C ultural - PowerPoint Presentation

Slide1

Cultural Aspects of Contraception

By Dr. Sadaf Cheema

GPST3 Slide2

Aims:

Awareness of ethical issues related to contraception

Cultural Values

Cultural

isolation

Population

migration

Religion

Migration-Unmet need for contraception

Politics

of contraception - control and

freedom

Emergency

contraception - hormonal or coil

insertion

T

ermination

of pregnancy

Contraception, abortion and

STIs

Doctor has a

conscientious objection to a particular procedure

Employing and contracting

bodies -

contractual requirements

Under 16

years guidance

-

Contraception

, abortion and

STIs

Slide3

Why its important for us!!!

P

rimary

care is responsible for issuing around a third of all EC

prescriptions.

I

t

is estimated that 40% of all pregnancies are unplanned out of which 60% end up as abortionsSlide4

Cultural Values Culture matters for contraception decisions.

Other historical factors such as

religion

,

women’s literacy

, and

education experiences

may also play a role.

Demand for the pill depends on women’s

fertility

,

education

and

career decisions

. Slide5

Differences in cultures regarding sex and contraception instilled by

parents

and

reinforced by others in the community

which may influence women’s decisions to adopt the pill. Slide6

Culture

Unfortunately, cultural expectations mean that the

burden

for arranging contraception falls

on women

. So, despite the wide availability of contraceptive methods, it is still perceived as a woman's

problem

.

Although female

sterilization is more invasive than vasectomy, it is still the more common procedure - approximately 100,000 women and 90,000 men are

sterilized

annually.Slide7

Religion

Religious

beliefs can limit a patient's contraceptive choices. When 'artificial' contraception is forbidden, a

few natural methods

may be acceptable:

Coitus

interruptus

-

at

best, 4% failure rate per

annum

Mucothermic

method

:

These

methods are better suited to older couples where fertility is reduced.

This group of patients is less likely to use emergency contraception or seek termination

.Slide8

Orthodox religions

These

include

Judaism, Islam, Hinduism and Sikhism.

Orthodox followers of all these religions tend to:

Regard

sex outside marriage

as taboo.

Forbid

abortion

and regard menses as unclean.

Extend the taboos against sex before marriage to sex outside marriage, i.e. adultery.

Forbid

seeing any other man than the husband

in intimate circumstances.

Consider a male physician often as not acceptable, even with a

chaperone

.

The

punishments for adultery

or sex before marriage in certain countries/cultures can be death. These cultural taboos are followed more closely in some cultures than in others, even if they are of the same religion.

NB

:

medical indications can override many prohibitions

.Slide9

Christianity

Contraception

and abortion

are forbidden in

Catholicism

. Mucothermic methods of contraception are acceptable.

The

best course is to ask the patient if there are any special considerations

you need to be aware of in view of their religion or background. This gives you a better picture of what they consider important.Slide10

Islam

Birth control is permissible in Islam for married couples because sex is considered to be a wholesome pleasure in and of

itself.

The

two criteria for contraception

use are that it doesn't cause permanent damage to the (male or female) reproductive

organs and

that it prevents

fertilization. Condoms

, diaphragms, spermicidal creams, intrauterine devices, oral contraceptive devices,

Norplant, tubal

ligations, and vasectomies are all permissible

.

There

is no problem in prescribing oral

contraceptive

to single girls when

medically indicated

, such as for

menorrhagia.


The

vast majority of scholars consider life to begin at the time of conception. Abortion, defined as the willful evacuation of an embryo or fetus, is considered equivalent to murder and is not ordinarily permitted, except when the mothers life is at stake, and the fetus is <4 months old. It is not permissible if the pregnancy was attributable to adultery or premarital sex, or because of minor or significant deformities.Slide11

Population migration

In recent years there has been

an increase in movement

between countries in

Western Europe

and

asylum-

seeking.

This can lead to problems in

communication.

This may involve

not only language

, but

style of communication

.

Problems

may be experienced when cultures clash, particularly over issues such as

attitudes to women

and

sexual morals

.Slide12

Cultural isolation

Some

cultures disapprove of the education of women. This can result in women becoming isolated, particularly when they

emigrate

with their family to a different country with a different primary

language

.

A

special need exists for their education

about the availability of different choices of contraceptive methods so that they can be empowered to control their fertility according to their needs

.Slide13

Politics of contraception - control and freedom

One of the effects of contraceptive control has been to liberate the tie between sex and

reproduction.

This gives women the

freedom to time their pregnancies

to fit in with a more

independent lifestyle

.

It also allows them

freedom to follow other paths such as study and employment

, and releases them from dependence on the men.

It has liberated them from

uncontrolled large families

(they can still have them but now it's by choice).

One of the results of this has been to

empower women within their societies.

Contraceptive control can have effects on political control. This means that

controlling the availability of certain contraceptive choices

can manipulate the population's

behaviour

– e.g. some governments or religious organizations may give inducements for using, or not using, contraception.Slide14

Emergency contraception - hormonal or coil insertion

Some groups find this an acceptable remedy to contraceptive failure -

e.g.,

slipped sheath or unprotected sex, when they would not accept termination

.

In some religious groups, such as the Roman Catholic church, this is seen as a form of termination,

i.e.

interfering with a

fertilized

ovum.

In certain risk-taking

teenage culture groups

this may be seen as a form of

contraception rather than an emergency intervention

.

One way of remedying this is by

making sure that the long-term contraceptive needs of such persons are addressed

.

There is also need to inform culturally isolated women about the availability of such methods.Slide15

Termination of Pregnancy

C

onscientious

O

bjection

If carrying out a particular procedure or giving advice about it

conflicts with your religious or moral beliefs

, and this conflict might affect the treatment or advice you provide, you must explain this to the patient and tell them

they have the right to see another doctor

. You should make sure that information about alternative services is readily available to all patients.

Children

and young people

in particular may have difficulty in making alternative arrangements themselves, so you

must make sure that arrangements are made

for another suitably qualified colleague to take over your role as quickly as

possible

.

You

must treat patients fairly

and with respect whatever their life choices and beliefs.

You must not express your personal beliefs (including political, religious and moral beliefs) to patients in ways that exploit their vulnerability or are likely to cause them distress.You must not unfairly discriminate against patients or colleagues by allowing your personal views to affect your professional relationships or the treatment you provide or arrangeIn this guidance,

GMC

explain how doctors can put these principles into practice

. Serious or persistent failure to follow this guidance will put your registration at

risk

. Slide16

Employing and contracting bodies - contractual requirements

Employing

and contracting bodies are entitled to require doctors to

fulfill

contractual

requirements

that

may restrict doctors’ freedom to work in accordance with their conscience.

This is a

matter between doctors and their employing or contracting bodies. 

You

may choose to opt out of providing a particular procedure because of your personal beliefs and values

, as long as this does not result in direct or indirect discrimination against, or harassment of, individual patients or groups of

patients.

You

should also be

open with employers, partners or colleagues about your conscientious objection.

You should explore with them how you can

practice

in accordance with your beliefs

without compromising patient care and without overburdening colleagues

.Slide17

Under 16 years Guidance

Contraception

, abortion and

STI

You can provide contraceptive,

abortion

and STI advice and treatment,

without parental knowledge or consent

, to young people under 16 provided that:

a.

they understand all aspects

of the advice and its implications

b. you cannot

persuade the young person to tell their parents

or to allow you to tell them

c. in relation to contraception and STIs, the young person is very

likely to have sex with or without such treatment

d.

their physical or mental health is likely to suffer

unless they receive such advice or treatment, and

e. it is

in the best interests of the young person to receive the advice and treatment without parental knowledge or consent.You should keep consultations confidential even if you decide not to provide advice or treatment, other than in the exceptional circumstances.Slide18

Reference

GMC website

www.pt.co.uk

Gpnotebook

Slide19