Cultural influences on health care use: two regional groups in India
Basu, A.M.
Studies in Family Planning 21(5): 275-286
1990
ISSN/ISBN: 0039-3665 PMID: 2237996 DOI: 10.2307/1966507Document Number: 371073
The author describes the utilization of health care services among 2 distinct cultural groups living side by side in a resettlement slum in Delhi. The Tamil group, from southern India, are generally of lower socioeconomic status, although a greater proportion of women are in paid employment. The Uttar Pradesh group, from northern India, are better off but the women lead more secluded lives. Both groups express confidence in modern medicine, especially that provided by private practitioners. This preference, the author suggests, could be related to the frequent lack of basic resources in government health facilities and, for those in employment, to the availability of private services out of working hours.Perceptions about the effectiveness of different treatments and about the severity of illnesses appear to play a part in the uptake of health services. Among both groups, antibiotics, particularly those given by injection, are popular: it is suggested that this is because of their obvious symptom-relieving effect. However, only a minority of children in either group receive the full course of DPT vaccinations which, at best, have no perceivable effect, and, at worst, make the child feel ill. Differences are also found in the types of illness for which treatment is sought, with greater emphasis placed on fever than on coughs or diarrhoea, the latter being perceived as irritating but not necessarily incapacitating. Fevers are also seen to be more readily cured by modern medicine.The cultural differences observed in uptake of health services are attributed to several factors. For example, it is suggested that the different status of women is the reason why Tamil mothers, who are more exposed to the outside world, use hospital maternity services 3 times more frequently than northern mothers, who prefer to rely on traditional birth attendants. It is also likely that the compulsory sterilization campaign in the north during the 1970s generated suspicion about modern health facilities, while the relative convenience and cheapness of home deliveries would be an added attraction. Tamil households are also more likely to use self-medication with modern drugs than are northern families, who rely more on traditional home remedies.Cultural factors are also attributed to the different treatment choices associated with sex and age. In particular, the uptake of healthcare services for girls is closer to that for boys among the Tamils than among the northern families who favour male children. This difference could perhaps be explained by the greater seclusion of females and their lesser economic value in the latter group, and the higher status of women and consequent greater role in decisions about healthcare among the Tamils.The role of traditional beliefs, e.g. that chicken pox is due to divine visitation, that breast-feeding should not commence until the third day after delivery and that food intake should be reduced during diarrhoea, is a further factor which health planners need to address in designing services and educational programmes to meet the needs of these 2 cultural groups.Jean King.