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Issues for South Asian Indian Patients Surrounding Sexuality, Fertility, and Childbirth in the US Health Care System

From the Department of Family Practice and Community Medicine (JAF, MB), University of Pennsylvania, Philadelphia, and Continuum Health Services (TT), Beth Israel, St. Lukes Roosevelt, Philadelphia

Correspondence: Address reprint requests to Judith A. Fisher, MD, Department of Family Practice and Community Medicine, 6th Floor Mutch Bldg, 39th and Market Streets, Philadelphia, PA 19104

Background: 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.

Methods: 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."

Results: 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.

Conclusion: 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.