Exploring Beliefs about Contraception in Bhutanese Women

Bhutanese immigrants are the first poor Hindus to arrive in the United States as refugees in large numbers. They lived in seven refugee camps in Nepal for about twenty years. They also identify themselves as Nepalese or Nepali Bhutanese. More than 49,000 Bhutanese refugees have been resettled in the United States as of early 2012. Health care providers are not familiar with family planning beliefs and practices of Bhutanese women. In addition, there is a gap in literature about contraception in Bhutanese Women. As a result, health care providers may not be able to facilitate family planning services congruent to Bhutanese beliefs. A qualitative study is important to increase understanding among health care providers about their contraceptive practices. The objectives were to explore and identify Bhutanese contraceptive beliefs and practices and disseminate findings to health care providers to facilitate provision of contraception to Bhutanese women. Another objective was to make recommendations for future research focusing on contraceptive needs in this immigrant population. According to the literature review, all contraceptive methods are acceptable in Hindu culture (Srikanthan & Reid, 2008). Sexual relationships are to be experienced within the norms of marriage in Hindu religion (Srikanthan & Reid, 2008). Therefore, sex before marriage is forbidden. Sexual health is often forbidden topic in traditional Hindu culture (Fisher, Bowman & Thomas, 2003; Aggarwal, Sharma & Chhabra, 2000) and in Bhutanese society (Maxym, 2010). Young women may have no education regarding contraception or normal sexual intercourse. They may not understand the concepts of ovulation and timing of pregnancies (Fisher et al., 2003). Hindu women are generally not educated about contraception until after the birth of the first child (Srikanthan & Reid, 2008). However, contraception was widely used and accepted in the Bhutanese refugee camps in Nepal (Human Rights Watch, 2003; Maxym, 2010). IRB approval was obtained from University Utah and individual interviews were conducted in 14 Bhutanese women in Nepali language. The interviews were audio recorded, later translated and transcribed verbatim. The interviews were evaluated for common themes and quotes. Findings from these interviews revealed that birth control is a private matter for Bhutanese women. They are comfortable talking about pregnancy and other health issues instead of birth control. Family planning is known and accepted in Bhutanese culture. There are no religious prohibitions regarding contraception. Depo Provera injection was the most common method of contraception. None of the Bhutanese women used long term contraception such as IUDs. Women are hesitant to use contraception because of the concerns about menstrual side effects and fears about infertility. Birth Control appears to be used by married women only and after the ideal family size is met. Single women did not use any contraception. Most of the women agreed that they discussed among married women for contraceptive information. Most women were exposed to birth control methods at the hospital after the birth of the first child. These findings will be presented nationally at the American College of Nurse Midwives convention. The findings will inform health care providers about Bhutanese women's beliefs so that they design culturally sensitive contraceptive counseling.