu religion teaches that the right hand is clean and the left is dirty. The right hand is for
holding religious books and eating utensils, and the left hand is used for dirty things, such as touching the
genitals. This belief complicates the use of contraceptives requiring the use of both hands, such as a diaphragm
(Bromwich & Parsons, 1990).
• In many cases, birth control is seen as an act of God. Purnell and Selekman (2008) describe the Muslim belief
that abortion is “haram” unless the mother’s life is in danger; consequently, unintended pregnancies are dealt with
by praying a miscarriage will occur. A fact that is perhaps of greater significance to fertility in Muslim women is
that a woman’s sterility can be reason for abandoning or divorcing her.
• The authors go on to say that Islamic law forbids adoption; infertility treatment is allowed, but is limited to artificial
insemination using the couple’s own sperm and eggs.
• According to Orthodox Jewish beliefs, infertility counseling and intervention such as sperm and egg donation
(from the couple) meet with religious approval; adoption is viewed as a last resort (Washofsky, 2000). The use of
condoms and birth control pills are acceptable; abortion and sterilization are the least-supported birth control
methods. However, in cases where the mother’s life is in jeopardy, abortion is not opposed (Kolatch, 2000).
• In some African cultures, there are strongly held beliefs and practices related to birth spacing. Because
postpartum sexual activity has traditionally been taboo, some women leave their home for as long as 2 years to
avoid pregnancy.
Cultural Influences on Fertility Control
• It is common for health professionals to have misconceptions about contraception and the prevention of
pregnancy in cultures different from their own. A qualitative study by Eckhardt and Lauderdale (2013) sought to
identify and describe the barriers to family planning in North Kamagambo, Kenya, to understand the cultural
context in which they exist.
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Since the Lwala Community Hospital’s opening in the North Kamagambo region of Kenya in 2007, the number of
patients seeking contraceptives and family planning counseling has increased. However, maternal mortality
remains high and the culture expects women to bear many children.
Although this places a large burden on women’s health and increases a lifetime risk of maternal mortality, cultural
and religious hesitance toward family planning persists.
Nurses providing family planning services must take care to be culturally sensitive so that women can be assisted
in examining their own attitudes, beliefs, and sense of gynecologic wellbeing regarding fertility control.
PREGNANCY AND CULTURE
Biologic Variations
• Knowledge of certain biologic variations resulting from genetic and environmental backgrounds is important for
nurses who care for childbearing families. For example, pregnant women who have the sickle cell trait and are
heterozygous for the sickle cell gene are at increased risk for asymptomatic bacterial and urinary tract infections
such as pyelonephritis. This places them at greater-than normal risk for premature labor as well.
• Although heterozygotes are found most commonly among African Americans (8% to 14%), individuals living in the
United States and Canada who are of Mediterranean ancestry, as well as those of Germanic and Native North
American descent, might also carry the trait (Overfield, 1985; Perry, 2000). If both parents are heterozygous,
there is a one-in-four chance that the infant will be born with sickle cell disease.
Diabetes Mellitus during Pregnancy
•
•
•
Another important biologic variation relative to pregnancy is diabetes mellitus. The incidence of non–insulindependent and gestational diabetes is much higher than normal among some American Indian groups—a
problem that increases maternal and infant morbidity. Illnesses that are common among European Americans
might manifest themselves differently in American Indian clients. For example, an American Indian woman might
have a high blood sugar level but be asymptomatic for diabetes mellitus. The mortality rate in pregnant American
Indian women with diabetes is higher than in White European American women.
Pregnant American Indians and Alaskan Native women with type 2 diabetes are at an increased risk of having
babies born with birth defects. Gestational diabetes increases the baby’s risk for problems such as macrosomia
(large body size) and neonatal hypoglycemia (low blood sugar).
Although the blood glucoses of American Indian and Alaskan Native women usually return to normal after
childbirth, these women have an increased risk of developing gestational diabetes in future pregnancies.
CULTURAL VARIATIONS INFLUENCING PREGNANCY
Alternative Lifestyle Choices
• Although the dominant cultural expectation for North American women remains motherhood within the context of
the nuclear family, recent cultural changes have made it more acceptable for women to have careers and pursue
alternative lifestyles.
• Changing of cultural expectations has influenced many middle-class North American women and couples to delay
childbearing until their late 20s and early 30s and to have small families. Many of today’s women are career
oriented, and they may delay childbirth until after they have finished college and established their career. Some
women are making choices regarding childbearing that might not involve the conventional method of conception
and childrearing.
• Lesbian childbearing couples are a distinct subculture of pregnant women with special needs (see Figure 5-6).
Randi (2012) reports that the way intake forms are completed needs to be re-evaluated in light of these social
changes. How the patient became pregnant is one such example. Instead of assuming she became pregnant via
intercourse, Randi suggests asking the patient to tell you “the story” of how she became pregnant, thus keeping
the interview less threatening and nonjudgmental.
In their review of the literature, McManus, Hunter, and Rennus (2006) found four areas that are significant in regard to
lesbians considering parenting:
(1) sexual orientation disclosure to providers and finding sensitive caregivers,
(2) conception options,
(3) assurance of partner involvement, and
(4) how to legally protect both the parents and the child.
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•
Lesbian and heterosexual pregnancies have many similarities. Issues of sexual activity, psychosocial changes
related to attaining the traditionally defined maternal tasks of pregnancy (Rubin, 1984), and birth education all
need to be addressed with lesbian couples.
Maternal Role Attainment
• Maternal role attainment is often taken for granted in Western culture. If you give birth and become a mother, the
assumption is that you automatically become “maternal” and successfully care for and nurture your infant.
• However, many factors can affect maternal role attainment, including separation of mother and infant in cases
such as illness, incarceration, or adoption, to name only a few.
• An example of successful maternal role attainment superimposed with a chronic illness is described in a
phenomenological study that explored factors affecting maternal role attainment in HIV-positive Thai mothers
selected for their successful adaptation to the maternal role.
The results indicated six internal and external factors used to assist in attainment:
(1) setting a purpose of raising their babies;
(2) keeping their HIV status secret;
(3) maintaining feelings of autonomy and optimism by living as if nothing were wrong, that is, normalization;
(4) belief of quality versus quantity of support from husbands, mothers, or sisters;
(5) hope for a cure; and
(6) belief that their secret is safe with their health care providers.
Nontraditional Support Systems
• A cultural variation that has important implications is a woman’s perception of the need for formalized assistance
from health care providers during the antepartum period. Western medicine is generally perceived as having a
curative rather than a preventive focus.
• Pregnant women and their partners have been placing increased emphasis on the quality of pregnancy and
childbirth for some time, with many childbearing women relying on nontraditional support systems.
• For couples who are married, white, middle class, and infrequent users of their extended family for advice and
support in childbirth-related matters, this kind of support might not be crucial.
• However, for other, more traditional cultural groups, including African Americans, Hispanics, Filipinos, Asians, and
Native Americans, the family and social network (especially the grandmother or other maternal relatives) may be
of primary importance in advising and supporting the pregnant woman.
• A number of factors influence childbearing practices for Filipino women including cultural beliefs, socioeconomic
factors, and, in recent years, Western medicine. Approximately 41% of Filipino births are supported by indigenous
attendants called hilots. The attendants act as a consultant throughout the pregnancy. During the postpartum
period, the hilot performs a ritualistic sponge bath with oils and herbs, which is believed to have both physical and
psychological benefits. The extended family is involved in the care of the baby, mother, and the household.
Breast-feeding is encouraged and hot soups are encouraged to increase milk production.
• In Arab countries, labor and delivery is considered the business of women. Traditionally, dayahs and midwives
presided over home deliveries. The dayahs provide support during the pregnancy and labor and are considered
by traditional Arab women to be most knowledgeable due to their experience in caring for other pregnant women.
Hospital births are on the rise in most Arab countries, with a decrease in the number of traditional home births.
Cultural Beliefs Related to Activity During Pregnancy
• Cultural variations also involve beliefs about activities during pregnancy. A belief is something held to be actual or
true on the basis of a specific rationale or explanatory model. Prescriptive beliefs, which are phrased positively,
describe what should be done to have a healthy baby; the more common restrictive beliefs, which are phrased
negatively, limit choices and behaviors and are practices/behaviors that the mother should not do in order to have
a healthy baby.
• Taboos, or restrictions with serious supernatural consequences, are practices believed to harm the baby or the
mother. Many people believe that the activities of the mother—and to a lesser extent of the father—influence
newborn outcome. Box 5-2 on your textbook describes some traditional prescriptive and restrictive beliefs and
taboos that provide cultural boundaries for parental activity during pregnancy. These beliefs are attempts to
increase a sense of control over the outcome of pregnancy.
• Negative or restrictive beliefs are widespread and numerous. They include activity, work, and sexual, emotional,
and environmental prescriptions.
• Taboos include the Orthodox Jewish avoidance of baby showers, divulgence of the infant’s name before the
infant’s official naming ceremony, and laws, customs, and practices during labor and delivery (Noble, Rom,
Newsome- Wicks, Engelhardt, & Woloski-Wruble, 2009).
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One Hispanic taboo involves the traditional belief that an early baby shower will invite bad luck, or mal ojo, the evil
eye (Spector, 2008).
Positive beliefs often involve wearing special articles of clothing, such as the muneco worn by some traditional
Hispanic women to ensure a safe delivery and prevent morning sickness. Other beliefs and practices involve
ceremonies and recommendations about physical and sexual activity.
Food Taboos and Cravings
• Many cultures traditionally believed that the mother had little control over the outcome of pregnancy except
through the avoidance of certain foods.
• Another traditional belief in many cultures is that a pregnant woman must be given the food that she smells to eat;
otherwise, the fetus will move inside of her and a miscarriage will result (Spector, 2008).
• Spicy, cold, and sour foods are often believed to be foods that a pregnant woman should avoid during pregnancy.
Some pregnant women experience pica: the craving for and ingestion of nonfood substances, such as clay,
laundry starch, or cornstarch.
• Some Hispanic women prefer the solid milk of magnesia that can be purchased in Mexico, whereas other women
eat the ice or frost that forms inside refrigerator units. The causes of pica are poorly understood, but there are
some cultural implications because women from certain ethnic or cultural groups experience this disorder more
frequently than others.
• In the United States, pica is common in African American women raised in the rural South and in women from
lower socioeconomic levels. It is not uncommon to see small balls of clay in plastic bags sold in country stores in
the rural South. The phenomenon of pica has also been described in other countries including Kenya, Uganda,
and Saudi Arabia.
Cultural Issues Impacting Prenatal Care
• Mexican American childbearing women seem to represent a healthy model for preventing LBW infants. However,
acculturation to US lifestyle may put them at an increased risk for poor birth outcomes, according to a study
conducted by Martin et al. (2004). A
• n ethnographic study in California examined the influence of acculturation on pregnancy beliefs and practices of
Mexican American childbearing women. Lagana (2003) reported that “selective biculturalism” emerged as a
protective approach to stress reduction and health promotion.
The women interviewed indicated that regardless of the level of acculturation to US culture, during pregnancy,
they returned to traditional Mexican practices. Such practices include a low-fat, high-protein, natural diet (eat
right—come bien); exercise for well-being (walk—camina); and avoidance of worry or stress, which could have a
negative effect on the pregnancy outcome (don’t worry—no se preocupe).
Cultural Interpretation of Obstetric Testing
• Many women do not understand the emphasis that Western prenatal care places on urinalysis, blood pressure
readings, and abdominal measurements.
• For traditional Islamic women from the Middle East, the vaginal examination can be so intrusive and
embarrassing that they avoid prenatal visits or request a female physician or midwife.
• For women of other cultural groups, common discomforts of pregnancy might be managed with folk, herbal,
home, or over-the-counter remedies on the advice of a relative (generally the maternal grandmother) or friends
(Spector, 2008).
• Health care providers can attempt to meet the needs of women from traditional cultures by explaining health
regimens so that they have meaning within the cultural belief system.
Cultural Preparation for Childbirth
• Women from diverse cultural backgrounds often use culturally appropriate ways of preparing for labor and
delivery. These methods might include assisting with childbirth from the time of adolescence, listening to birth and
baby stories told by respected elderly women, or following special dietary and activity prescriptions during the
antepartal period. Most commonly in American culture, pregnant women and their significant others attend
childbirth classes/or get pregnancy information from the Internet.
BIRTH AND CULTURE
Traditional Home Birth
• All cultures have an approach to birth rooted in a tradition of home birth, being within the province of women. For
generations, traditions among the poor included the use of “granny” midwives by rural Appalachian Whites and
southern African-Americans and parteras by Mexican Americans.
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A dependence on self-management, a belief in the normality of labor and birth, and a tradition of delivery at home
might influence some women to arrive at the hospital in advanced labor. The need to travel a long distance to the
closest hospital might also be a factor contributing to arrival during late labor or to out-of-hospital delivery for
many American Indian women living on rural, isolated reservations.
Liberian women are reluctant to share information about pregnancy and childbirth as these subjects are taboo to
talk about with others.
Husbands or male elders are the ones who make decisions about allowing a woman to seek care at a clinic or
hospital when she is experiencing a difficult and arduous labor. Further complicating this situation, women are
reluctant to seek professional health care at clinics or hospitals because they are more comfortable in their own
homes with traditional (but untrained) birth attendants
Support During Childbirth
• Despite the traditional emphasis on female support and guidance during labor, women from diverse cultures
report a desire to have husbands or partners present for the birth.
• Spouses or partners are now encouraged and even expected to make important contributions in supporting
pregnant women during labor. Unfortunately, some US hospitals still enforce rules that limit the support person
from attending the birth unless he or she has attended a formal childbirth education program.
• Many women also wish to have their mother or some other female relative or friend present during labor and birth.
Cultural Expression of Labor Pain
• Although the pain threshold is remarkably similar in all persons, regardless of gender or social, ethnic, or cultural
differences, these differences play a definite role in a person’s perception and expression of pain. Pain is a highly
personal experience, dependent on cultural learning, the context of the situation, and other factors unique to the
individual (Ludwig-Beymer, 2008).
• In the past, it was commonly believed that because women from Asian and Native American cultures were stoic,
they did not feel pain in labor (Bachman, 2000). In addition to the physiologic processes involved, cultural
attitudes toward the normalcy and conduct of birth, expectations of how a woman should act in labor, and the role
of significant others influence how a woman expresses and experiences labor pain.
• Callister and Vega (1998) reported that Guatemalan women in labor tend to vocalize their pain. Coping strategies
include moaning or breathing rhythmically and massaging the thighs and abdomen.
• Japanese, Chinese, Vietnamese, Laotian, and other women of Asian descent maintain that screaming or crying
out during labor or birth is shameful; birth is believed to be painful but something to be endured.
Birth Positions
• Numerous anecdotal reports in the literature describe “typical” birth positions for women of diverse cultures, from
the seated position in a birth chair favored by Mexican American women to the squatting position chosen by
Laotian Hmong women.
Cultural Meaning Attached to Infant Gender
• The meaning that parents attach to having a son or daughter varies from culture to culture. Historically in the
United States, families saw males as being the preferred gender of the firstborn child for reasons including male
dominated inheritance patterns, carrying on the family name, and becoming the “man” of the family should the
need arise.
• As a long tradition in Asian culture, the preferred sex of the firstborn child is male. One question related to gender
preference that has not been studied until recently is, if a mother does not have the preferred firstborn sex, does
this increase the likelihood of postpartum depression (PPD).
CULTURE AND THE POSTPARTUM PERIOD
Postpartum Depression
• Postpartum depression (PPD) is reported worldwide. However, identifying and reporting of PPD in non-Western
cultures may be delayed by culturally unacceptable labeling of the disorder, varying symptoms, or differences in
treatments from culture to culture
•
“Jinn” possession, as reported in a study conducted in the United Kingdom by Hanely and Brown (2014), includes
possession by an evil spirit that has a negative power over the mind and the body. Symptoms include anxiety,
crying, mood swings, and emotional instability, all of which are symptoms of PPD. However, in this particular
culture, the symptoms are not associated with PPD but are believed to be caused by the Jinn’s influence. The
purpose of the study was to explore the maternal experience of Jinn possession compared with Western
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interpretations of PPD. The study, which took place in an Arabian Gulf state in a Muslim community, included 10
women who had recently given birth and identified themselves as experiencing Jinn possession.
Hot/Cold Theory
• Central to the belief of perceived imbalance in the mother’s physical state is adherence to the hot/cold theories of
disease causation. Pregnancy is considered a “hot” state.
• Because a great deal of the heat of pregnancy is thought to be lost during the birth process, postpartum practices
focus on restoring the balance between the hot and cold, or yin and yang.
• Common components of this theory focus on the avoidance of cold, in the form of air, water, or food. This real
fear of the detrimental effects of cold air and water in the postpartum period can cause cultural conflict when the
woman and infant are hospitalized.
• The common use of perineal ice packs and sitz baths to promote healing can be replaced with the use of heat
lamps, heat packs, and anesthetic or astringent topical agents for those who prefer to avoid cold influences. The
routine distribution of ice water to all postpartum women is another aspect of care that can be modified to meet a
woman’s cultural needs.
Postpartum Dietary Prescriptions and Activity Levels
• Dietary prescriptions are also common in this period. The nurse might note that a woman eats little “hospital” food
and relies on family and friends to bring food to her while she is in the hospital. If there are no dietary restrictions
for health reasons, this practice should be respected. Fruits and vegetables and certainly cold drinks might be
avoided because they are considered “cold” foods.
• Regulation of activity in relation to the concept of disharmony or imbalance includes the avoidance of air, cold,
and evil spirits.
• Hispanic women are encouraged to stay indoors and avoid strenuous work. Since pregnancy and birth are
believed to cause a “hot” state, the woman should avoid “hot” activities such as excessive exercise, including sex,
strenuous household chores, quarrelling, or crying (Sein, 2013) in order to achieve the balance between hot and
cold.
• Some women from traditional cultural groups view themselves as “sick” during the post-partal lochia flow. They
might avoid heavy work, showering, bathing, or washing their hair during this time.
• Cultural prescriptions vary regarding when women can return to full activity after childbirth: Many traditional
cultures suggest that a woman can resume normal activities in as little as 2 weeks; others suggest waiting up to 4
months.
Cultural Influences on Breast-Feeding and Weaning Practices
• Culturally, breast-feeding and weaning can be affected by a variety of values and beliefs related to societal
trends, religious beliefs, the mother’s work activities, ethnic cultural beliefs, social support, access to information
on breast-feeding, and the health care provider’s personal beliefs and experiences regarding breast-feeding
and/or weaning practices, to name a few.
• The World Health Organization and UNICEF (2010) recommend children worldwide be breast-fed exclusively for
the first 6 months of life followed by the addition of nutritional foods, as they continue to breast-feed for up to 2
years, with no defined upper limit on the duration.
CHECK FOR UNDERSTANDING (25 minutes)
The instructor will prepare a 10 item questions that will help develop the critical thinking skills of the students. These series
of questions will be worked on by the students and they will write their rationale for each answered question.
Multiple Choice
1. Which of the following religions are not in favor of artificial methods of contraception?
a. Islam
b. Buddhism
c. Roman Catholic
d. Hindu
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________
2. The Church of Jesus Christ and the Latter-Day Saints are against methods of contraception because
a. the Bible does not permit both natural and artificial methods of contraception.
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b. the church encourages married couples about their spiritual responsibility to have large families and promote
church growth.
c. contraceptives are against the teachings of Jesus Christ.
d. according to their beliefs, contraceptives promote premarital sex.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________
3. Which of the following is NOT true regarding the religious practice of the Hindu religion?
a. Hinduism teaches its people to practice cleanliness of the right hand and the dirtiness of the left hand.
b. The right hand is for holding religious books and eating utensils.
c. The left hand is used for dirty things, such as holding the genitals.
d. This makes the belief easier for married couples to use contraceptives.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________
4. The traditional indigenous birth attendants in the Philippines are known as
a. Hilots
b. Dayahs
c. Ayuhs
d. Albularyo
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________
5. Which of the following religions do not permit the divulgence of the baby’s name prior to the infant’s naming
ceremony?
a. Roman Catholics
b. Islam
c. Orthodox Jewish
d. Shintoism
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________
6. Which of the following is NOT true regarding pica?
a. In the United States, pica is common in African American women.
b. Pica is commonly occurring in Caucasian women from a higher socioeconomic level.
c. Pica is common in women who are raised in the rural South of the US.
d. Pica is also occurring in countries such as Kenya, Uganda, and Saudi Arabia.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________
7. Traditional Mexican practices toward pregnancy includes the following EXCEPT
a. A low-fat, high-protein, natural diet (eat right- come bien)
b. Exercise for well-being (walk-camina)
c. Avoidance of worry or stress, which could have a negative effect on the pregnancy outcome (don’t worry – no
se preocupe)
d. Avoidance of baby showers since it can cause bad luck (mal ojo)
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________
8. Which of the following cultures believe that birth is painful and it is something that must be endured?
a. Asian
b. European
c. Hispanics
d. Native Americans
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ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________
9. Postpartum depression in the Middle East is thought to be caused by
a. Bad luck
b. Jinn possession
c. Unhealthy practices during pregnancy
d. Having a female as a firstborn
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________
10. Which of the following is NOT true regarding the Hot/Cold Theory of pregnancy?
a. Pregnancy is considered a “hot” state.
b. Avoidance of cold, in the form of air, water or food during pregnancy.
c. A great deal of the heat of pregnancy is thought to be retained during the birth process.
d. The woman should avoid “hot” activities such as excessive exercise, strenuous household chores, quarreling,
or crying.
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
______________________________________________________________
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
Your instructor will now rationalize the answers for you. You can now ask questions and debate among yourselves. Write
the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
______________________________________________________________
2. ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
______________________________________________________________
3. ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
______________________________________________________________
4. ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
______________________________________________________________
5. ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
______________________________________________________________
6. ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
______________________________________________________________
7. ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
______________________________________________________________
8. ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
______________________________________________________________
9. ANSWER: ________
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RATIO:___________________________________________________________________________________________
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10. ANSWER: ________
RATIO:___________________________________________________________________________________________
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(For 1-10 items, please refer to the questions in the Rationalization Activity)
GUIDED / RATIONALIZATION ACTIVITY (DURING THE FACE TO FACE INTERACTION WITH THE STUDENTS)
The instructor will now rationalize each answer and will encourage students to ask questions and also discuss to among
their classmates for 20 minutes.
LESSON WRAP-UP (5 minutes)
Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.
You are done with the session! Let’s track your progress.
Reading Reflections and 3-2-1
1. The instructor will assign a particular section of the text to read for homework.
2. For the next Session, the instructor will have the students prepare and write down the following:
1.) three things they learned from the reading,
2.) one way that learning might affect them in clinical practice, and
3.) one question they hope to have answered in this topic
3. In the next session, the students will hand in their written reflections, and then discuss the various takeaways as a
class.
END NOTES:
Reading assignment for the next session is: Transcultural Perspectives in the Nursing Care of Children
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