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The childbearing experience of Indo-Canadian immigrant women Struser, Halina Gail 1985

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THE CHILDBEARING EXPERIENCE OF INDO-CANADIAN IMMIGRANT WOMEN BY HALINA G A I L STRUSER B.A., C o n c o r d i a U n i v e r s i t y , 1976 THESIS SUBMITTED IN PARTIAL FULFILLMENT THE REQUIREMENTS OF THE DEGREE OF MASTER OF SCIENCE IN NURSING i n THE FACULTY OF GRADUATE STUDIES The S c h o o l o f N u r s i n g We a c c e p t t h i s t h e s i s as c o n f o r m i n g t o t h e r e c k u i r ^ d s t a n d a r d THE UNIVERSITY OF B R I T I S H COLUMBIA A u g u s t 1985 ® H a l i n a G a i l S t r u s e r , 1985 In presenting t h i s thesis i n p a r t i a l f u l f i l m e n t of the requirements fo r an advanced degree at the University of B r i t i s h Columbia, I agree that the Library s h a l l make i t f r e e l y available for reference and study. I further agree that permission for extensive copying of t h i s thesis for scholarly purposes may be granted by the head of my department or by h i s or her representatives. I t i s understood that copying or publication of t h i s thesis for f i n a n c i a l gain s h a l l not be allowed without my written permission. Department of S c h o o l o f Nursing The University of B r i t i s h Columbia 1956 Main Mall Vancouver, Canada V6T 1Y3 August 27,1985 i i ABSTRACT THE CHILDBEARING EXPERIENCE OF INDO-CANADIAN IMMIGRANT WOMEN T h i s s t u d y was d e s i g n e d t o e l i c i t I n d o - C a n a d i a n women i m m i g r a n t s ' e x p e r i e n c e o f c h i l d b e a r i n g . H e a l t h c a r e p r o f e s s i o n a l s do n o t know enough a b o u t t h e c h i l d b e a r i n g e x p e r i e n c e s o f t h i s c u l t u r a l g r o u p . T h i s may l e a d t o c o n f l i c t s and d i s c r e p a n c i e s o f v i e w p o i n t s b e t w e e n c l i e n t s and p r o f e s s i o n a l s w h i c h may r e s u l t i n n u r s e s p r o v i d i n g c a r e t h a t i s n o t p e r c e i v e d as r e l e v a n t by t h e i n d i v i d u a l . T h i s s t u d y was d i r e c t e d by t h e f o l l o w i n g q u e s t i o n s : What a r e I n d o - C a n a d i a n women's b e l i e f s a b o u t c h i l d b e a r i n g ? What a r e t h e i r p e r c e p t i o n s o f t h e i r t r a d i t i o n a l p r a c t i c e s , i n t h e i r e t h n i c c o m m u n i t y , s u r r o u n d i n g c h i l d b e a r i n g ? What a r e t h e w e s t e r n h e a l t h c a r e r e s o u r c e s u t i l i z e d by t h e women d u r i n g c h i l d b e a r i n g ? How a r e t h e s e w e s t e r n h e a l t h c a r e r e s o u r c e s p e r c e i v e d by t h e women? P h e n o m e n o l o g y , a q u a l i t a t i v e r e s e a r c h m e t h o d o l o g y , was u s e d i n t h i s s t u d y . D a t a w ere c o l l e c t e d t h r o u g h a s e r i e s o f i n d e p t h i n t e r v i e w s w i t h e i g h t women. The i n i t i a l a u d i o t a p e d i n t e r v i e w s w e r e g u i d e d by t h e r e s e a r c h q u e s t i o n s and a d d r e s s e d t h e women's p e r c e p t i o n s o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s . The d a t a were c o m p r i s e d o f t h e a c c o u n t s g i v e n by t h e women i n t h e s e i n t e r v i e w s . D a t a c o l l e c t i o n and a n a l y s i s o c c u r r e d s i m u l t a n e o u s l y t h r o u g h o u t t h e s t u d y . i i i A n a l y t i c m a t e r i a l was t h u s u s e d t o f o c u s and c l a r i f y t h e o n g o i n g c o n s t r u c t i o n o f a c c o u n t s . The women d e s c r i b e d v e r y d i f f e r e n t c h i l d b e a r i n g e x p e r i e n c e s . D i s s i m i l a r i t i e s i n t h e phenomena u n d e r i n v e s t i g a t i o n were more e v i d e n t t h a n s i m i l a r i t i e s and were a t t r i b u t e d t o t h e c o n c e p t o f a c c u l t u r a t i o n . Two themes emerged f r o m t h e d a t a : t h e s u b j e c t s ' r e l a t i o n s h i p s w i t h t h e i r f a m i l i e s and t h e s u b j e c t s ' r e l a t i o n s h i p s w i t h h e a l t h c a r e p r o f e s s i o n a l s . E a c h theme a f f e c t e d and was a f f e c t e d by t h e c o n c e p t o f a c c u l t u r a t i o n . I n f l u e n c i n g f a c t o r s w i t h i n t h e two themes were r e s p e c t , a u t h o r i t y , l a c k o f k n o w l e d g e a n d , i n t h e c a s e o f t h e f a m i l y , s h y n e s s . P e r c e i v e d d i s c r i m i n a t i o n was an i n f l u e n c i n g f a c t o r i n t h e s u b j e c t s ' r e l a t i o n s h i p s w i t h p o s t - p a r t u m h o s p i t a l n u r s e s . T h i s s t u d y c o n c l u d e d t h a t d i s s i m i l a r i t i e s i n t h e c h i l d b e a r i n g e x p e r i e n c e s o f I n d o - C a n a d i a n i m m i g r a n t women a r e a t t r i b u t a b l e t o t h e p r o c e s s o f a c c u l t u r a t i o n ; and t h a t t h e women's c h i l d b e a r i n g e x p e r i e n c e s a r e l o c a t e d w i t h i n a b r o a d e r c o n t e x t o f m e a n i n g s a s s o c i a t e d w i t h t h e r e p r o d u c t i v e c y c l e . The s u b j e c t s ' r e l a t i o n s h i p s w i t h t h e i r f a m i l i e s and w i t h h e a l t h c a r e p r o f e s s i o n a l s a r e s i g n i f i c a n t a s p e c t s o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s and a r e i n f l u e n c e d by a u t h o r i t y , r e s p e c t , l a c k o f k n o w l e d g e and s h y n e s s . D i s c r i m i n a t i o n i s p e r c e i v e d by t h e women i n r e l a t i o n t o t h e p o s t - p a r t u m h o s p i t a l n u r s e s . T h e s e c o n c l u s i o n s have i m p l i c a t i o n s f o r n u r s i n g p r a c t i c e , r e s e a r c h and e d u c a t i o n . I i v TABLE OF CONTENTS ABSTRACT i i TABLE OF CONTENTS i v L I S T OF TABLES v i L I S T OF FIGURES v i i ACKNOWLEDGMENTS v i i i CHAPTER 1 INTRODUCTION B a c k g r o u n d t o t h e S t u d y and C o n c e p t u a l i z a t i o n o f t h e P r o b l e m 1 P r o b l e m S t a t e m e n t 9 P u r p o s e s o f t h e S t u d y 10 T h e o r e t i c a l and M e t h o d o l o g i c a l P e r s p e c t i v e s o f t h e S t u d y 11 D e f i n i t i o n o f Terms 14 A s s u m p t i o n s o f t h e S t u d y 14 L i m i t a t i o n s o f t h e S t u d y 15 O r g a n i z a t i o n o f t h e T h e s i s 15 Summary 16 CHAPTER 2 METHODOLOGY S e l e c t i o n o f P a r t i c i p a n t s 19 C r i t e r i a f o r S e l e c t i o n 19 S e l e c t i o n P r o c e d u r e 20 C h a r a c t e r i s t i c s o f t h e P a r t i c i p a n t s 21 D a t a C o l l e c t i o n 23 I n t e r v i e w e r ' s R o l e 24 D a t a A n a l y s i s 25 E t h i c a l C o n s i d e r a t i o n s and Human R i g h t s i n R e s e a r c h . . . 26 Summary . 28 CHAPTER 3 ANALYZING THE DATA D i v e r s i t y o f t h e D a t a 29 D e v e l o p i n g t h e C o n c e p t o f A c c u l t u r a t i o n 30 A c c u l t u r a t i o n 31 Themes R e l a t e d t o A c c u l t u r a t i o n and t h e C h i l d b e a r i n g E x p e r i e n c e 35 R e l a t i o n s h i p o f A n a l y t i c Framework t o t h e E x p l a n a t o r y M o d e l 37 The A n a l y t i c Framework and t h e S t u d y F i n d i n g s 38 Summary 38 CHAPTER 4 SUBJECTS' PERCEPTIONS OF THEIR CHILDBEARING EXPERIENCES The S u b j e c t s ' R e l a t i o n s h i p s w i t h t h e i r F a m i l i e s 40 H e a l t h B e l i e f s and P r a c t i c e s and I n f l u e n c i n g F a c t o r s 42 V S e x u a l i t y 43 A r r a n g e d M a r r i a g e 48 Sex P r e f e r e n c e o f O f f s p r i n g 59 P r e g n a n c y 64 P o s t - P a r t u m 77 Summary o f t h e S u b j e c t s ' R e l a t i o n s h i p s w i t h t h e i r F a m i l i e s 86 The S u b j e c t s ' R e l a t i o n s h i p s w i t h H e a l t h C a r e P r o f e s s i o n a l s and I n f l u e n c i n g F a c t o r s 89 The R e l a t i o n s h i p w i t h t h e P h y s i c i a n 91 The R e l a t i o n s h i p w i t h Community H e a l t h N u r s e . . 94 The R e l a t i o n s h i p w i t h t h e P o s t - P a r t u m H o s p i t a l N u r s e 98 The P r e f e r e n c e f o r a H o s p i t a l D e l i v e r y 114 Summary 117 CHAPTER 5 SUMMARY, CONCLUSIONS AND IMPLICATIONS FOR NURSING Summary 118 C o n c l u s i o n s 126 I m p l i c a t i o n s f o r N u r s i n g P r a c t i c e 127 I m p l i c a t i o n s f o r N u r s i n g R e s e a r c h 130 I m p l i c a t i o n s f o r N u r s i n g E d u c a t i o n 132 Summary o f C h a p t e r 133 REFERENCE L I S T 135 APPENDICES 142 APPENDIX A I n f o r m a t i o n and C o n s e n t t o C o n t a c t Form 143 APPENDIX B C o n s e n t Form 145 APPENDIX C S a m p l e Q u e s t i o n s f o r I n i t i a l I n t e r v i e w . 146 APPENDIX D D e m o g r a p h i c I n f o r m a t i o n 147 v i L I S T OF TABLES T a b l e 1: Theme: The S u b j e c t s ' R e l a t i o n s h i p s w i t h t h e i r F a m i l i e s 41 T a b l e 2: Theme: The S u b j e c t s ' R e l a t i o n s h i p s w i t h H e a l t h C a r e P r o f e s s i o n a l s 90 v i i L I S T OF FIGURES F i g u r e 1: A c c u l t u r a t i o n : An a n a l y t i c f r a m e w o r k f o r t h e c h i l d b e a r i n g e x p e r i e n c e 37 ACKNOWLEDGMENTS I am g r a t e f u l f o r the expert guidance of the members of my t h e s i s committee,Professors Joan Anderson ( c h a i r ) , and Roberta Hewat. Penny Dunn played a p r o f e s s i o n a l and p e r s o n a l r o l e i n t h i s p r o j e c t . Her f r i e n d s h i p remains i n v a l u a b l e . Debby C h o i t , Michael and Diane Eyre, and Nadia Peterson deserve my thanks f o r t h e i r emotional and p r a c t i c a l support. My mother, Babs S t r u s e r , became my f r i e n d ; my husband Gerry Greenstone, remained my f r i e n d , and my daughter, Tamara Greenstone, always helped put t h i n g s i n p e r s p e c t i v e . I thank them. I am g r a t e f u l to the community h e a l t h p r o f e s s i o n a l s who made t h i s work p o s s i b l e . I t i s t o the e i g h t s t u d y p a r t i c i p a n t s t h a t I owe my g r e a t e s t thanks. By transcending c u l t u r a l b a r r i e r s they allowed me the p r i v i l e g e of e n t e r i n g i n t o t h e i r world and i n so doing, they c o n t r i b u t e d to my knowledge. 1 CHAPTER 1 I n t r o d u c t i o n B a c k g r o u n d t o t h e S t u d y and C o n c e p t u a l i z a t i o n o f t h e P r o b l e m I n t h e l i t e r a t u r e one f i n d s many r e s e a r c h s t u d i e s f o c u s i n g on t h e e x p e r i e n c e o f c h i l d b e a r i n g f o r w h i t e , A n g l o - S a x o n , N o r t h A m e r i c a n women ( C a m e r o n , 1979; C a r t e r - J e s s o p , 1 9 8 1; R u b i n , 1 9 6 7 ) . L a y l i t e r a t u r e h a s an i n c r e a s i n g number o f p u b l i c a t i o n s on t h e s u b j e c t ( A r m s , 1977; K i t z i n g e r , 1978; K o r t e & S c a e r , 1 9 8 4 ) . The e f f e c t o f c u l t u r e on t h e c h i l d b e a r i n g e x p e r i e n c e i n t h e U n i t e d S t a t e s has been r e s e a r c h e d d ( B r o w n , 1976; C l a r k & A f f o n s o , 1 9 7 9 ) . However, l i t t l e i n f o r m a t i o n i s a v a i l a b l e a b o u t c u l t u r a l v a r i a t i o n s among c h i l d b e a r i n g women i n C a n a d a . The n u r s i n g p r o f e s s i o n v a l u e s c a r i n g f o r c l i e n t s i n an i n d i v i d u a l i s t i c manner. T h e r e f o r e , t h e r e i s a need t o u n d e r s t a n d and a p p r e c i a t e t h e h e a l t h b e l i e f s a n d p r a c t i c e s s u r r o u n d i n g c h i l d b e a r i n g i n t h e d i f f e r e n t c u l t u r a l g r o u p s t h a t make up n u r s i n g ' s c l i e n t e l e . I m m i g r a t i o n t o Canada f r o m n o n - w e s t e r n c o u n t r i e s has g e n e r a l l y i n c r e a s e d i n r e c e n t y e a r s and t h e I n d o - P a k i s t a n i p o p u l a t i o n i n B r i t i s h C o l u m b i a h a s grown r a p i d l y . Ames and I n g l i s ( 1 9 7 6 ) s t a t e t h a t t h e m a j o r i t y o f I n d o - P a k i s t a n i i m m i g r a n t s t o B r i t i s h C o l u m b i a h a v e been o f t h e S i k h r e l i g i o n 2 f r o m t h e P u n j a b r e g i o n o f I n d i a . P r i o r t o 1 9 8 1 , t h e C a n a d i a n c e n s u s d i d n o t s e p a r a t e P u n j a b i - s p e a k i n g E a s t I n d i a n s f r o m o t h e r I n d o - P a k i s t a n i g r o u p s . I n 1 9 7 1 , 13,200 I n d o - P a k i s t a n i s were l i v i n g i n B r i t i s h C o l u m b i a ( S t a t i s t i c s C a n a d a , 1 9 7 1 ) . By 1976 t h a t number had r i s e n t o 19,850 ( S t a t i s t i c s C a n a d a , 1 9 7 6 ) , a n d by 1981 t h e p o p u l a t i o n t o t a l l e d 43,070 ( S t a t i s t i c s C a n a d a , 1 9 8 1 ) . P u n j a b i - s p e a k i n g p e o p l e i n t h a t y e a r numbered 32,725 o r 76% o f t h e t o t a l I n d o - P a k i s t a n i i m m i g r a n t p o p u l a t i o n . As t h e numbers have g r o w n , E a s t I n d i a n i m m i g r a n t s h a v e made up a g r e a t e r p e r c e n t a g e o f n u r s i n g ' s c l i e n t e l e . N u r s e s s h o u l d , t h e r e f o r e , have an i n c r e a s i n g i n t e r e s t i n p r o v i d i n g r e l e v a n t h e a l t h c a r e t o t h i s e t h n i c g r o u p . T h e r e i s a p a u c i t y o f r e s e a r c h and w r i t i n g s a b o u t t h e c h i l d b e a r i n g e x p e r i e n c e s o f I n d o - C a n a d i a n women i m m i g r a n t s . I n o r d e r t o p l a n and i m p l e m e n t c o m p r e h e n s i v e , c l i e n t - c e n t r e d n u r s i n g c a r e , h e a l t h c a r e p r o f e s s i o n a l s s h o u l d know and u n d e r s t a n d t h e i r c l i e n t s ' e x p e r i e n c e s f r o m t h e i r own p e r s p e c t i v e s . L i t e r a t u r e r e l a t e d t o p r e g n a n c y o f I n d o - C a n a d i a n women i s l i m i t e d m a i n l y t o s c i e n t i f i c d e s c r i p t i o n s o f i n t e r v e n t i o n programmes ( B r a d l e y , 1978; V a n c o u v e r I s l a n d P u b l i c H e a l t h D e p a r t m e n t , 1 9 8 1 ; V a n d e r Ende, 1 9 8 0 ) . S t u d i e s o f t h e c h i l d b e a r i n g e x p e r i e n c e s o f E a s t I n d i a n women i n t h e i r own c o u n t r y h a v e been c o n d u c t e d by a n t h r o p o l o g i s t s , who have c o n c l u d e d t h a t c h i l d b e a r i n g i s p e r c e i v e d b y t h e s e women a s a n o r m a l l i f e e v e n t , w i t h r i g h t s 3 and d u t i e s , b a s e d on t r a d i t i o n s and c u s t o m s t h a t v a r y t h r o u g h o u t I n d i a ( G i d e o n , 1 9 62; P a r k e r & Neumann, 1 9 7 9 ) . The s t u d i e s c o n d u c t e d i n I n d i a , a l t h o u g h o r i e n t e d more t o t h e p s y c h o - s o c i a l a s p e c t s o f c h i l d b e a r i n g , r e m a i n l i m i t e d i n number. I n a d d i t i o n , one c a n n o t assume t h a t women i n t h e P u n j a b and women who have e m i g r a t e d f r o m t h a t c o u n t r y t o Canada h a v e t h e same c h i l d b e a r i n g e x p e r i e n c e s . H e a l t h c a r e p r o f e s s i o n a l s i n Canada a c k n o w l e d g e t h a t t h e women o f t h e I n d o - C a n a d i a n c o m m u n i t y u n d e r u t i l i z e t h e p r e n a t a l programmes a v a i l a b l e t o them (T. J o h n s t o n e , p e r s o n a l c o m m u n i c a t i o n , May, 1982; K e n d a l l , 1 9 8 1 ; W. M e e k i s o n , p e r s o n a l c o m m u n i c a t i o n , O c t o b e r , 1 983; P. P u l l e n , p e r s o n a l c o m m u n i c a t i o n , May, 1 9 8 2 ) . T h i s i s o f p a r t i c u l a r c o n c e r n t o h e a l t h p r o f e s s i o n a l s as t h e y r e c o g n i z e t h e I n d o - C a n a d i a n p o p u l a t i o n a s b e i n g a t r i s k f o r d e l i v e r i n g l o w b i r t h w e i g h t b a b i e s ( l e s s t h a n 2500 g r a m s ) w i t h c o n c o m i t a n t b i o - p h y s i o l o g i c a l p r o b l e m s ( B r i t i s h C o l u m b i a G o v e r n m e n t , 1 9 8 1 ; B r i t i s h C o l u m b i a G o v e r n m e n t , 1 982; G. G r e e n s t o n e , p e r s o n a l c o m m u n i c a t i o n , J u n e , 1984; T. J o h n s t o n e , p e r s o n a l c o m m u n i c a t i o n , May, 1982; F. S i m o n , p e r s o n a l c o m m u n i c a t i o n , S e p t e m b e r , 1 9 8 4 ) . As t h e I n d o - C a n a d i a n p o p u l a t i o n c o n t i n u e s t o g r o w , n u r s e s h a v e a g r e a t e r r e s p o n s i b i l i t y t o p r o v i d e i n d i v i d u a l i s t i c and r e l e v a n t c a r e t o t h i s e t h n i c g r o u p . N u r s e s o f t e n assume t h a t t h e y u n d e r s t a n d t h e i r c l i e n t s ' e x p e r i e n c e s o f h e a l t h and i l l n e s s and t h a t t h e y a r e p r o v i d i n g c o m p r e h e n s i v e , c l i e n t - c e n t r e d c a r e ( H e n d e r s o n , 1967; Luckmann & S o r e n s e n , 1974; N i g h t i n g a l e , 1969; S u n d e e n , S t u a r t , R a n k i n & C o h e n , 1 9 8 1 ) . However, a n u r s e ' s p e r c e p t i o n o f h e a l t h and i l l n e s s i s f r e q u e n t l y d r a w n f r o m t h e v i e w p o i n t o f a h e a l t h c a r e p r o f e s s i o n a l m o d e l . The c l i e n t s o f t e n v i e w h e a l t h and i l l n e s s f r o m a l a y p e r s o n ' s p e r s p e c t i v e , w h i c h d i f f e r s f r o m t h e p r o f e s s i o n a l ' s . D i s c r e p a n c i e s and c o n f l i c t s may a r i s e b e t w e e n t h e s e v i e w p o i n t s and l e a d t o n u r s i n g c a r e t h a t i s n o t c l i e n t c e n t r e d . T h i s p o t e n t i a l f o r d i s c o r d a n t v i e w s i n c r e a s e s when t h e c l i e n t a n d t h e h e a l t h p r o f e s s i o n a l come f r o m d i f f e r e n t e t h n i c o r c u l t u r a l b a c k g r o u n d s ( K l e i n m a n , 1980; T r i p p - R e i m e r , B r i n k & S a u n d e r s , 1 9 8 4 ) . H e a l t h c a r e p r o f e s s i o n a l s must t r a n s c e n d c u l t u r a l and e t h n i c b a r r i e r s t o a r r i v e a t an u n d e r s t a n d i n g o f t h e e x p e r i e n c e o f c h i l d b e a r i n g f o r t h e i n d i v i d u a l c l i e n t . S e v e r a l r e s e a r c h e r s h a v e s t u d i e d t h e p s y c h o - s o c i a l a s p e c t s o f h e a l t h and i l l n e s s and many ha v e d i s c u s s e d how t h e s e p s y c h o - s o c i a l a s p e c t s a r e l e a r n e d w i t h i n a c u l t u r a l c o n t e x t . L i p o w s k i ( 1 9 6 9 ) b e l i e v e s t h a t t h e p s y c h o - s o c i a l a s p e c t s o f i l l n e s s a r e i m p o r t a n t f a c t o r s i n f l u e n c i n g t h e c o u r s e a n d outcome o f e v e r y i l l n e s s . T h e s e p s y c h o l o g i c a l a s p e c t s a l s o d e t e r m i n e w h e t h e r an i n d i v i d u a l w i l l move f r o m b e i n g i n a s t a t e o f h e a l t h t o one o f i l l n e s s . L i p o w s k i d i s c u s s e s f o u r c l a s s e s o f v a r i a b l e s t h a t make up t h e c o m p o n e n t s o f p s y c h o l o g i c a l r e a c t i o n s " t h e p e r s o n a l i t y o f t h e p a t i e n t and h i s l i f e h i s t o r y , t h e s t a t e o f t h e p a t i e n t ' s c u r r e n t i n t e r p e r s o n a l r e l a t i o n s h i p , c h a r a c t e r i s t i c s o f h i s non-human e n v i r o n m e n t , and t h e n a t u r e and c h a r a c t e r i s t i c s o f t h e p a t h o l o g i c a l p r o c e s s o r i n j u r y " ( p . 1 1 9 7 ) . T h e r e a r e t h r e e c o m p o n e n t s t o t h e r e s u l t i n g p s y c h o l o g i c a l r e a c t i o n s : t h e i n t r a p s y c h i c , t h e b e h a v i o u r a l , and t h e s o c i a l . The i n t r a p s y c h i c " r e f e r s t o what t h e p a t i e n t p e r c e i v e s , f e e l s and t h i n k s — t o p e r c e p t u a l , e m o t i o n a l and c o g n i t i v e c o m p o n e n t s " ( p . 1 2 0 2 ) . S o c i o - c u l t u r a l f a c t o r s h ave an i n f l u e n c e h e r e b e c a u s e b e l i e f s i n t h e c l i e n t ' s s o c i a l s i t u a t i o n t o w a r d s c e r t a i n c o n d i t i o n s , as w e l l a s a b o u t t h e i r c a u s e and p r o g n o s i s , and t h e e f f i c a c y o f t r e a t m e n t , i n f l u e n c e c l i e n t s ' r e s p o n s e t o t h e i l l n e s s . The b e h a v i o u r a l a s p e c t c o n c e r n s t h e c l i e n t ' s c o m m u n i c a t i o n s a nd b e h a v i o u r : "what t h e p a t i e n t c o m m u n i c a t e s , how he d o e s i t , t o whom and when, i s a p r o b l e m o f c o n s i d e r a b l e i m p o r t a n c e f o r t h e d e l i v e r y o f m e d i c a l c a r e " ( p . 1 2 0 4 ) . L i p o w s k i c a u t i o n s t h a t c l i e n t c o m m u n i c a t i o n i s a two-way p r o c e s s t h a t i s m o d i f i e d by t h e r e s p o n s e s o f t h e r e c e i v e r and t h a t p a t i e n t c o m m u n i c a t i o n w i l l i n f l u e n c e and be i n f l u e n c e d by a l l t h o s e who l i s t e n . The s o c i a l a s p e c t s p e r t a i n t o t h e p a t i e n t ' s i n t e r a c t i o n w i t h o t h e r s , e s p e c i a l l y f a m i l y members and h e a l t h c a r e p r o f e s s i o n a l s . How t h e i n d i v i d u a l p l a y s t h e s i c k r o l e " i n f l u e n c e s t h e c o u r s e , d u r a t i o n and outcome o f any i l l n e s s .... They a r e d e t e r m i n e d by t h e i n t e r p l a y b e t w e e n t h e p a t i e n t , h i s i l l n e s s , and h i s s o c i a l e n v i r o n m e n t " ( p . 1 2 0 5 ) . L i p o w s k i s t a t e s t h a t t o u n d e r s t a n d t h e e x p e r i e n c e o f h e a l t h and i l l n e s s f o r t h e i n d i v i d u a l , one has t o know what a l l a s p e c t s o f t h e s i t u a t i o n mean t o t h e i n d i v i d u a l and what r e s p o n s e he o b t a i n s f r o m o t h e r p e r s o n s , i n c l u d i n g h e a l t h c a r e p r o f e s s i o n a l s . 6 Fabrega (1975) e l a b o r a t e s on L i p o w s k i ' s view of the importance of the s o c i a l and b e h a v i o u r a l d i m e n s i o n s o f i l l n e s s , and he agrees and expands on the i d e a t h a t communication i s a two-way p r o c e s s . He p o i n t s out t h a t u n t i l the p a s t two hundred y e a r s , s o c i a l - b e h a v i o u r a l changes s e r v e d as the c r i t i c a l s i g n s of d i s e a s e . W ith i n c r e a s e d s c i e n t i f i c c o n t r o l of h e a l t h and i l l n e s s , t h e r e has been a s h i f t away from the s o c i a l - b e h a v i o u r a l a s p e c t s ; and w i t h t h i s s h i f t , problems have a r i s e n between c o n t r a s t i n g meanings g i v e n t o h e a l t h and i l l n e s s by the h e a l t h c a r e p r o f e s s i o n a l and the c l i e n t . He s t a t e s t h a t " f o r m a l a t t r i b u t e s of d i s e a s e may be shared ... but not o t h e r s r e l a t e d t o the i n d i v i d u a l ' s e q u i l i b r i u m " (p. 973). Fabrega f e e l s t h a t d i f f e r e n c e s i n the o r i e n t a t i o n of each p a r t y i n an i n t e r a c t i o n l e a d t o a f a l s e consensus where the same use o f language means d i f f e r e n t t h i n g s t o each p e r s o n . He argues f o r a more s o c i a l l y o r i e n t e d paradigm which would r e n d e r a more p r o d u c t i v e p r o f e s s i o n a l - c l i e n t r e l a t i o n s h i p . Kleinman e l a b o r a t e s on both L i p o w s k i ' s and Fabrega's emphasis on the s o c i a l - p s y c h o l o g i c a l a s p e c t s of h e a l t h and i l l n e s s and the d i f f i c u l t i e s t h a t d i f f e r i n g meanings c r e a t e f o r the p r o f e s s i o n a l - c l i e n t r e l a t i o n s h i p . He has c o n t r i b u t e d t o the s o c i a l s c i e n c e l i t e r a t u r e a " C u l t u r a l Systems Model" t h a t views h e a l t h and i l l n e s s as s o c i a l l y c o n s t r u c t e d . T h i s system i s an e x p l a n a t o r y model i n which a l l a s p e c t s of the h e a l t h c a r e system are c o n c e p t u a l i z e d as c u l t u r a l systems. These c u l t u r a l systems are s y m b o l i c systems which are s o c i a l l y a nd c u l t u r a l l y c o n s t r u c t e d f o r m s o f s o c i a l r e a l i t y . S o c i a l r e a l i t y i s t h e t r a n s a c t i o n a l w o r l d i n w h i c h e v e r y d a y l i f e i s e n a c t e d , s o c i a l r o l e s a r e d e f i n e d and p e r f o r m e d , and i n w h i c h p e o p l e i n t e r a c t w i t h e a c h o t h e r i n e s t a b l i s h e d r e l a t i o n s h i p s . The i n d i v i d u a l i n t e r n a l i z e s s o c i a l r e a l i t y — a s a s y s t e m o f s y m b o l i c m e a n i n g s and norms g o v e r n i n g h i s b e h a v i o u r , h i s p e r c e p t i o n o f t h e w o r l d , h i s c o m m u n i c a t i o n w i t h o t h e r s and h i s u n d e r s t a n d i n g o f b o t h t h e e x t e r n a l i n t e r p e r s o n a l e n v i r o n m e n t he i s i n , and h i s own i n t e r n a l , i n t r a p s y c h i c s p a c e — d u r i n g t h e p r o c e s s o f a c c u l t u r a t i o n ( K l e i n m a n , 1980, p. 3 6 ) . K l e i n m a n c o n c e p t u a l i z e s t h r e e d i s t i n c t , o v e r l a p p i n g d o m a i n s o f h e a l t h c a r e i n s o c i e t y : t h e p o p u l a r s e c t o r , w h i c h c o n s i s t s o f t h e i n d i v i d u a l , f a m i l y , s o c i a l n e t w o r k and c o m m u n i t y ; t h e p r o f e s s i o n a l s e c t o r , w h i c h e n c o m p a s s e s t h e p r o f e s s i o n a l h e a l t h c a r e w o r k e r ; and t h e f o l k s e c t o r , t h a t i n c l u d e s n o n - p r o f e s s i o n a l h e a l e r s ( K l e i n m a n , 1977; K l e i n m a n , E i s e n b e r g & Good, 1 9 7 8 ) . E a c h s e c t o r h a s i t s own e x p l a n a t o r y s y s t e m s w i t h s o c i a l r o l e s , i n t e r a c t i o n s e t t i n g s and i n s t i t u t i o n s . E x p l a n a t o r y s y s t e m s a r e s t r o n g l y i n f l u e n c e d by s o c i o - c u l t u r a l f a c t o r s and t h e r e f o r e may v a r y , n o t o n l y a c r o s s t h e s e c t o r s b u t a l s o amongst and b e t w e e n c u l t u r a l g r o u p s i n t h e same s e c t o r . I t i s K l e i n m a n ' s c o n t e n t i o n t h a t i n any i n t e r a c t i o n b e t w e e n t h e s e c t o r s , t h e e x p l a n a t o r y s y s t e m s , o r m o d e l s , must be u n d e r s t o o d by a l l and made 8 e x p l i c i t i n o r d e r t o r e d u c e m i s u n d e r s t a n d i n g s and a l l o w n e g o t i a t i o n s b e t w e e n m o d e l s t o o c c u r . I t i s i n t h i s way t h a t a p p r o p r i a t e and e f f e c t i v e h e a l t h c a r e d e l i v e r y i s e n s u r e d . C h r i s m a n ( 1 9 7 7 ) , u s i n g K l e i n m a n ' s e a r l y work as a b a s e , s u g g e s t s t h e need f o r a c o m p r e h e n s i v e a p p r o a c h t o t h e s t u d y o f t h e " h e a l t h s e e k i n g p r o c e s s " ( p . 3 5 1 ) . He s u g g e s t s s e v e r a l p r o p o s i t i o n s t h a t i l l u s t r a t e r e l a t i o n s h i p s among h e a l t h s e e k i n g e l e m e n t s . He b e l i e v e s t h a t c l i e n t s ' e x p l a n a t o r y m o d e l s t e n d t o r e f l e c t r e t r o s p e c t i v e v i e w s o f e v e r y d a y e v e n t s as " c a u s a l " e l e m e n t s f o r t h e i r s i c k n e s s e s ; and t h a t t r e a t m e n t s t h a t r e c o g n i z e t h e i n f l u e n c e s o f e v e r y d a y l i f e w i l l l e a d t o a h i g h e r d e g r e e o f c o m p l i a n c e . C h r i s m a n a l s o s u g g e s t s t h a t a h i g h e r p r o p o r t i o n o f t h e h e a l t h b e l i e f s f o u n d among s t r u c t u r a l l y i n s u l a r g r o u p s w i l l be s h a r e d a c r o s s g e n e r a t i o n a l l i n e s t h a n w i l l a p p l y among more open g r o u p s . Among i n s u l a r g r o u p s l a y c o n s u l t a n t s a r e more l i k e l y t o be c o n s i s t e n t l y c o n s u l t e d f o r many i l l n e s s e p i s o d e s , w h e r e a s n o n - i n s u l a r g r o u p s t e n d t o make o n l y s p o r a d i c u s e o f p a r t i c u l a r p e r s o n s . F i n a l l y , s t a t e s C h r i s m a n , t h e q u a l i t y o f d o c t o r - c l i e n t t r a n s a c t i o n s , a n d t h e d e g r e e o f c o m p l i a n c e a r e e n h a n c e d by s p e c i f i c p r a c t i t i o n e r a t t e n t i o n t o e x p l a n a t o r y m o d e l s , r o l e c o n s t r a i n t s , and t h e v i e w s and i n f l u e n c e o f l a y c o n s u l t a n t s . C h r i s m a n u r g e s t h a t t h e s e p r o p o s i t i o n s be t a k e n i n t o a c c o u n t when c a r i n g f o r i n d i v i d u a l s i n a c o m p r e h e n s i v e manner. The l i t e r a t u r e d i s c u s s e d a b o v e a c c e n t u a t e s t h e i m p o r t a n c e o f t h e i n d i v i d u a l ' s s o c i o - c u l t u r a l b a c k g r o u n d s i n 9 t h e i r e x p l a n a t i o n s o f h e a l t h and i l l n e s s . The need i s s e e n f o r h e a l t h c a r e p r o f e s s i o n a l s t o go b e y o n d mere u n d e r s t a n d i n g o f t h e s e e x p l a n a t i o n s a n d , when n e g o t i a t i n g w i t h c l i e n t s , t h e c l i e n t s e x p l a n a t o r y m o d e l s must be e l i c i t e d and t a k e n i n t o c o n s i d e r a t i o n . I t i s t h r o u g h t h e s e n e g o t i a t i o n s t h a t i n t e r v e n t i o n s a r e a r r i v e d a t t h a t a r e m u t u a l l y a c c e p t a b l e , and t h i s a c c e p t a n c e i n c r e a s e s t h e p r o b a b i l i t y o f s u c c e s s f u l n u r s i n g i n t e r v e n t i o n s . I t i s K l e i n m a n ' s v i e w t h a t t h e i n t e n t o f c l i n i c a l r e s e a r c h i s t o u n d e r s t a n d and d e s c r i b e t h e c l i e n t ' s e x p e r i e n c e . The e x p l a n a t o r y m o d e l , w i t h i t s e m p h a s i s on t h e s o c i a l and c u l t u r a l a s p e c t s o f t h e e x p e r i e n c e , a l l o w s t h e h e a l t h p r o f e s s i o n a l t o a c c o u n t f o r and u n d e r s t a n d t h e d i f f e r e n c e b e t w e e n t h e p o p u l a r and p r o f e s s i o n a l e x p l a n a t o r y m o d e l s . P r o b l e m S t a t e m e n t H e a l t h p r o f e s s i o n a l s do n o t know en o u g h a b o u t t h e c h i l d b e a r i n g e x p e r i e n c e o f I n d o - C a n a d i a n women i m m i g r a n t s . T h i s may l e a d t o c o n f l i c t s and d i s c r e p a n c i e s o f v i e w p o i n t s b e t w e e n c l i e n t s and p r o f e s s i o n a l s , w h i c h may r e s u l t i n n u r s e s p r o v i d i n g c a r e t h a t i s n o t p e r c e i v e d a s r e l e v a n t by t h e i n d i v i d u a l . T h i s s t u d y a t t e m p t s t o g a i n k n o w l e d g e o f t h e h e a l t h b e l i e f s and p r a c t i c e s o f I n d o - C a n a d i a n women i m m i g r a n t s d u r i n g t h e c h i l d b e a r i n g e x p e r i e n c e . By u s i n g t h e women a s t h e s o u r c e o f i n f o r m a t i o n , t h e s t u d y w i l l b e g i n t o 10 b u i l d a knowledge base about the e x p e r i e n c e s o f thes e women. T h i s s t u d y i s d i r e c t e d by the f o l l o w i n g s p e c i f i c q u e s t i o n s : 1. What are Indo-Canadian women's b e l i e f s about c h i l d b e a r i n g ? 2. What are Indo-Canadian women's p e r c e p t i o n s of t h e i r t r a d i t i o n a l p r a c t i c e s , i n t h e i r e t h n i c community, s u r r o u n d i n g c h i l d b e a r i n g ? 3. What are the w e s t e r n h e a l t h c a r e r e s o u r c e s u t i l i z e d by the women d u r i n g c h i l d b e a r i n g ? 4. How are these w e s t e r n h e a l t h c a r e r e s o u r c e s p e r c e i v e d by the women? Purposes o f the Study To u n d e r s t a n d the c h i l d b e a r i n g e x p e r i e n c e from the Indo-Canadian women immigrants' v i e w p o i n t s , t h i s s t u d y proposed t o : 1. e l i c i t the Indo-Canadian women's b e l i e f s about c h i l d b e a r i n g , 2. determine Indo-Canadian women's p e r c e p t i o n s of the t r a d i t i o n a l p r a c t i c e s , i n t h e i r e t h n i c communities, s u r r o u n d i n g c h i l d b e a r i n g , 3. i d e n t i f y the we s t e r n h e a l t h c a r e r e s o u r c e s u t i l i z e d by the women d u r i n g c h i l d b e a r i n g , and 4. d e t e r m i n e the women's p e r c e p t i o n s of thes e we s t e r n h e a l t h c a r e r e s o u r c e s . T h e o r e t i c a l and M e t h o d o l o g i c a l P e r s p e c t i v e s o f t h e S t u d y P h e n o m e n o l o g y , a p h i l o s o p h y , an a p p r o a c h and a t y p e o f q u a l i t a t i v e r e s e a r c h m e t h o d o l o g y , was c h o s e n f o r u s e i n t h i s s t u d y . The n u r s i n g p r o f e s s i o n ' s v a l u i n g o f t h e i n d i v i d u a l and t h e g o a l s o f c o m p r e h e n s i v e , c l i e n t - c e n t r e d c a r e , p a r a l l e l s t h e r e v e r e n c e f o r t h e human e x p e r i e n c e c e n t r a l t o t h i s m e t h o d o l o g y ( A n d e r s o n , 1 9 8 1 ; O i l e r , 1 9 82; Ornery, 1 9 8 3 ) . P h e n o m e n o l o g y p l a c e s i m p o r t a n c e on u n d e r s t a n d i n g b e h a v i o u r " f r o m t h e a c t o r ' s own f r a m e o f r e f e r e n c e " ( R i s t , 1 9 7 9 , p. 19) and i t " d e s c r i b e s e x p e r i e n c e as i t i s l i v e d " ( O i l e r , 1 9 8 2 , p. 1 7 8 ) . T h i s m e t h o d o l o g y " e n a b l e s a c o m p r e h e n s i o n o f human b e h a v i o u r i n g r e a t e r d e p t h t h a n i s p o s s i b l e f r o m t h e s t u d y o f s u r f a c e b e h a v i o u r " ( R i s t , 1 9 7 9 , p. 20) . P h e n o m e n o l o g y v i e w s a l l phenomena u n d e r i n v e s t i g a t i o n as s o c i a l l y c o n s t r u c t e d , and e m p h a s i s i s p l a c e d on " i n n e r o r s u b j e c t i v e u n d e r s t a n d i n g o f e v e n t s , b e h a v i o u r s and s u r r o u n d i n g s " ( R i s t , 1 979, p. 19) t o e x p l a i n how t h e w o r l d i s e x p e r i e n c e d (Wagner, 1 9 7 0 ) . " S t r e s s i s made on t h e need f o r t h e r e s e a r c h e r t o ' t a k e t h e r o l e o f t h e o t h e r ' and t o u n d e r s t a n d t h e ' d e f i n i t i o n o f t h e s i t u a t i o n ' f r o m w i t h i n t h e f r a m e w o r k o f t h e p a r t i c i p a n t s " ( R i s t , 1 979, p. 2 0 ) . T h i s m e t h o d o l o g y a c c e p t s t h e i n t e r s u b j e c t i v i t y o f r e s e a r c h e r and s u b j e c t and i t i s t h i s i n t e r s u b j e c t i v i t y w h i c h t a k e s i n t o 12 a c c o u n t t h e s o c i a l n a t u r e o f t h e r e s e a r c h a c t . The r e s e a r c h e r as w e l l as t h e s u b j e c t b r i n g t o t h e s i t u a t i o n b a c k g r o u n d k n o w l e d g e t h r o u g h w h i c h t h e s i t u a t i o n i s i n t e r p r e t e d . D a t a c o l l e c t i o n and a n a l y s i s w i t h i n t h i s m e t h o d o l o g y i s c o n t i n u o u s t h r o u g h o u t t h e r e s e a r c h p r o c e s s . S u b j e c t s a r e c h o s e n s p e c i f i c a l l y f o r t h e i r a b i l i t y t o a n s w e r q u e s t i o n s p o s e d by t h e i n v e s t i g a t o r . T h i s m e t h o d o f p u r p o s i v e s a m p l i n g means t h a t t h e e x a c t number o f s u b j e c t s i s d e t e r m i n e d a s t h e r e s e a r c h e r moves t h r o u g h d a t a c o l l e c t i o n and a n a l y s i s and a s c e r t a i n s t h e n e e d f o r f u r t h e r s u b j e c t i n t e r v i e w s . C o n s t a n t c o m p a r a t i v e a n a l y s i s i s t h e t e r m g i v e n t o t h e p r o c e s s by w h i c h t h e d a t a a r e e x a m i n e d . The a n a l y s i s s e r v e s t o g e n e r a t e c o n c e p t u a l c a t e g o r i e s , and i t r e l i e s upon c o n t i n u o u s a n a l y s i s o f s i m i l a r i t i e s and d i s s i m i l a r i t i e s b e t w e e n t h e s o c i a l u n i t s u n d e r i n v e s t i g a t i o n . T h i s p r o c e s s c o n t i n u e s u n t i l s u c h t i m e as t h e r e s e a r c h e r h a s d e v e l o p e d c o n s i s t e n t themes f r o m t h e c o n c e p t u a l c a t e g o r i e s and h a s a r r i v e d a t an u n d e r s t a n d i n g o f t h e phenomena i n q u e s t i o n . I n t h i s q u a l i t a t i v e m e t h o d o l o g y , i d e a s and c o n c e p t s w i t h w h i c h t h e r e s e a r c h e r a p p r o a c h e s h e r s u b j e c t a r e u s e d t o s e n s i t i z e h e r i n i t i a l l y ; t h e y p r o v i d e a s t a r t i n g p o i n t f r o m w h i c h s h e may g a i n d i r e c t i o n b u t f r o m w h i c h s h e may d i v e r g e a s t h e r e s e a r c h p r o c e s s c o n t i n u e s . The r e s e a r c h e r b e g i n s w i t h : g r o u n d e d e v e n t s ... t h e p e r c e p t i o n s and u n d e r s t a n d i n g s o f t h e e v e n t s i n q u e s t i o n , and t h e n 13 s e e k s t o a r t i c u l a t e b r o a d e r p a t t e r n s and p r o c e s s e s t h a t a r e a p p l i c a b l e t o o t h e r i n d i v i d u a l s and g r o u p s i n o t h e r c i r c u m s t a n c e s and s e t t i n g s . The t a s k i s a l w a y s one o f l e a r n i n g how t h o s e i n v o l v e d i n t e r p r e t e d and g a v e m e a n i n g t o t h e s i t u a t i o n ( R i s t , 1 9 7 9 , p. 2 0 ) . I n t h i s m e t h o d o l o g y , t h e b a c k g r o u n d k n o w l e d g e o f t h e i n v e s t i g a t o r i s s e e n a s e s s e n t i a l t o any k i n d o f a n a l y s i s ( A n d e r s o n , 1 9 8 1 ; C i c o u r e l , 1 9 6 4 ) . T h i s b a c k g r o u n d k n o w l e d g e must be made e x p l i c i t t o t h e r e a d e r when s t u d y r e s u l t s a r e r e p o r t e d . B e c a u s e b o t h r e s e a r c h e r a n d s u b j e c t i n a q u a l i t a t i v e m e t h o d o l o g y c a n c l a r i f y v i e w s and s o c i a l l y c o n s t r u c t t h e e x p e r i e n c e u n d e r i n v e s t i g a t i o n , d a t a o b t a i n e d a r e r i c h e r t h a n i s t h e c a s e i n q u a n t i t a t i v e a n a l y s i s . T h i s c l o s e n e s s t o t h e d a t a r e s u l t s i n h i g h l y v a l i d r e s e a r c h f i n d i n g s ( R i s t , 1 9 7 9 ) . E x p l i c a t i n g t h e r e s e a r c h e r ' s own f r a m e w o r k , e n s u r e s t h a t o t h e r i n v e s t i g a t o r s a n a l y z i n g t h e same d a t a and u s i n g t h e same f r a m e w o r k s h o u l d a r r i v e a t s i m i l a r f i n d i n g s . I n t h i s way s t u d y r e l i a b i l i t y i s i n c r e a s e d . K l e i n m a n ( 1 9 7 8 ) s t a t e s t h a t t h e p h e n o m e n o l o g i c a l method i s a p p r o p r i a t e f o r i n v e s t i g a t i n g t h e l a y p e r s o n ' s e x p e r i e n c e o f h e a l t h and i l l n e s s . S i n c e a l l phenomena a r e s o c i a l l y c o n s t r u c t e d and g i v e n m e a n i n g by t h e i n d i v i d u a l , t h e p o p u l a r and p r o f e s s i o n a l ' s e x p l a n a t o r y m o d e l s o f h e a l t h and i l l n e s s may be e x p l o r e d w i t h t h e a p p l i c a t i o n o f t h i s m e t h o d o l o g y . P h e n o m e n o l o g y i s a l s o an a p p r o p r i a t e m e t h o d o l o g y f o r 14 i d e n t i f y i n g t h e h e a l t h b e l i e f s and p r a c t i c e s s u r r o u n d i n g c h i l d b e a r i n g o f I n d o - C a n a d i a n women i m m i g r a n t s as t h e s t u d y o b j e c t i v e s f o c u s on e x p l a i n i n g t h e e x p e r i e n c e o f c h i l d b e a r i n g f r o m t h e p e r s o n a l p e r s p e c t i v e s o f members o f t h i s g r o u p . T h r o u g h e l i c i t i n g and e x p l a i n i n g t h i s e x p e r i e n c e , h e a l t h c a r e p r o f e s s i o n a l s w i l l h a v e t h e k n o w l e d g e r e q u i r e d t o p l a n r e l e v a n t , i n d i v i d u a l c a r e . D e f i n i t i o n o f Terms 1. I n d o - C a n a d i a n i m m i g r a n t woman: a woman o f t h e S i k h r e l i g i o n , who was b o r n i n t h e P u n j a b R e g i o n o f I n d i a . 2. c h i l d b e a r i n g e x p e r i e n c e : p e r c e p t i o n s , f e e l i n g s , and p r a c t i c e s s u r r o u n d i n g p r e g n a n c y , l a b o u r , d e l i v e r y , and t h e f i r s t p o s t p a r t u m week. 3. b e l i e f s : t h e i n d i v i d u a l ' s p e r c e p t i o n , v i e w o r o u t l o o k . 4. p r a c t i c e s : b e h a v i o u r s b a s e d on an i n d i v i d u a l ' s b e l i e f s . A s s u m p t i o n s o f t h e S t u d y 1. A l t h o u g h t h e r e m i g h t be i n d i v i d u a l d i f f e r e n c e s i n t h e c h i l d b e a r i n g e x p e r i e n c e , c e r t a i n c o m m o n a l i t i e s i n t h e e x p e r i e n c e do e x i s t f o r t h i s c u l t u r a l g r o u p . 2. U s i n g t h e p h e n o m e n o l o g i c a l method o f r e s e a r c h , t h e 15 i n v e s t i g a t o r c a n g a i n an u n d e r s t a n d i n g o f t h e h e a l t h b e l i e f s and p r a c t i c e s s u r r o u n d i n g c h i l d b e a r i n g o f I n d o - C a n a d i a n i m m i g r a n t women. 3. The . h e a l t h b e l i e f s and p r a c t i c e s s u r r o u n d i n g c h i l d b e a r i n g o f I n d o - C a n a d i a n i m m i g r a n t women d i f f e r f r o m t h o s e o f t h e N o r t h A m e r i c a n C a u c a s i a n p o p u l a t i o n . L i m i t a t i o n s o f t h e S t u d y 1. B e c a u s e o f i n t r a - c u l t u r a l d i v e r s i t y amongst t h e S i k h p o p u l a t i o n t h e s e f i n d i n g s may n o t be a p p l i c a b l e t o a l l members o f t h i s p o p u l a t i o n . 2. I n d o - C a n a d i a n women who a r e " v e r b a l i n E n g l i s h " may d i f f e r f r o m t h e i r p e e r s t h r o u g h s o c i a l c l a s s a n d / o r a c c u l t u r a t i o n . T h i s may a l s o l i m i t g e n e r a l i z a b i l i t y o f f i n d i n g s . 3. The p r e s e n c e o f f a m i l y members a t i n t e r v i e w s may have i n f l u e n c e d t h e women's v e r b a l i z a t i o n s i n t h e i n t e r v i e w s i t u a t i o n . 4. Time c o n s t r a i n t s and c u l t u r a l c h a r a c t e r i s t i c s o f t e n p r e c l u d e d t h e d e v e l o p m e n t o f a r e l a t i o n s h i p w i t h t h e I n d o - C a n a d i a n women i n w h i c h t h e y w o u l d f e e l c o m f o r t a b l e b e i n g i n t e r v i e w e d i n d e p t h . O r g a n i z a t i o n o f t h e T h e s i s The f o l l o w i n g c h a p t e r s o f t h i s t h e s i s w i l l d i s c u s s 16 r e l e v a n t a s p e c t s o f t h e r e s e a r c h p r o c e s s and e x p a n d on t h e s t u d y ' s c e n t r a l q u e s t i o n s . C h a p t e r 2 w i l l d i s c u s s t h e p r o c e s s o f d a t a c o l l e c t i o n and a n a l y s i s , as w e l l as t h e e t h i c a l and human r i g h t s i s s u e s o f t h e s t u d y . C h a p t e r 3 w i l l d e s c r i b e t h e c e n t r a l s t r u c t u r e a r o u n d w h i c h t h e d a t a were o r g a n i z e d . C h a p t e r 4 w i l l d e s c r i b e t h e s u b j e c t s ' p e r c e p t i o n s o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s . By c o n s t r u c t i n g a c c o u n t s f r o m t h e women's p e r s p e c t i v e s , t h e r e s e a r c h e r w i l l be d e s c r i b i n g what K l e i n m a n h a s t e r m e d t h e p e r s p e c t i v e o f t h e p o p u l a r s e c t o r . T h e s e p o p u l a r a c c o u n t s w i l l s e r v e t o a n s w e r t h e s t u d y ' s c e n t r a l q u e s t i o n s . I n a d d i t i o n , i n C h a p t e r 4 , t h e s e a c c o u n t s w i l l be c o m p a r e d and c o n t r a s t e d w i t h p r o f e s s i o n a l a c c o u n t s as t h e y a p p e a r i n r e l e v a n t p r o f e s s i o n a l l i t e r a t r e . The t h e s i s w i l l c o n c l u d e i n C h a p t e r 5 w i t h t h e i m p l i c a t i o n s t h e s t u d y h a s f o r n u r s i n g p r a c t i c e , e d u c a t i o n and f u r t h e r r e s e a r c h . Summary T h i s c h a p t e r h a s d i s c u s s e d t h e b a c k g r o u n d t o t h e s t u d y , f r o m w h i c h f l o w s t h e s t u d y ' s p r o b l e m a n d p u r p o s e . The i n v e s t i g a t o r ' s c o n c e p t u a l i z a t i o n o f t h e p r o b l e m h a s been d e s c r i b e d and shown t o com p l e m e n t t h e m e t h o d o l o g i c a l p e r s p e c t i v e o f t h e s t u d y . M a t e r i a l p r e s e n t e d i n t h i s c h a p t e r g i v e s d i r e c t i o n t o g a t h e r i n g and a n a l y z i n g d a t a r e l a t e d t o t h e h e a l t h b e l i e f s and p r a c t i c e s o f I n d o - C a n a d i a n women d u r i n g t h e c h i l d b e a r i n g e x p e r i e n c e . I t i s o n l y t h r o u g h 17 u n d e r s t a n d i n g t h e women's p e r s p e c t i v e s t h a t n u r s e s c a n n e g o t i a t e w i t h c l i e n t s t o r e d u c e t h e c o n f l i c t s and m i s u n d e r s t a n d i n g s t h a t o c c u r b e t w e e n t h e p r o f e s s i o n a l and p o p u l a r e x p l a n a t o r y m o d e l s o f c h i l d b e a r i n g . 18 CHAPTER 2 M e t h o d o l o g y As d e s c r i b e d i n C h a p t e r 1, t h e p h e n o m e n o l o g i c a l method was u s e d t o s t u d y s u b j e c t s ' p e r c e p t i o n s o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s . B e c a u s e t h e r e s e a r c h e r ' s t a s k , u s i n g t h e p h e n o m e n o l o g i c a l m e t h o d , i s t o i n v e s t i g a t e and d e s c r i b e human e x p e r i e n c e i n t h e way t h e phenomena a p p e a r t o t h e i n d i v i d u a l (Ornery, 1 9 8 3 ) , and t h e d a t a o b t a i n e d s h o u l d r e f l e c t t h e way i n w h i c h s u b j e c t s v i e w t h e i r w o r l d ( B o g d a n & T a y l o r , 1975; F i l s t e a d , 1 9 7 0 ) , d a t a w e re g a t h e r e d f r o m I n d o - C a n a d i a n women i m m i g r a n t s who had had a r e c e n t c h i l d b e a r i n g e x p e r i e n c e i n C a n a d a . D a t a w ere c o l l e c t e d i n t h e p a r t i c i p a n t s ' n a t u r a l home s e t t i n g s . I n t h e i r own homes, t h e s u b j e c t s f e l t c o m f o r t a b l e r e l a t i n g t h e i r d e s c r i p t i o n s i n f a m i l i a r e n v i r o n m e n t s i n w h i c h t h e m a j o r p a r t o f t h e i r e x p e r i e n c e s w e r e l i v e d . I n t h i s way, t h e s u b j e c t s ' d e s c r i p t i o n s o f t h e i r e x p e r i e n c e s were e n h a n c e d ( O i l e r , 1 9 8 2 ) . T h e s e d e s c r i p t i o n s p r o v i d e d t h e means f o r t h e r e s e a r c h e r t o u n d e r s t a n d t h e phenomena o f c h i l d b e a r i n g f r o m t h e I n d o - C a n a d i a n women's p e r s p e c t i v e . I n t h i s c h a p t e r , t h e i m p l e m e n t a t i o n o f t h e r e s e a r c h m e t h o d o l o g y w i l l be d i s c u s s e d i n r e l a t i o n t o t h e s e l e c t i o n o f p a r t i c i p a n t s , d a t a c o l l e c t i o n and a n a l y s i s , and t h e e t h i c a l and human r i g h t s c o n s i d e r a t i o n s o f t h i s s t u d y . S e l e c t i o n o f P a r t i c i p a n t s 19 The p h e n o m e n o l o g i c a l a p p r o a c h d i r e c t s t h e r e s e a r c h e r t o c o l l e c t t h e d a t a f r o m t h o s e who ha v e l i v e d t h e e x p e r i e n c e ( G i o r g i , 1975b; O i l e r , 1 982; Ornery, 1 9 8 3 ) . T h e r e f o r e , I n d o - C a n a d i a n i m m i g r a n t women who had r e c e n t l y had a c h i l d i n C a n a d a , w e r e c h o s e n a s t h e s o u r c e o f i n f o r m a t i o n . I n o r d e r t o ha v e a r e a d y s o u r c e t o e x p l o r e t h e s u b j e c t i v e m e a n i n g o f t h e e x p e r i e n c e , a p u r p o s i v e s a m p l i n g t e c h n i q u e was u t i l i z e d t o s e l e c t s u b j e c t s f o r p a r t i c i p a t i o n i n t h e s t u d y . I n t h i s s a m p l e , s u b j e c t s w e re s e l e c t e d s p e c i f i c a l l y f o r t h e i r a b i l i t y t o a n s w e r q u e s t i o n s p o s e d by t h e i n v e s t i g a t o r . The s u b j e c t s were t h u s " c o m p e t e n t " t o a n s w e r t h e s t u d y ' s q u e s t i o n s b y v i r t u e o f t h e i r h a v i n g l i v e d t h e e x p e r i e n c e and by h a v i n g f u l f i l l e d f o u r p r e - s e l e c t e d c r i t e r i a . C r i t e r i a f o r S e l e c t i o n The f o l l o w i n g c r i t e r i a were u s e d t o s e l e c t t h e I n d o - C a n a d i a n women i m m i g r a n t s who p a r t i c i p a t e d i n t h e s t u d y . The s u b j e c t had t o h a v e : 1. l i v e d i n t h e P u n j a b u n t i l t h e age o f 17 y e a r s o r o l d e r 2. b een a member o f t h e S i k h r e l i g i o n 3. e x p e r i e n c e d c h i l d b e a r i n g i n Canada w i t h i n 12 months o f s e l e c t i o n f o r t h e s t u d y 20 o f s e l e c t i o n f o r t h e s t u d y 4. t h e a b i l i t y t o c o m m u n i c a t e v e r b a l l y and r e a d i n E n g l i s h . Some o f t h e s e c r i t e r i a were c h o s e n t o e n s u r e t h a t t h e s a m p l e o f women were c o m p e t e n t t o d e s c r i b e t h e i r e x p e r i e n c e o f c h i l d b e a r i n g a s I n d o - C a n a d i a n women i m m i g r a n t s i n C a n a d a . S e l e c t i o n P r o c e d u r e A l l s u b j e c t s i n c l u d e d i n t h e s t u d y w e re d r a w n f r o m a l a r g e m u n i c i p a l i t y l o c a t e d 35 k i l o m e t r e s s o u t h o f V a n c o u v e r , B r i t i s h C o l u m b i a . P e r m i s s i o n t o c o n t a c t p o t e n t i a l s u b j e c t s was o b t a i n e d f r o m t h e p r o v i n c i a l p u b l i c h e a l t h d e p a r t m e n t . The r e s e a r c h e r a t t e n d e d i n - s e r v i c e m e e t i n g s i n t h r e e h e a l t h u n i t o f f i c e s , a t w h i c h t i m e t h e s t u d y q u e s t i o n s , m e t h o d o l o g y , and c r i t e r i a f o r s u b j e c t s were e x p l a i n e d t o c o m m u n i t y h e a l t h n u r s e s . B e c a u s e home v i s i t s a r e made by co m m u n i t y h e a l t h n u r s e s t o a l l new m o t h e r s i n t h e p r o v i n c e , t h e s e n u r s e s were i d e a l l y s u i t e d t o a s s e s s p o t e n t i a l s u b j e c t s . I n a l l c a s e s , t h e l o c a l c o m m u n i t y h e a l t h n u r s e made t h e i n i t i a l c o n t a c t w i t h t h e s u b j e c t . The s t u d y was d i s c u s s e d b r i e f l y and t h e I n f o r m a t i o n and C o n s e n t t o C o n t a c t f o r m ( s e e A p p e n d i x A) was r e v i e w e d . T h i s l e t t e r e x p l a i n e d t h e p u r p o s e o f t h e s t u d y a s w e l l as t h e r e q u e s t t o i n t e r v i e w t h e women. I f t h e p o t e n t i a l s u b j e c t a g r e e d and s i g n e d t h e f o r m , t h e community h e a l t h n u r s e c o n t a c t e d t h e r e s e a r c h e r and p a s s e d on t h e s u b j e c t ' s name and t e l e p h o n e number. 21 The r e s e a r c h e r ' s i n i t i a l c o n t a c t w i t h t h e p o t e n t i a l p a r t i c i p a n t was by t e l e p h o n e . A t t h i s t i m e f | t h e s t u d y was o u t l i n e d i n d e t a i l and q u e s t i o n s were a n s w e r e d . I f t h e p o t e n t i a l s u b j e c t a g r e e d , a home v i s i t was a r r a n g e d . A t t h e f i r s t home v i s i t , t h e i n v e s t i g a t o r r e - a s s e s s e d t h e p r o s p e c t i v e s u b j e c t i n t e r m s o f m e e t i n g t h e s t u d y c r i t e r i a , e x p l a i n e d t h e s t u d y i n d e t a i l , i n c l u d i n g t h e s u b j e c t ' s t i m e p a r a m e t e r s , and a n s w e r e d q u e s t i o n s . I f t h e p o t e n t i a l s u b j e c t a g r e e d t o p a r t i c i p a t e , t h e r e s e a r c h e r r e a d t h e c o n s e n t f o r m a l o u d and t h e n h a d t h e s u b j e c t r e - r e a d a n d s i g n i t ( s e e A p p e n d i x B ) . The i n v e s t i g a t o r t h e n p r o c e e d e d w i t h t h e f i r s t i n t e r v i e w , w h i c h was r e c o r d e d on a u d i o - t a p e . A l t h o u g h t h e c o m m u n i t y h e a l t h n u r s e s were i n v a l u a b l e i n l o c a t i n g and a s s e s s i n g c l i e n t s , t h e r e s e a r c h e r d e c i d e d , on h e r i n i t i a l home v i s i t , t o e x c l u d e two women f r o m t h e s t u d y due t o t h e i r i n a b i l i t y t o c o m m u n i c a t e v e r b a l l y i n E n g l i s h a t t h e l e v e l r e q u i r e d f o r t h e i n v e s t i g a t o r t o be a b l e t o e x p l o r e t h e s u b j e c t i v e m e a n i n g o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s . I n a d d i t i o n , one s u b j e c t , i n c o n f l i c t w i t h h e r h u s b a n d o v e r p a r t i c i p a t i o n , r e g r e t f u l l y w i t h d r e w f o l l o w i n g one i n t e r v i e w . C h a r a c t e r i s t i c s o f t h e P a r t i c i p a n t s Ten women c o n s e n t e d t o p a r t i c i p a t e i n t h i s s t u d y . Of t h i s number, e i g h t met t h e c r i t e r i a and were i n c l u d e d i n t h e s t u d y . A l l o f t h e women were m a r r i e d and l i v e d w i t h t h e i r s p o u s e s a t t h e t i m e o f t h e s t u d y . A l l m a r r i a g e s h a d b e e n 22 a r r a n g e d by t h e s u b j e c t s ' p a r e n t s and a l l w e d d i n g s had o c c u r r e d i n I n d i a . I n a l l c a s e s , a t t h e t i m e o f m a r r i a g e , one p a r t n e r had l i v e d i n Canada and r e t u r n e d t o I n d i a f o r t h e w e d d i n g . Then b o t h had r e t u r n e d t o C a n a d a . The s u b j e c t s h a d been m a r r i e d b e t w e e n t h r e e and s e v e n y e a r s . The p a r t i c i p a n t s ' a g e s r a n g e d f r o m 23 t o 32 y e a r s . S i x o f t h e women had two c h i l d r e n and two had t h r e e c h i l d r e n . A l l c h i l d b e a r i n g e x p e r i e n c e s , e x c e p t o n e , had o c c u r r e d i n C a n a d a . Of t h e e i g h t s u b j e c t s , s i x h a d gr o w n up i n s m a l l v i l l a g e s i n t h e P u n j a b and two i n c i t i e s . A l l s u b j e c t s had l i v e d i n e x t e n d e d f a m i l y s i t u a t i o n s i n t h e P u n j a b . S i x l i v e d i n s i m i l a r f a m i l i e s i n C a n a d a . Two s u b j e c t s l i v e d i n n u c l e a r f a m i l i e s . A l l s u b j e c t s h a d l i v e d i n Canada f r o m f i v e t o t e n y e a r s . Of t h e e i g h t p a r t i c i p a n t s , s e v e n had e a r n e d a B.A. i n I n d i a — c o n s i d e r e d i n Canada t o be a h i g h s c h o o l d i p l o m a . The e i g h t h p a r t i c i p a n t c o m p l e t e d h i g h s c h o o l i n C a n a d a . One s u b j e c t a t t a i n e d a t e a c h e r ' s d e g r e e i n t h e P u n j a b and a n o t h e r was w o r k i n g t o w a r d h e r M a s t e r ' s D e g r e e ( c o n s i d e r e d t o be a B.A. e q u i v a l e n t i n Canada) a t t h e t i m e o f h e r e m i g r a t i o n . I n C a n a d a , t h e women were e m p l o y e d a s f o l l o w s : one woman w o r k e d as a p a r t - t i m e k e y p u n c h o p e r a t o r ; one a s a l i c e n s e d r e a l e s t a t e a g e n t ; t h r e e a s s e a s o n a l f a r m w o r k e r s , and t h r e e a s p a r t - t i m e u n s k i l l e d f a c t o r y w o r k e r s . A l l t h e p a r t i c i p a n t s h a d i n f a n t s b e t w e e n two weeks and t h r e e months o f a g e . A l l s u b j e c t s d e l i v e r e d t h e i r b a b i e s a t t h e same f i v e h u n d r e d bed c o m m u n i t y h o s p i t a l . H o s p i t a l s t a y s 23 r a n g e d f r o m t h r e e d a y s f o r v a g i n a l b i r t h s t o f i v e d a y s f o r c a e s a r e a n d e l i v e r i e s . S e v e n o f t h e e i g h t women i n t e n d e d t o hav e a n o t h e r c h i l d w i t h i n t h e n e x t e i g h t e e n m o n t h s . D a t a C o l l e c t i o n I n - d e p t h i n t e r v i e w i n g was t h e p r o c e s s u s e d t o c o l l e c t d a t a r e g a r d i n g t h e s u b j e c t s ' c h i l d b e a r i n g e x p e r i e n c e s . The f i r s t s e m i - s t r u c t u r e d i n t e r v i e w s t o o k p l a c e i n t h e s u b j e c t s ' homes a t t h e t i m e o f s i g n i n g t h e c o n s e n t f o r m . S u b s e q u e n t i n t e r v i e w s were a r r a n g e d a t i n t e r v a l s o f a t l e a s t one week t o a l l o w t h e r e s e a r c h e r t i m e t o r e v i e w t h e a u d i o - t a p e s , have them t r a n s c r i b e d , and a n a l y z e t h e d a t a . S p e c i f i c i n t e r v i e w t i m e s w e re a r r a n g e d a t t h e s u b j e c t s ' c o n v e n i e n c e . I n t e r v i e w s were a u d i o - t a p e d and l a s t e d f r o m f i f t e e n t o n i n e t y m i n u t e s . S e v e r a l i n t e r v i e w s were t e r m i n a t e d e a r l y due t o f r e q u e n t i n t e r r u p t i o n s . F o r e x a m p l e , one woman a r r a n g e d t o be i n t e r v i e w e d a t a t i m e when she was c a r i n g f o r s e v e n c h i l d r e n a g e d newborn t o t h r e e y e a r s . When t h e s e s i t u a t i o n s o c c u r r e d , t h e s u b j e c t and r e s e a r c h e r a g r e e d t o more f r e q u e n t b u t s h o r t e r i n t e r v i e w s . F o l l o w i n g e a c h i n t e r v i e w , t h e i n v e s t i g a t o r s p e n t t i m e w i t h t h e women, s o c i a l v i s i t i n g and a t t e m p t i n g t o c r e a t e a r e l a t i o n s h i p o f t r u s t a n d r a p p o r t . F o l l o w - u p i n t e r v i e w s c l a r i f i e d and e x p a n d e d on d a t a o b t a i n e d i n p r i o r i n t e r v i e w s . Two women r e f u s e d s e c o n d i n t e r v i e w s . S u b j e c t s w e r e i n t e r v i e w e d f r o m one t o f i v e t i m e s . I n a l l , t w e n t y - f i v e i n t e r v i e w s w i t h e i g h t i n d i v i d u a l s were c o m p l e t e d 24 o v e r a p e r i o d o f s e v e r a l m o n t h s . The s e m i - s t r u c t u r e d i n t e r v i e w s were g u i d e d by a s e r i e s o f o p e n - e n d e d q u e s t i o n s w h i c h d i r e c t e d t h e d i s c u s s i o n t o t h e c e n t r a l q u e s t i o n s o f t h e s t u d y . The q u e s t i o n s u s e d t o e l i c i t t h e s u b j e c t s ' e x p l a n a t o r y m o d e l s o f c h i l d b e a r i n g o r i g i n a t e d f r o m K l e i n m a n ' s d i s c u s s i o n o f t h e s e m i - s t r u c t u r e d i n t e r v i e w ( K l e i n m a n , 1 9 8 0 ) . (See A p p e n d i x C f o r s a m p l e q u e s t i o n s . ) T h ese q u e s t i o n s were u s e d t o g u i d e t h e d i s c u s s i o n t o t h e s u b j e c t s ' h e a l t h b e l i e f s and p r a c t i c e s s u r r o u n d i n g c h i l d b e a r i n g . I n t e r v i e w e r ' s R o l e I n an e f f o r t t o e n t e r i n t o t h e " l i f e w o r l d " ( G i o r g i , 1975a) o f t h e s u b j e c t s and t o e n c o u r a g e them t o f e e l c o m f o r t a b l e i n d e s c r i b i n g t h e i r e x p e r i e n c e s , t h e r e s e a r c h e r e s t a b l i s h e d a r e l a t i o n s h i p o f t r u s t and c o m m u n i c a t i o n . T h i s r e l a t i o n s h i p was d e v e l o p e d i n ways t h a t w e re a t t i m e s u n c o n v e n t i o n a l t o t h e r e s e a r c h p r o c e s s . F o r e x a m p l e , d u r i n g b l u e b e r r y s e a s o n , t h r e e o f t h e s u b j e c t s w o r k e d i n t h e i r b l u e b e r r y f i e l d s d a i l y and e x p r e s s e d d i s t r e s s a t b e i n g s h o r t h a n d e d . The i n v e s t i g a t o r s p e n t s e v e r a l d a y s i n t h e f i e l d s w i t h t h e women h e l p i n g t o h a r v e s t t h e i r c r o p s . P r i o r t o e a c h i n t e r v i e w , t h e s t u d y p u r p o s e s were r e c l a r i f i e d and e t h i c a l c o n s i d e r a t i o n s r e i t e r a t e d . S u b j e c t s r e q u e s t e d f r e q u e n t r e a s s u r a n c e s t h a t t h e y w e re " a n s w e r i n g t h e q u e s t i o n c o r r e c t l y " , and t h e s t a n c e t a k e n by t h e i n t e r v i e w e r 25 was t h a t " r i g h t and w r o n g " were n o t an i s s u e i n t h i s s i t u a t i o n , b u t r a t h e r t h a t i t was i m p o r t a n t t o s h a r e i n f o r m a t i o n . The a t t i t u d e t a k e n by t h e i n v e s t i g a t o r i n t h e i n t e r v i e w s was one o f g e n u i n e i n t e r e s t . A l l d a t a o b t a i n e d were a c c e p t e d a s g i v e n and a v a l i d p a r t o f t h e i n d i v i d u a l ' s e x p e r i e n c e (Omery, 1 9 8 3 ) . S u b j e c t s were n o t p r e s s e d a b o u t i s s u e s t h e y a p p e a r e d h e s i t a n t t o d i s c u s s . As t h e r e s e a r c h r e l a t i o n s h i p d e v e l o p e d , t h e i n v e s t i g a t o r c o u l d o f t e n s u c c e s s f u l l y r e t u r n t o t h e s e p r e v i o u s l y s e n s i t i v e a r e a s . D a t a A n a l y s i s C o n s t a n t c o m p a r a t i v e a n a l y s i s i s t h e t e r m g i v e n t o t h e p r o c e s s by w h i c h t h e d a t a w e re a n a l y z e d . E a c h a u d i o - t a p e d i n t e r v i e w was t r a n s c r i b e d and a n a l y z e d by t h e r e s e a r c h e r . E v e r y i n t e r v i e w was r e a d s e v e r a l t i m e s t o g e t a s e n s e o f t h e w h o l e , a s w e l l a s t o d e t e r m i n e t h e n a t u r a l m e a n i n g u n i t s o f t h e phenomena a s e x p r e s s e d by t h e s u b j e c t s ( G i o r g i , 1 9 7 5 a ) . A l l p a r t s o f t h e i n t e r v i e w were a n a l y z e d . R e d u n d a n t n a t u r a l m e a n i n g u n i t s w e r e e l i m i n a t e d b u t a l l o t h e r u n i t s were k e p t a s p a r t o f t h e d a t a . E a c h m e a n i n g u n i t r e p r e s e n t e d a d i f f e r e n t p a r t o f t h e phenomena u n d e r i n v e s t i g a t i o n . The n a t u r a l m e a n i n g u n i t s w e r e t h e n r e l a t e d t o e a c h o t h e r a nd t o t h e phenomena as a w h o l e . The r e s e a r c h e r s p e n t t i m e r e f l e c t i n g on e a c h m e a n i n g u n i t and s y s t e m a t i c a l l y i n v e s t i g a t e d what e a c h u n i t r e v e a l e d a b o u t t h e I n d o - C a n a d i a n i m m i g r a n t woman's c h i l d b e a r i n g e x p e r i e n c e . The 26 i n s i g h t s t h a t o c c u r r e d were s y n t h e s i z e d and i n t e g r a t e d i n t o a c o n s i s t e n t d e s c r i p t i o n o f t h e phenomena u n d e r i n v e s t i g a t i o n ( G i o r g i , 1 9 7 5 b ) . T h r o u g h o u t t h e p r o c e s s o f a n a l y s i s , t h e r e s e a r c h e r was aware o f h e r own p e r s p e c t i v e a n d t h e manner i n w h i c h h e r s u b j e c t i v e e x p e r i e n c e s i n f l u e n c e d t h e m e a n i n g g i v e n t o t h e d a t a . (The r e s e a r c h e r ' s p r o f e s s i o n a l p e r s p e c t i v e w i l l be e x p l i c a t e d i n C h a p t e r 4 o f t h i s t h e s i s . ) T h i s i n v o l v e m e n t o f t h e r e s e a r c h e r i n a t t a c h i n g m e a n i n g t o , and m a k i n g s e n s e o f t h e d a t a , i s c o n s i s t e n t w i t h t h e p h e n o m e n o l o g i c a l method o f i n q u i r y ( A n d e r s o n , 1 9 8 1; G i o r g i , 1 9 7 5 b ) . E t h i c a l C o n s i d e r a t i o n s a n d Human R i g h t s i n R e s e a r c h E t h i c a l i s s u e s s u r r o u n d i n g s u b j e c t s e l e c t i o n have been d i s c u s s e d . P r i o r t o s i g n i n g t h e c o n s e n t f o r m , t h e r e s e a r c h e r d e s c r i b e d t h e s t u d y , e x p l a i n e d t h e p u r p o s e o f a u d i o - t a p i n g , and a n s w e r e d q u e s t i o n s . S u b j e c t s were e n c o u r a g e d t o make t h e i r own d e c i s i o n s a b o u t g i v i n g c o n s e n t . One s u b j e c t and h e r h u s b a n d r e q u e s t e d t h a t t h e i n t e r v i e w s n o t be t a p e d , b u t a g r e e d t o h a v i n g t h e i n v e s t i g a t o r t a k e e x t e n s i v e f i e l d n o t e s t h r o u g h o u t t h e s e i n t e r v i e w s . F r e q u e n c y o f c o n t a c t and t i m e r e q u i r e d p e r i n t e r v i e w were a l s o d i s c u s s e d w i t h e a c h s u b j e c t . Q u e s t i o n s a b o u t t h e s t u d y p u r p o s e s o r m e t h o d o l o g y were b r o u g h t u p , n o t by t h e women, b u t by t h e i r h u s b a n d s . T h e s e q u e s t i o n s w e re a n s w e r e d by t h e i n v e s t i g a t o r . P r i o r t o t h e i r g i v i n g c o n s e n t , t h e p o t e n t i a l s u b j e c t s w e re a d v i s e d t h a t 27 p a r t i c i p a t i o n was v o l u n t a r y and t h a t t h e y w e re f r e e t o w i t h d r a w a t any t i m e o r r e f u s e t o a n s w e r any q u e s t i o n s , w i t h o u t p r e j u d i c e t o any h e a l t h c a r e t h e y w o u l d r e c e i v e . B e f o r e e a c h i n t e r v i e w , s u b j e c t s were a g a i n r e m i n d e d t h a t t h e y c o u l d w i t h d r a w a t any t i m e o r r e f u s e t o a n s w e r q u e s t i o n s . T h i s o n g o i n g and c a r e f u l c l a r i f i c a t i o n was n e c e s s a r y t o r e a s s u r e t h e p a r t i c i p a n t s ' h u s b a n d s . The men were g e n e r a l l y s u s p i c i o u s o f t h e p u r p o s e o f t h e s t u d y and use o f t h e d a t a and t h e r e f o r e r e q u i r e d a c o n t i n u o u s r e i t e r a t i o n o f t h e e t h i c a l c o n s i d e r a t i o n s and human r i g h t s i n r e s e a r c h . I t was t h e h u s b a n d s who g a v e o r w i t h h e l d c o n s e n t t o t h e i r w i v e s t o p a r t i c i p a t e . P o t e n t i a l s u b j e c t s w e re i n f o r m e d t h a t p a r t i c i p a t i o n d i d n o t i n v o l v e any known r i s k s and t h a t p o s s i b l e b e n e f i t s , a s t h e y c o n t r i b u t e d t o n u r s i n g k n o w l e d g e , w o u l d h e l p s u b j e c t s i n f u t u r e c h i l d b e a r i n g e x p e r i e n c e s . The r e s e a r c h e r d i s c u s s e d w i t h t h e p o t e n t i a l s u b j e c t s t h a t p r i v a c y and c o n f i d e n t i a l i t y w o u l d be a s s u r e d i n t h e f o l l o w i n g manner: 1. I f t h e u s e o f a u d i o - t a p e s was a g r e e d t o , t h e r e s e a r c h e r and h e r t h e s i s c o m m i t t e e w o u l d be t h e o n l y i n d i v i d u a l s w i t h a c c e s s t o t h e r e c o r d e d d a t a . 2. E a c h s u b j e c t w o u l d be a s s i g n e d a c o d e name t o r e p l a c e h e r own name on t h e t a p e s , t r a n s c r i p t s , and a l l w r i t t e n m a t e r i a l . 3. The l i s t o f s u b j e c t s ' names, c o d e s and c o n s e n t f o r m s w o u l d be k e p t s e p a r a t e f r o m t h e d a t a and w o u l d be a v a i l a b l e o n l y t o t h e r e s e a r c h e r . 4. Any i n f o r m a t i o n w h i c h c o u l d i d e n t i f y t h e s u b j e c t 28 w o u l d n o t be r e v e a l e d . 5. The t a p e s and t r a n s c r i p t s w o u l d be d e s t r o y e d upon s t u d y c o m p l e t i o n . The s u b j e c t s e x p r e s s e d a s t r o n g d e s i r e t o be a p p r i s e d o f t h e f i n d i n g s o f t h e s t u d y and t h e r e s e a r c h e r a g r e e d t o c o n t a c t them when t h e s t u d y was c o m p l e t e d . The r e s e a r c h e r i n f o r m e d p o t e n t i a l s u b j e c t s t h a t , i f s i t u a t i o n s r e q u i r i n g i m m e d i a t e i n t e r v e n t i o n s w e r e o b s e r v e d , t h e s e w o u l d be r e f e r r e d b a c k t o t h e a r e a c o m m u n i t y h e a l t h n u r s e . The s u b j e c t s were t o l d t h a t t h e s e s i t u a t i o n s w o u l d be d i s c u s s e d w i t h them p r i o r t o r e f e r r a l . Summary T h i s c h a p t e r h a s r e v i e w e d t h e i m p l e m e n t a t i o n o f t h e p h e n o m e n o l o g i c a l m e thod i n o r d e r t o e l i c i t t h e s u b j e c t s ' p e r c e p t i o n o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s . M e t h o d s f o r s u b j e c t s e l e c t i o n , d a t a c o l l e c t i o n and a n a l y s i s h ave b e e n d i s c u s s e d . The e t h i c a l c o n s i d e r a t i o n s and human r i g h t s i s s u e s o f t h i s r e s e a r c h s t u d y have a l s o b e e n r e v i e w e d . 29 CHAPTER 3 A n a l y z i n g t h e D a t a I n t h i s c h a p t e r , t h e d a t a a n a l y s i s p r o d e d u r e w i l l be e l u c i d a t e d t o e x p l i c a t e t h e i n v e s t i g a t o r ' s v i e w p o i n t and way o f i n t e r p r e t i n g t h e i n f o r m a t i o n o b t a i n e d f r o m t h e s u b j e c t s . T h i s e x p l i c a t i o n i s c e n t r a l t o t h i s p h a s e o f t h e p h e n o m e n o l o g i c a l m e thod o f i n q u i r y ( A n d e r s o n , 1 9 8 1 ; O i l e r , 1982) and i s e s s e n t i a l t o e n s u r e s t u d y r e l i a b i l i t y ( G i o r g i , 1975; O i l e r , 1 9 8 2 ) . T h i s c h a p t e r w i l l a l s o p r o v i d e a b a s i s on w h i c h t o p r e s e n t t h e f i n d i n g s o f t h e s t u d y : a d e s c r i p t i o n o f t h e c h i l d b e a r i n g e x p e r i e n c e s o f t h e women s u b j e c t s . D i v e r s i t y o f t h e D a t a The m e thod o f d a t a a n a l y s i s h a s b e e n d i s c u s s e d i n C h a p t e r 2. W h i l e a n a l y z i n g t h e s u b j e c t s ' a c c o u n t s o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s , t h e i n v e s t i g a t o r had e x p e c t e d t o f i n d t h a t t h e s e e x p e r i e n c e s w o u l d be f a i r l y u n i f o r m . The p a r t i c i p a n t s had s a t i s f i e d c e r t a i n c r i t e r i a f o r i n c l u s i o n i n t h e s t u d y , and t h e r e s e a r c h e r h a d assumed t h a t b e c a u s e t h e s u b j e c t s met t h e s e c r i t e r i a , t h e y w o u l d be s i m i l a r , r e s u l t i n g i n common c h i l d b e a r i n g e x p e r i e n c e s . D i s s i m i l a r i t i e s i n t h e phenomena u n d e r i n v e s t i g a t i o n w e r e , h o w e v e r , more e v i d e n t t h a n s i m i l a r i t i e s . The women d e s c r i b e d v e r y d i f f e r e n t 30 e x p e r i e n c e s . D a t a r e l a t e d t o t h e i r b e l i e f s , p r a c t i c e s , and u s e s and p e r c e p t i o n o f w e s t e r n h e a l t h c a r e r e s o u r c e s , were d i v e r s e and d i f f i c u l t t o s y n t h e s i z e i n t o a m e a n i n g f u l w h o l e . R e f l e c t i o n on t h e d a t a , and v e r i f i c a t i o n w i t h s t u d y s u b j e c t s , made t h e i n v e s t i g a t o r aware t h a t one c e n t r a l c o n c e p t , a c c u l t u r a t i o n , a c c o u n t e d f o r t h e i n d i v i d u a l d i f f e r e n c e s i n t h e e x p e r i e n c e s . D e v e l o p i n g t h e C o n c e p t o f A c c u l t u r a t i o n D u r i n g t h e e a r l y s t a g e s o f i n t e r v i e w i n g and s i m u l t a n e o u s d a t a a n a l y s i s , t h e r e s e a r c h e r became aware t h a t t h e c o n c e p t o f a c c u l t u r a t i o n was h e l p i n g h e r t o make s e n s e o f t h e d a t a . The r e s e a r c h e r r e v i e w e d t h e a u d i o - t a p e d i n t e r v i e w s , l i s t e n i n g f o r t h e i r o v e r a l l t o n e . The d a t a r e f l e c t e d d i f f e r e n c e s i n t h e s u b j e c t s ' a b i l i t i e s t o u n d e r s t a n d and s p e a k E n g l i s h . The women d e s c r i b e d a t t i t u d e s , b e l i e f s , and p r a c t i c e s s u r r o u n d i n g c h i l d b e a r i n g t h a t w e re s i m i l a r t o t h o s e p r e s e n t i n e i t h e r t h e E a s t I n d i a n o r C a n a d i a n c u l t u r e . The s u b j e c t s were a l s o a s s e s s e d a c c o r d i n g t o s t y l e o f d r e s s , h o u s e , d e c o r , r e l a t i o n s h i p w i t h s p o u s e and c u r r e n t d i e t , a n d , f o r e a c h woman, t h e s e c h a r a c t e r i s t i c s were f o u n d t o be e i t h e r d i s t i n c t l y more E a s t I n d i a n o r more C a n a d i a n i n c h a r a c t e r . D u r i n g t h e c o u r s e o f i n t e r v i e w i n g , i t became e v i d e n t t h a t t h e two women who came f r o m c i t i e s , n o t v i l l a g e s ; who l i v e d i n n u c l e a r , n o t e x t e n d e d f a m i l i e s , and who had a c h i e v e d h i g h e r e d u c a t i o n l e v e l s , h a d had c h i l d b e a r i n g e x p e r i e n c e s 31 t h a t more c l o s e l y r e s e m b l e d t h o s e t y p i c a l l y f o u n d i n C a n a d i a n c u l t u r e t h a n h a d o t h e r s u b j e c t s whose e x p e r i e n c e s more c l o s e l y p a r a l l e l e d t h o s e t y p i c a l l y o b s e r v e d i n E a s t I n d i a n c u l t u r e . When a n a l y z i n g t h e d e m o g r a p h i c i n f o r m a t i o n , t h e i n v e s t i g a t o r became a w a r e t h a t d e m o g r a p h i c f a c t o r s a f f e c t e d t h e women's d e g r e e o f a c c u l t u r a t i o n i n t o C a n a d i a n s o c i e t y . T h i s e n r i c h e d d a t a g ave d i r e c t i o n t o t h e r e s e a r c h e r ' s d e s c r i p t i o n o f t h e s u b j e c t s ' e x p e r i e n c e s i n t e r m s o f t h e i r s i m i l a r i t i e s and d i s s i m i l a r i t i e s t o b o t h c u l t u r e s . The c o n c e p t o f a c c u l t u r a t i o n w h i c h emerged f r o m t h e d a t a a c c o u n t e d f o r t h e d i f f e r e n c e s i n t h e s u b j e c t s ' e x p e r i e n c e s . I t was a t t h i s t i m e t h a t t h e r e s e a r c h e r c o n s u l t e d t h e l i t e r a t u r e on a c c u l t u r a t i o n and r e t u r n e d t o r e i n t e r v i e w t h e s u b j e c t s t o v a l i d a t e f i n d i n g s and s a t u r a t e t h e c o n c e p t u a l c a t e g o r y o f a c c u l t u r a t i o n . T h e s e two s t e p s a r e c o n s i s t e n t w i t h t h e p h e n o m e n o l o g i c a l m e t h o d o f a n a l y s i s ( K n a a c k , 1 9 8 4 ) . B o t h t h e l i t e r a t u r e a n d t h e s u b j e c t s ' a c c o u n t s r e c o n f i r m e d t h a t t h e p r o c e s s o f a c c u l t u r a t i o n was t h e c e n t r a l c o n c e p t o f t h e s t u d y ' s f i n d i n g s . A c c u l t u r a t i o n The c o n c e p t o f a c c u l t u r a t i o n h a s i t s r o o t s i n a n t h r o p o l o g y and l a t e r i n p s y c h o l o g y and s o c i o l o g y . A l t h o u g h t h e c o n c e p t i s u s e d i n t h e l i t e r a t u r e a s e a r l y a s 1880, t h e r e a r e two c l a s s i c d e f i n i t i o n s c u r r e n t l y i n u s e . R e d f i e l d , 32 L i n t o n and H e r s k o v i t s ( 1 9 3 6 , p.149) s t a t e d : A c c u l t u r a t i o n c o m p r e h e n d s t h o s e phenomena w h i c h r e s u l t when g r o u p s o f i n d i v i d u a l s h a v i n g d i f f e r e n t c u l t u r e s come i n t o c o n t i n u o u s f i r s t hand c o n t a c t , w i t h s u b s e q u e n t c h a n g e s i n t h e o r i g i n a l c u l t u r e p a t t e r n s o f e i t h e r o r b o t h g r o u p s . D u r i n g t h e p r o c e s s o f a c c u l t u r a t i o n , c e r t a i n c u l t u r a l t r a i t s a r e s e l e c t e d f r o m t h e d o n o r c u l t u r e and i n t e g r a t e d i n t o t h e a c c e p t i n g c u l t u r e . R e d f i e l d e t a l . ( 1 9 3 6 ) d e s c r i b e t h r e e p o s s i b l e r e s u l t s o f a c c u l t u r a t i o n : 1. A c c e p t a n c e : where t h e p r o c e s s o f a c c u l t u r a t i o n r e s u l t s i n t h e t a k i n g o v e r o f t h e g r e a t e r p o r t i o n o f a n o t h e r c u l t u r e and t h e l o s s o f most o f t h e o l d e r c u l t u r a l h e r i t a g e . I n t h i s o u t c o m e , g r o u p members a s s i m i l a t e t h e b e h a v i o u r p a t t e r n s a s w e l l a s t h e i n n e r v a l u e s o f t h e c u l t u r e w i t h w h i c h t h e y have come i n t o c o n t a c t . 2. A d a p t a t i o n : w here b o t h o l d and new c u l t u r a l t r a i t s a r e c o m b i n e d i n t o a d i f f e r e n t and h a r m o n i o u s c u l t u r a l w h o l e o r where t h e i n d i v i d u a l s r e t a i n a s e r i e s o f c o n f l i c t i n g a t t i t u d e s and v a l u e s t h a t a r e r e c o n c i l e d i n e v e r y d a y l i f e a s s p e c i f i c o c c a s i o n s a r i s e , a n d , 3. R e a c t i o n : where b e c a u s e o f o p p r e s s i o n , o r t h e u n f o r e s e e n r e s u l t s o f t h e a c c e p t a n c e o f new c u l t u r a l t r a i t s , c o n t r a - a c c u l t u r a t i o n movements a r i s e and a r e m a i n t a i n e d . R e d f i e l d e t a l . ( 1 9 3 6 ) drew up a s p e c i f i c o u t l i n e t o f a c i l i t a t e f i e l d a n t h r o p o l o g i s t s ' s t u d y o f a c c u l t u r a t i o n . T h e i r work r e m a i n e d t h e most w i d e l y a c c e p t e d u n t i l 1 954, when t h e S o c i a l S c i e n c e R e s e a r c h C o u n c i l ' s (SSRC) Summer S e m i n a r r e v i e w e d a l l t h e work done on a c c u l t u r a t i o n t o t h a t d a t e and d e f i n e d a c c u l t u r a t i o n as f o l l o w s : . . . c u l t u r e c h a n g e t h a t i s i n i t i a t e d by t h e c o n j u n c t i o n o f two o r more autonomous c u l t u r a l s y s t e m s . A c c u l t u r a t i v e c h a n g e may be t h e c o n s e q u e n c e o f d i r e c t c u l t u r a l t r a n s m i s s i o n ; i t may be d e r i v e d f r o m n o n - c u l t u r a l c a u s e s , s u c h as e c o l o g i c a l o r d e m o g r a p h i c m o d i f i c a t i o n s , i n d u c e d by an i m p i n g i n g c u l t u r e ; i t may be d e l a y e d , as w i t h i n t e r n a l a d j u s t m e n t s f o l l o w i n g upon t h e a c c e p t a n c e o f a l i e n t r a i t s o r p a t t e r n s ; o r i t may be a r e a c t i v e a d a p t a t i o n o f t r a d i t i o n a l modes o f l i f e . I t s d y n a m i c s c a n be s e e n as t h e s e l e c t i v e a d a p t a t i o n o f v a l u e s y s t e m s , t h e p r o c e s s e s o f i n t e g r a t i o n and d i f f e r e n t i a t i o n , t h e g e n e r a t i o n o f d e v e l o p m e n t a l s e q u e n c e s , and t h e o p e r a t i o n o f r o l e d e t e r m i n a n t s and p e r s o n a l i t y f a c t o r s ( p . 9 7 4 ) . B e r r y ( 1 9 8 0 ) , e x p a n d i n g on t h e work o f t h e SSRC, s t a t e s t b a t a l t h o u g h i n t h e o r y a c c u l t u r a t i o n c a n o c c u r i n e i t h e r o f t h e two c o n t a c t i n g c u l t u r e s , one g r o u p g e n e r a l l y d o m i n a t e s t h e o t h e r w e a k e r g r o u p and c o n t r i b u t e s more t o t h e f l o w o f c u l t u r a l t r a i t s . The c o n c e p t o f t h e d o m i n a t i o n o f one c u l t u r e by a n o t h e r , " s u g g e s t s t h a t what h a p p e n s b e t w e e n c o n t a c t and c h a n g e may be d i f f i c u l t , r e a c t i v e and c o n f l i c t u a l r a t h e r t h a n a s m o o t h t r a n s i t i o n " ( B e r r y , 1 9 8 0 , p . 1 0 ) . R e l a t i o n s h i p s b e t w e e n t h e two c u l t u r e s t h e r e f o r e a r e l i k e l y 34 t o be f r a u g h t w i t h c o n f l i c t . B e r r y p r o p o s e s a t h r e e - p h a s e c o u r s e t o a c c u l t u r a t i o n : c o n t a c t , c o n f l i c t and a d a p t a t i o n . F o r a c c u l t u r a t i o n t o o c c u r , c o n t a c t i s n e c e s s a r y , c o n f l i c t i s p r o b a b l e and a d a p t a t i o n i s i n e v i t a b l e . W i t h o u t c o n t a c t t h e r e i s no a c c u l t u r a t i o n , t h e r e f o r e t h i s p h a s e i s a p r e r e q u i s i t e f o r t h e o t h e r two p h a s e s . C o n f l i c t t a k e s p l a c e o n l y i n t h e c a s e o f some d e g r e e o f r e s i s t a n c e ; b u t , a s B e r r y ( 1 9 8 0 ) p o i n t s o u t , e x p e r i e n c e shows t h a t g r o u p s do n o t l i g h t l y g i v e up c u l t u r a l b e l i e f s and v a l u e s . C o n f l i c t a t some p o i n t d u r i n g c o n t a c t h a s t h e r e f o r e b een t h e r u l e . A d a p t a t i o n r e f e r s t o t h e t h r e e ways i n w h i c h c o n f l i c t i s r e d u c e d o r s t a b i l i z e d : a d j u s t m e n t , r e a t i o n o r w i t h d r a w a l . When one c o n s i d e r s B e r r y ' s ( 1 9 8 0) t h r e e - p h a s e c o u r s e o f a c c u l t u r a t i o n , i t i s a p p a r e n t t h a t c o n t a c t , c o n f l i c t , a n d a d a p t a t i o n a r e p h a s e s t h a t may be a p p l i e d a t b o t h t h e g r o u p and i n d i v i d u a l l e v e l s . Thus " a c c u l t u r a t i o n may be t r e a t e d a s a t w o - l e v e l p h e n o m e n o n — t h a t o f t h e g r o u p and t h a t o f t h e i n d i v i d u a l " ( B e r r y , 1 9 8 0 , p . 1 1 ) . D u r i n g i n t e r v i e w s t h e s u b j e c t s , i n a t t a c h i n g m e a n i n g t o t h e i r e x p e r i e n c e s , d i s c u s s e d t h e p h a s e s o f t h e i r a c c u l t u r a t i o n , o f t e n u s i n g t h e t e r m " a c c u l t u r a t i o n . " The women d i f f e r e d i n t h e i r a b i l i t y t o r e c o g n i z e and d i s c u s s t h e p r o c e s s o f a c c u l t u r a t i o n , a l t h o u g h i t was o b v i o u s t h a t t h e p r o c e s s h a d s h a p e d t h e i r p e r c e p t i o n s o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s . Women who were i n l a t e r p h a s e s o f t h e p r o c e s s o f a c c u l t u r a t i o n were a b l e t o u n d e r s t a n d and e x p l a i n t h e i r c h i l d b e a r i n g e x p e r i e n c e s i n t e r m s o f t h i s p r o c e s s , w h e r e a s 35 women who were i n t h e e a r l i e r p h a s e s o f a c c u l t u r a t i o n a l l u d e d t o c u l t u r a l d i f f e r e n c e s b u t c o u l d n o t d i r e c t l y d i s c u s s them. I n g e n e r a l , h o w e v e r , t h e women's a c c o u n t s o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s s p o k e e l o q u e n t l y o f t h e p r o c e s s o f a c c u l t u r a t i o n . Themes R e l a t e d t o A c c u l t u r a t i o n a n d t h e C h i l d b e a r i n g E x p e r i e n c e W i t h t h e eme r g e n c e o f a c c u l t u r a t i o n a s t h e c e n t r a l , o r g a n i z i n g c o n c e p t , t h e r e s e a r c h e r r e t u r n e d t o t h e o r i g i n a l d a t a and a n a l y z e d t h e women's a c c o u n t s f r o m a new p e r s p e c t i v e . I t was f o u n d t h a t a s t h e women a d o p t e d v a r i o u s a s p e c t s o f C a n a d i a n c u l t u r e , t h e y b egan t o a c q u i r e C a n a d i a n b e l i e f s a n d p r a c t i c e s . I n a c y c l i c a l p r o c e s s , a s t h e women t o o k on C a n a d i a n b e l i e f s and p r a c t i c e s , t h e i r p r o c e s s o f a c c u l t u r a t i o n i n t o C a n a d i a n c u l t u r e was a c c e l e r a t e d . As p a r t o f t h e i r s y s t e m o f b e l i e f s and p r a c t i c e s , t h e i r a t t i t u d e s , v i e w s and b e h a v i o u r s p e r t a i n i n g t o h e a l t h , a l s o t o o k on C a n a d i a n c h a r a c t e r i s t i c s . A l t h o u g h t h e r e s e a r c h q u e s t i o n s g u i d i n g t h i s s t u d y d e a l t s p e c i f i c a l l y w i t h t h e women's b e l i e f s a b o u t c h i l d b e a r i n g , t h e i r p e r c e p t i o n s o f t h e i r t r a d i t i o n a l c h i l d b e a r i n g p r a c t i c e s , as w e l l a s t h e women's p e r c e p t i o n s o f t h e h e a l t h c a r e r e s o u r c e s t h e y u t i l i z e d d u r i n g c h i l d b e a r i n g , t h e women c o u l d n o t make s e n s e o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s w i t h o u t p l a c i n g them w i t h i n a b r o a d e r c o n t e x t . A c c o r d i n g l y , a s t h e women s p o k e o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s t h e y 36 t a l k e d o f t h e i r h e a l t h b e l i e f s and p r a c t i c e s , s e x u a l i t y , a r r a n g e d m a r r i a g e s , a p r e f e r e n c e f o r m a l e o f f s p r i n g , t h e a u t h o r i t y and r e s p e c t due e l d e r s , and h e a l t h c a r e p r o f e s s i o n a l s as w e l l a s s h y n e s s and l a c k o f k n o w l e d g e i n a r e a s o f t h e i r own s e x u a l i t y . A l l o f t h e women i n t h e s t u d y s p o k e o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s i n r e l a t i o n t o t h e abov e t o p i c s , and t h e i r p e r c e p t i o n s o f t h e s e t o p i c s seemed t o be a f f e c t e d by t h e c e n t r a l p r o c e s s o f a c c u l t u r a t i o n . By v i e w i n g t h e c h i l d b e a r i n g e x p e r i e n c e w i t h i n a b r o a d e r c o n t e x t , t h e r e s e a r c h e r was a b l e t o c o n t i n u e a n a l y s i s and s e e t h a t two themes emerged f r o m t h e d a t a and r e l a t e d t o t h e c e n t r a l p r o c e s s o f a c c u l t u r a t i o n . T h e s e themes e x i s t e d t h r o u g h o u t t h e c h i l d b e a r i n g e x p e r i e n c e , v a r y i n g i n p r o m i n e n c e a t d i f f e r e n t t i m e s , b u t a l w a y s p r e s e n t t o some d e g r e e . The two themes i d e n t i f i e d t h r o u g h t h e d a t a w e r e : 1. The s u b j e c t s ' r e l a t i o n s h i p s w i t h t h e i r f a m i l i e s a n d , 2 . The s u b j e c t s ' r e l a t i o n s h i p s w i t h h e a l t h c a r e p r o f e s s i o n a l s . T h r o u g h o u t t h e c h i l d b e a r i n g e x p e r i e n c e , I n d o - C a n a d i a n i m m i g r a n t women a r e i n c o n t a c t w i t h f a m i l y members as w e l l as h e a l t h c a r e p r o f e s s i o n a l s . How e a c h woman r e l a t e s t o e a c h g r o u p i s d e t e r m i n e d by h e r d e g r e e o f a c c u l t u r a t i o n . The women's r e l a t i o n s h i p s w i t h e a c h g r o u p a l s o p l a y e d a s i g n i f i c a n t r o l e i n s h a p i n g t h e i r p e r c e p t i o n s o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s . T h e i r r e l a t i o n s h i p s w i t h t h e i r f a m i l i e s and w i t h h e a l t h c a r e p r o f e s s i o n a l s s e r v e d a s f u r t h e r o r g a n i z i n g c e n t r e s a r o u n d w h i c h t h e s e women's c h i l d b e a r i n g e x p e r i e n c e s c o u l d be e x p l a i n e d . The a n a l y t i c f r a m e w o r k w h i c h emerged t o d e s c r i b e t h e c h i l d b e a r i n g e x p e r i e n c e s o f I n d o - C a n a d i a n women i s s c h e m a t i c a l l y r e p r e s e n t e d as f o l l o w s : C h i l d b e a r i n g E x p e r i e n c e The r e l a t i o n s h i p The r e l a t i o n s h i p w i t h w i t h f a m i l y members h e a l t h c a r e p r o f e s s i o n a l s F i g u r e 1. A c c u l t u r a t i o n : An a n a l y t i c f r a m e w o r k f o r t h e c h i l d b e a r i n g e x p e r i e n c e . R e l a t i o n s h i p o f A n a l y t i c Framework t o t h e E x p l a n a t o r y M o d e l As d i s c u s s e d i n C h a p t e r 1, K l e i n m a n ' s e x p l a n a t o r y m o d e l s u g g e s t s t h a t h e a l t h and i l l n e s s a r e s o c i a l l y c o n s t r u c t e d and t h a t s u b j e c t s i n t e r n a l i z e s o c i a l r e a l i t y o f a new c u l t u r e t h r o u g h t h e p r o c e s s o f a c c u l t u r a t i o n ( K l e i n m a n , 1 9 8 0 ) . The p r o c e s s o f a c c u l t u r a t i o n , i n w h i c h a s u b j e c t l e a r n s and i n t e r n a l i z e s a d i f f e r e n t s o c i a l r e a l i t y , i s c o n s i s t e n t w i t h t h e e x p l a n a t o r y m o d e l . W i t h i n t h e p o p u l a r d o m a i n , s u b j e c t s * e x p l a n a t o r y m o d e l s w o u l d a l t e r a s t h e y move t h r o u g h t h e p r o c e s s o f a c c u l t u r a t i o n . The A n a l y t i c Framework and t h e S t u d y F i n d i n g s 38 The c e n t r a l c o n c e p t o f a c c u l t u r a t i o n and two themes r e l a t e d t o i t , p r o v i d e d d i r e c t i o n f o r t h e r e s e a r c h e r t o s y n t h e s i z e t h e s u b j e c t s ' e x p e r i e n c e s i n t o an o r g a n i z e d d e s c r i p t i o n . U s i n g t h e a n a l y t i c f r a m e w o r k d e s c r i b e d , t h e r e s e a r c h e r was a b l e t o u n d e r s t a n d t h e s u b j e c t s ' e x p e r i e n c e s f r o m t h e i r v i e w p o i n t s . C h a p t e r 4 w i l l d e s c r i b e t h i s e x p e r i e n c e i n c o n j u n c t i o n w i t h a p p r o p r i a t e p r o f e s s i o n a l l i t e r a t u r e . Summary T h i s c h a p t e r h a s e x p l a i n e d how t h e d a t a were a n a l y z e d a c c o r d i n g t o t h e p h e n o m e n o l o g i c a l m e t h o d o f i n q u i r y . The a n a l y t i c f r a m e w o r k was p r e s e n t e d and d i s c u s s e d a s a way o f u n d e r s t a n d i n g t h e phenomena u n d e r i n v e s t i g a t i o n . The f r a m e w o r k was shown t o be c o n s i s t e n t w i t h K l e i n m a n * s (1980) e x p l a n a t o r y m o d e l . 39 CHAPTER 4 The S u b j e c t s ' P e r c e p t i o n s of t h e i r C h i l d b e a r i n g Experiences D e s c r i p t i v e accounts of the Indo-Canadian women immigrants' c h i l d b e a r i n g experiences were e l i c i t e d using the phenomenological method. These accounts e l u c i d a t e d the explanatory model f o r the c h i l d b e a r i n g experience of t h i s p a r t i c u l a r c u l t u r a l group. As d i s c u s s e d i n Chapter 3, the women's explanatory models of c h i l d b e a r i n g were c o n s t r u c t e d w i t h i n a broader c o n t e x t . Although the res e a r c h questions g u i d i n g t h i s study d e a l t with c h i l d b e a r i n g s p e c i f i c a l l y , the women made sense of t h e i r experiences w i t h i n a l a r g e r framework which i n c l u d e d s e x u a l i t y , arranged marriage, b i r t h c o n t r o l , sex pre f e r e n c e of t h e i r o f f s p r i n g , the a u t h o r i t y o f , and r e s p e c t f o r e l d e r s and h e a l t h care p r o f e s s i o n a l s , as w e l l as shyness and lack of knowledge. The concept of a c c u l t u r a t i o n helped the res e a r c h e r to make sense of the women's e x p e r i e n c e s . The two themes, r e l a t e d to a c c u l t u r a t i o n , a l s o emerged: 1. The s u b j e c t s ' r e l a t i o n s h i p s with t h e i r f a m i l i e s , and 2. The s u b j e c t s ' r e l a t i o n s h i p s with h e a l t h care p r o f e s s i o n a l s . These two themes served as o r g a n i z i n g c e n t r e s f o r the women's pe r c e p t i o n s of t h e i r c h i l d b e a r i n g experiences i n Canada. 40 I n t h i s c h a p t e r , t h e s u b j e c t s ' a c c o u n t s w i l l be p r e s e n t e d a c c o r d i n g t o t h e u m b r e l l a c o n c e p t o f a c c u l t u r a t i o n and t h e d a t a w i l l be o r d e r e d a r o u n d t h e two i d e n t i f i e d t h e m e s . T h i s w i l l s e r v e t o f u r t h e r o r g a n i z e t h e d a t a and e x p l i c a t e t h e e x p e r i e n c e s u n d e r i n v e s t i g a t i o n . R e l e v a n t l i t e r a t u r e w i l l be d i s c u s s e d i n r e l a t i o n t o t h e d a t a t h e r e b y s e r v i n g a s a c o m p a r i s o n b e t w e e n t h e p o p u l a r and p r o f e s s i o n a l v i e w s o f t h e c h i l d b e a r i n g e x p e r i e n c e s o f I n d o - C a n a d i a n women i m m i g r a n t s . The S u b j e c t s ' R e l a t i o n s h i p s w i t h t h e i r F a m i l i e s I n t h i s s e c t i o n t h e women's a c c o u n t s o f t h e i r h e a l t h b e l i e f s and p r a c t i c e s d u r i n g c h i l d b e a r i n g w i l l be d e s c r i b e d and d i s c u s s e d i n r e l a t i o n t o t h e i r f a m i l i e s . The s u b j e c t s ' a c c o u n t s i n d i c a t e t h a t t h e i r h e a l t h b e l i e f s and p r a c t i c e s a r e s t r o n g l y i n f l u e n c e d by t h e i r f a m i l i e s . The u m b r e l l a c o n c e p t o f a c c u l t u r a t i o n w i l l be woven t h r o u g h t h i s s e c t i o n and i t w i l l be shown t h a t t h e p r o c e s s o f a c c u l t u r a t i o n b o t h a f f e c t s and i s a f f e c t e d by t h e s u b j e c t s ' r e l a t i o n s h i p s w i t h t h e i r f a m i l i e s . The p r o c e s s o f a c c u l t u r a t i o n t h e r e f o r e i m p a c t e d on t h e h e a l t h b e l i e f s and p r a c t i c e s s u r r o u n d i n g c h i l d b e a r i n g . As t h e women t a l k e d o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s , t h e y e x p l a i n e d t h e i r h e a l t h b e l i e f s a n d p r a c t i c e s i n r e l a t i o n t o s e x u a l i t y , a r r a n g e d m a r r i a g e , s e x p r e f e r e n c e o f o f f s p r i n g , p r e g n a n c y a n d t h e p o s t - p a r t u m p e r i o d . A l l o f t h e s e h e a l t h b e l i e f s and p r a c t i c e s w e r e a f f e c t e d by t h e s u b j e c t s ' r e l a t i o n s h i p s w i t h t h e i r f a m i l i e s , a n d were a l t e r e d by t h e p r o c e s s o f a c c u l t u r a t i o n . I n t h e women's a c c o u n t s o f t h e i r r e l a t i o n s h i p s w i t h t h e i r f a m i l i e s d u r i n g t h e c h i l d b e a r i n g e x p e r i e n c e , t h e i n f l u e n c i n g f a c t o r s o f a u t h o r i t y , r e s p e c t , s h y n e s s , a n d l a c k o f k n o w l e d g e e m e r g e d . T h e s e f a c t o r s p e r v a d e d t h e s u b j e c t s ' r e l a t i o n s h i p s w i t h t h e i r f a m i l i e s , and had an i m p a c t on t h e women's h e a l t h b e l i e f s a n d p r a c t i c e s r e l a t e d t o t h e c h i l d b e a r i n g e x p e r i e n c e . The i n f l u e n c e o f t h e s e f a c t o r s on t h e women's h e a l t h b e l i e f s and p r a c t i c e s was a l s o d e t e r m i n e d by t h e p r o c e s s o f a c c u l t u r a t i o n . The h e a l t h b e l i e f s and p r a c t i c e s t h e women s p o k e o f , t o g e t h e r w i t h t h e i d e n t i f i e d i n f l u e n c i n g f a c t o r s i n r e g a r d t o t h e i r f a m i l i e s , f o r m e d a m a j o r p o r t i o n o f t h e women's e x p l a n a t o r y m o d e l s o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s . T a b l e 1. Theme; The S u b j e c t s ' R e l a t i o n s h i p s w i t h T h e i r F a m i l i e s H e a l t h B e l i e f s I n f l u e n c i n g and P r a c t i c e s F a c t o r s a u t h o r i t y r e s p e c t s h y n e s s l a c k o f k n o w l e d g e , I n t h i s s e c t i o n t h e s u b j e c t s ' a c c o u n t s w i l l be p r e s e n t e d a c c o r d i n g t o t h e theme, h e a l t h b e l i e f s a n d p r a c t i c e s , a n d i n f l u e n c i n g f a c t o r s . s e x u a l i t y a r r a n g e d m a r r i a g e s e x p r e f e r e n c e o f o f f s p r i n g p r e g n a n c y p o s t - p a r t u m H e a l t h B e l i e f s and P r a c t i c e s and I n f l u e n c i n g F a c t o r s 42 The women d e s c r i b e d a s e r i e s of h e a l t h b e l i e f s and p r a c t i c e s r e l a t e d t o the c h i l d b e a r i n g e x p e r i e n c e t h a t were l e a r n e d and e x p r e s s e d w i t h i n the c o n t e x t o f everyday f a m i l y l i f e . The e x p l a n a t o r y models t h a t emerged from the d a t a r e v e a l e d t h a t o l d e r , e x p e r i e n c e d women a c t as the a u t h o r i t i e s on c h i l d b e a r i n g b e l i e f s and p r a c t i c e s ; f u r t h e r m o r e , the acc o u n t s d e s c r i b e d how p a r e n t a l a u t h o r i t y and r e s p e c t f o r e l d e r s c o n t r i b u t e t o the women's p e r c e p t i o n s t h a t shyness i s a c u l t u r a l t r a i t which d e f i n e s t h e i r s e x u a l i t y from c h i l d h o o d onward. In t u r n t h i s shyness a f f e c t s the women's p e r c e p t i o n s of t h e i r c h i l d b e a r i n g e x p e r i e n c e s and c o n t r i b u t e s t o t h e i r l a c k o f knowledge i n many ar e a s o f c h i l d b e a r i n g . T h i s l a c k o f knowledge may i n f a c t c o n t r i b u t e t o the f a m i l y e l d e r s ' c o n t i n u e d a u t h o r i t y i n c e r t a i n h e a l t h b e l i e f s and p r a c t i c e s . A l l the women t a l k e d of " l i s t e n i n g t o the d o c t o r f i r s t " , b ut the degree t o which the d o c t o r s ' a d v i c e superseded t h a t of the e l d e r s on m a t t e r s such as d i e t and a c t i v i t y , was d i r e c t l y r e l a t e d t o the degree o f each woman's a c c u l t u r a t i o n i n t o Canadian s o c i e t y . I n t h e i r a c c o u n t s of the on s e t o f menses, the women h e l p e d the i n v e s t i g a t o r u n d e r s t a n d the o r i g i n s of t h e i r p r e s e n t - d a y p e r c e p t i o n s of t h e i r c h i l d b e a r i n g e x p e r i e n c e s . S e x u a l i t y 43 The women spoke of shyness i n r e l a t i o n to matters of s e x u a l i t y . They used t h i s term to d e s c r i b e t h e i r u p b r i n g i n g i n I n d i a , e x p l a i n i n g that shyness i s common to a l l East Indian women and has a gre a t impact on c h i l d b e a r i n g because i t a f f e c t s menstruation, sex, and b i r t h c o n t r o l . One woman s a i d of her u p b r i n g i n g : As I t o l d you, i n the o l d country, people are very shy. Right because we are brought up th a t way....All people are not same, but mostly you know, I'm t a l k i n g about the n i n e t y - n i n e p e r c e n t , maybe n i n e t y - e i g h t , you're always going to count that much r i g h t , nobody counts two persons you know. N i n e t y - e i g h t percent people, they don't t a l k to t h e i r parents you know...I think I t o l d you t h a t we're brought up l i k e t h a t . You know, when we are in I n d i a , we are not t a l k i n g to our mothers, you know when the menses i s coming f i r s t time you know, they don't want to t a l k about t h a t . Another woman, t a l k i n g on the t o p i c of s e x u a l i t y , s a i d : In our country we are shy from t h a t , we r e s p e c t p a r e n t s — w e don't t a l k from those t h i n g s . Women o f t e n r e l a t e d how they had t h e i r f i r s t menstruation without having any i n f o r m a t i o n of t h i s p h y s i o l o g i c a l occurrence. One woman, who had grown up i n a c i t y i n the Punjab, l i v e d i n a nu c l e a r f a m i l y i n Canada, and spoke E n g l i s h w e l l , s a i d o f h e r f i r s t m e n s t r u a t i o n . Y e a h , i t was a s u r p r i s e . I was v i s i t i n g w i t h one o f my o t h e r f r i e n d s . T h ey were h a v i n g r i g h t , and t h e y w e r e t e l l i n g m e — b u t I n e v e r had a n y t h i n g f r o m my m o t h e r o r a n y t h i n g f r o m my o t h e r s i s t e r s y o u know b e c a u s e i t ' s t h e k i n d o f t h i n g t h a t p e o p l e a r e v e r y s h y r i g h t . T h ey d o n ' t want t o , y o u know, a s k y o u know. E v e n when I g o t , I was h i d i n g y o u know, f r o m my m o t h e r a nd f r o m my s i s t e r y o u know, b u t my s i s t e r y o u know, she f o u n d o u t and she t o l d me what I s h o u l d do y o u know. A n o t h e r woman, who l i v e d i n a l a r g e e x t e n d e d f a r m f a m i l y i n C a n a d a , had b e e n t o l d a b o u t m e n s t r u a t i o n when she a p p r o a c h e d h e r s i s t e r a f t e r s h e had begun t o b l e e d . A s k e d i f she h a d b e e n f r i g h t e n e d , she r e p l i e d : Y e a h , t h a t ' s r i g h t . I t e l l my s i s t e r , l i k e i t ' s b l e e d i n g b l o o d f r o m my body y o u know, and s h e t o l d me "Use p a d . I t s h o u l d c o n t i n u e f i v e d a y s i t ' s maybe y o u ha v e p e r i o d . " Of t h e f i r s t t i m e s h e m e n s t r u a t e d one s u b j e c t , who came f r o m a v i l l a g e , l i v e d i n an e x t e n d e d f a m i l y i n Canada and s p o k e v e r y l i t t l e E n g l i s h , s a i d : I f e e l v e r y d i f f i c u l t when I g e t my p e r i o d t h e f i r s t t i m e . . . I d i d n ' t know what i t was... A n o t h e r woman, r e l a t i n g how h e r m o t h e r h a d n o t g i v e n h e r any i n f o r m a t i o n a b o u t p u b e r t y , s a i d : See i n o u r c u l t u r e , t h e y d o n ' t t e l l a n y t h i n g l i k e 45 s m a l l g i r l s , r i g h t , b u t h e r e t h e y ' r e g o i n g t o s e e a m o v i e f i l m i n g r a d e f i v e o r s i x r i g h t . . . Y e a h , i n t h e s c h o o l , b u t i n o u r c u l t u r e t h e y d o n ' t t e l l a n y t h i n g a b o u t t h i s i n I n d i a . T h i s woman had e m i g r a t e d t o Canada j u s t p r i o r t o g r a d u a t i n g f r o m h i g h s c h o o l . I n Canada s he had been p u t b a c k s e v e r a l s c h o o l y e a r s and r e q u i r e d t o r e p e a t h i g h s c h o o l . She had s o c i a l i z e d i n t o C a n a d i a n s o c i e t y and r e a l i z e d and a c c e p t e d t h a t i n Canada h e r d a u g h t e r w o u l d be a p a r t o f t h i s o p en s o c i e t y . One p a r t i c i p a n t , s p o k e E n g l i s h w e l l and had be e n a s c h o o l t e a c h e r i n t h e P u n j a b . I n d r e s s and m a n n e r s she a p p e a r e d a c c u l t u r a t e d i n t o C a n a d i a n s o c i e t y , and t o l d o f a d i f f e r e n t e x p e r i e n c e : W e l l , my s i s t e r , my m o t h e r and me s a t down and s a i d s o m e t i m e s o t h e r l a d i e s s a i d , t h e y t a l k a b o u t t h a t , t h e n I u n d e r s t a n d . T h i s d i r e c t p a r t i c i p a t i o n i n d i a l o g u e a b o u t t h e o n s e t o f m e n s t r u a t i o n e n c o u r a g e d t h i s s u b j e c t t o a p p r o a c h h e r m o t h e r l a t e r o n . Y e a h , when I s t a r t my p e r i o d , t h e n I go t o my m o t h e r and she t o l d me a b o u t u s i n g t h e p a d . And t h e n I u s e d i t . R e g a r d l e s s o f who had t o l d t h e women a b o u t what t o do and what t o u s e when t h e y m e n s t r u a t e d , n o t one o f t h e s u b j e c t s h a d b e e n t o l d t h e p u r p o s e o f t h i s n o r m a l p h y s i o l o g i c a l p r o c e s s . When a s k e d i f t h e y were t o l d o r knew why t h e y m e n s t r u a t e d , one s u b j e c t s a i d : No, I d i d n ' t . I d i d n o t . And a n o t h e r : I d o n ' t know b e c a u s e I t h i n k t h a t e v e r y b o d y g o t i t . I g o t i t — m y s i s t e r . I n e v e r had been t o l d ( w h y ) . A t h i r d s a i d : I no u n d e r s t a n d why I g e t t h i s b l e e d i n g , no one t e l l me. W h i l e a t u n i v e r s i t y one s u b j e c t e x p l a i n e d t h a t s h e had s o u g h t o u t h e r own i n f o r m a t i o n and r e a d an E n g l i s h book i n w h i c h m e n s t r u a t i o n was e x p l a i n e d . P u r s u i n g h e r own a n s w e r s s e t t h i s woman a p a r t f r o m o t h e r s t u d y p a r t i c i p a n t s and may be p a r t i a l l y e x p l a i n e d by h e r b a c k g r o u n d . L i v i n g i n a c i t y i n t h e P u n j a b and h a v i n g g o o d E n g l i s h s k i l l s h a d g i v e n h e r a c c e s s t o t h e m a t e r i a l s h e w a n t e d . A n o t h e r woman c o u l d n o t r e c a l l e x a c t l y w here h e r i n f o r m a t i o n a b o u t m e n s t r u a t i o n h a d come f r o m . I t h i n k when I came h e r e ( a g e 1 8 ) , I f i n d t h a t e v e r y t h i n g i s c o m p l e t e l y d i f f e r e n t f r o m , y o u know, f r o m I n d i a , e s p e c i a l l y on T . V . — I t h i n k f r o m t h e r e and a s w e l l I d o n ' t s e e anyone p e r s o n a l l y , I d o n ' t a s k a n y o n e b u t I knew j u s t f r o m my f r i e n d s . My f r i e n d s t h e y g o t m a r r i e d b e f o r e me r i g h t , and s o m e t i m e s t h e y a r e t e l l i n g me a l l w h a t ' s h a p p e n i n g and e v e r y t h i n g . A t t h i s t i m e t h i s woman was r e c e i v i n g i n f o r m a t i o n on n o t o n l y m e n s t r u a t i o n b u t a l s o s e x u a l a c t i v i t i e s a n d c o n c e p t i o n . I t 47 s h o u l d be n o t e d t h a t by o c c u p a t i o n ( a s a r e a l e s t a t e a g e n t ) , l i v i n g a r r a n g e m e n t s and a b i l i t y t o s p e a k E n g l i s h , t h i s woman was more a c c u l t u r a t e d i n t o C a n a d i a n s o c i e t y t h a n were t h e o t h e r p a r t i c i p a n t s . H o wever, i n f o r m a t i o n a b o u t s e x u a l i t y was g i v e n t o h e r p a s s i v e l y . D e s p i t e h e r a c c u l t u r a t i o n , s h y n e s s i n t h i s a r e a was s t i l l a f o r c e i n h e r l i f e . T h r e e o f t h e a b o v e women a s k e d t h e r e s e a r c h e r f o r i n f o r m a t i o n a b o u t m e n s t r u a t i o n and c o n c e p t i o n . The i n v e s t i g a t o r v o l u n t e e r e d t o p r o v i d e t h e f a c t s a f t e r t h e i n t e r v i e w i n g was c o m p l e t e d . The t h r e e women l i v e d on a l a r g e e x t e n d e d f a m i l y f a r m i n C a n a d a . A l l had gr o w n up i n s m a l l v i l l a g e s i n t h e P u n j a b , none o f them w o r k e d o u t s i d e t h e home o r f a r m , and t h e i r a b i l i t y t o s p e a k E n g l i s h v a r i e d f r o m p o o r t o a c c e p t a b l e . The women a l l h a d more t h a n one c h i l d , b u t showed i g n o r a n c e o f m e n s t r u a t i o n and c o n c e p t i o n . They a s k e d t o t a l k i n d i v i d u a l l y w i t h t h e i n v e s t i g a t o r w h i l e she was g i v i n g them i n f o r m a t i o n . One o f t h e women t o l d t h e r e s e a r c h e r s h e was " t o o s h y " t o p a r t i c p a t e i n a g r o u p d i s c u s s i o n on t h i s t o p i c . S h y n e s s a s i t i n f l u e n c e s how o r what t h e women l e a r n a b o u t t h e i r b o d i e s and m e n s t r u a t i o n i n t h e i r y o u n g e r y e a r s , s e t s up a s i t u a t i o n o f i g n o r a n c e i n a d u l t h o o d when t h e women e n t e r m a r r i a g e and t h e n e x p e r i e n c e c h i l d b e a r i n g . I t a p p e a r s t h a t a s women become more a c c u l t u r a t e d i n t o C a n a d i a n s o c i e t y t h e y l e a r n more a b o u t t h e i r b o d i e s , b u t e v e n t h i s k n o w l e d g e i s o f t e n f r a g m e n t a r y and p a s s i v e l y r e c e i v e d . M o st o f t h e p a r t i c i p a n t s l e a r n e d e a r l y i n l i f e . t h a t i t was a p p r o p r i a t e t o 48 be s h y a b o u t a l l a r e a s o f t h e i r s e x u a l i t y and n o t t o a s k q u e s t i o n s . T h e i r a r r a n g e d m a r r i a g e s t o men t h e y d i d n o t know s e r v e d t o p u t them a t a f u r t h e r d i s a d v a n t a g e . A t t h i s t i m e t h e i r a c c o u n t s s p o k e o f how t h e i r r e s p e c t f o r t h e i r e l d e r s l e d t o t h e s e a r r a n g e d m a r r i a g e s and t h e i r s h y n e s s and l a c k o f k n o w l e d g e t h e n p u t them a t r i s k f o r u n w a n t e d p r e g n a n c i e s . A r r a n g e d M a r r i a g e The women made s e n s e o f t h e i r a r r a n g e d m a r r i a g e s w i t h i n a l a r g e r c o n t e x t t h a n t h e m a r r i a g e i t s e l f . T h e i r s p o u s e s were c h o s e n by t h e i r p a r e n t s , and t h e y r e s p e c t e d and t r u s t e d t h e i r p a r e n t s t o make t h e r i g h t d e c i s i o n s . H owever, t h e women t o l d o f b e i n g s h y and m a r r y i n g men t h e y d i d n o t know. T h i s r e s u l t e d i n t h e women's c o n t i n u e d l a c k o f k n o w l e d g e o f s e x , b i r t h c o n t r o l o r c o n c e p t i o n . T h i s i g n o r a n c e h a d r e p e r c u s s i o n s t h e r e f o r e on t h e c h i l d b e a r i n g e x p e r i e n c e as i t o f t e n l e d t o u n p l a n n e d , u n w a n t e d p r e g n a n c i e s . The women t o l d o f how, when t h e y m a r r y , t h e y owe r e s p e c t t o t h e i r i n - l a w s . T h e i r i n - l a w s e x e r t a g r e a t i n f l u e n c e on them f r o m t h e b e g i n n i n g o f t h e i r m a r r i a g e and on t h r o u g h t h e i r c h i l d b e a r i n g y e a r s . A g a i n , b e c a u s e t h e m a r r i a g e i s a r r a n g e d , t h e y do n o t know t h e s e new r e l a t i v e s b e f o r e t h e w e d d i n g . I t i s n o t u n u s u a l f o r t h e i n d i v i d u a l woman t o have e m b a r k e d on a new m a r r i a g e and a new p r e g n a n c y w i t h o u t h a v i n g p r i o r k n o w l e d g e o f t h e i r s p o u s e o r i n - l a w s . A l l o f t h e women i n t h i s s t u d y t o l d o f h a v i n g h a d t h e i r 49 m a r r i a g e s a r r a n g e d by p a r e n t s . S e v e r a l o f t h e women d i d n o t meet t h e i r f u t u r e s p o u s e s u n t i l t h e w e d d i n g a r r a n g e m e n t s w ere b e i n g made. One woman had n o t been g i v e n t h e c h a n c e t o a c c e p t o r r e j e c t t h e man c h o s e n f o r h e r . Once t h e m a r r i a g e had b e e n a r r a n g e d , h e r f u t u r e h u s b a n d had r e t u r n e d f r o m Canada t o I n d i a f o r t h e w e d d i n g . The woman t h e n t r a v e l l e d t o Canada f o r t h e f i r s t t i m e . She d e s c r i b e d h e r e x p e r i e n c e . E v e r y woman a f t e r m a r r i a g e w i l l l o v e t h e i r h u s b a n d . To l o v e i s t o l i k e t o o much. A f t e r some t i m e , t h e n a l l t h e t i m e o v e r t h e r e , and t h e i r f a t h e r and m o t h e r f a r away and t h e n s h e t a k e s h e r h u s b a n d and t h e n s h e l i k e s h i m t o o m u c h . . . . I t was h a r d . Too much h a r d . Y e a h , when I came h e r e , I c r i e d t o o much. A l l n i g h t t i m e and I n e v e r showed i t t o a n y b o d y . I go i n t h e b a t h r o o m and t h e n a f t e r t h a t I wash my f a c e — . T h i s woman d e s c r i b e d t h e d i f f i c u l t y and i s o l a t i o n o f m a r r y i n g a s t r a n g e r and l e a v i n g h e r h o m e l a n d and t h e s u p p o r t o f h e r b i r t h f a m i l y . . T h i s woman's e x p e r i e n c e a t m a r r i a g e s u b s t a n t i a t e s N i c h t e r ' s ( 1 9 81) f i n d i n g t h a t women who m a r r y i n t o t h e i r h u s b a n d s ' f a m i l i e s and move f a r away f r o m t h e i r b i r t h homes, e x p e r i e n c e d i s t r e s s a t g i v i n g up t h e s u p p o r t o f t h e i r p e e r s , m o t h e r s and s i s t e r s a f t e r m a r r i a g e . D e s p i t e h e r f e e l i n g s , s h e d e s c r i b e d h e r i n t e n t i o n t o a r r a n g e m a r r i a g e s f o r h e r d a u g h t e r s i n C a n a d a : I n o u r c u l t u r e i t i s o u r d u t y a s p a r e n t s t o do. t h i s . 50 She t o l d o f a s t r o n g b e l i e f i n t h i s E a s t I n d i a n c u s t o m a l t h o u g h s he r e a l i z e d t h e r i s k s t h i s c o u l d e n t a i l : B u t some i s a l o v e m a r r i a g e . I n d i a n p e o p l e s o m e t i m e s t h e y ' r e — s o m e g i r l s l o v e a n o t h e r b o y s a nd i t ' s n o t a r r a n g e d . They j u s t l i k e them v e r y much. B u t h e r f a t h e r and m o t h e r d o e s n o t want t o m a r r y them. And t h e n t h e d a u g h t e r l o s t t o o much t o them. T h a t ' s what means l o v e m a r r i a g e . I n C a n a d a , t h i s woman i n t e n d e d t o u p h o l d t h i s E a s t I n d i a n t r a d i t i o n b e c a u s e s he saw i t a s h e r p a r e n t a l d u t y . She was aware t h a t i n t h e f u t u r e t h i s m i g h t p u t h e r i n d i r e c t c o n f l i c t w i t h h e r d a u g h t e r s ' b e l i e f s . A l l b u t one o f t h e women i n t h i s s t u d y t o l d o f b e i n g g i v e n t h e f i n a l c h o i c e a f t e r m e e t i n g t h e i r p r o s p e c t i v e m a t e s . One woman s a i d : T hey a r e a r r a n g e d . B u t t h e y s t i l l a s k us t o o , do we l i k e them o r n o t ; s o i s o u r c h o i c e . And a n o t h e r : He ( h e r f a t h e r ) m i g h t a s k me t o o , n o t f o r c e me t o hav e m a r r i e d h i m , r i g h t . He a s k e d me many t i m e s i f y o u l i k e h i m t h e n y o u c a n , o t h e r w i s e s a y no. A l t h o u g h g i v e n t h i s c h o i c e , n o t one o f t h e women t o l d o f r e f u s i n g h e r p a r e n t s ' c h o i c e . W e l l s e e — t h e p a r e n t s , l i k e , t h e y know u s — s o s e e , t h e y know what t h e mans s h o u l d be l i k e f o r u s , s o we t r u s t them b e c a u s e t h e y i s o u r p a r e n t s . The women a p p e a r t o t r u s t t h e i r p a r e n t s t o make t h e 51 r i g h t c h o i c e and t h i s f i n d i n g i s c o n s i s t e n t w i t h t h e l i t e r a t u r e d e s c r i b i n g f a m i l y r e l a t i o n s h i p s i n I n d i a ( G i d e o n , 1962; S i d d i q u e , 1 9 7 7 ) . T h i s i s a l s o c o n s i s t e n t w i t h t h e f i n d i n g s o f Chance ( 1 9 6 5 ) and Yu ( 1 9 8 4 ) , b o t h o f whom d e s c r i b e t h e d i f f i c u l t i e s an a c c u l t u r a t i n g g r o u p h a s i n g i v i n g up o l d v a l u e s and t a k i n g on new on e s t h a t o f t e n c l a s h . Yu s t a t e s t h a t , a t t h e t i m e t h a t t h e y a r e f e e l i n g a l i e n a t e d f r o m t h e ways o f t h e i r b i r t h c o u n t r y , t h e y a r e i n t h e p r o c e s s o f a c c u l t u r a t i n g t o t h e i r new c o u n t r y and may f o r a t i m e f e e l d i s l o c a t e d , t o some e x t e n t , f r o m b o t h c u l t u r e s . T h i s i s e v i d e n t i n one woman who had had h e r m a r r i a g e a r r a n g e d and f e l t i t was t h e r i g h t t h i n g f o r h e r p a r e n t s t o d o . Of h e r c h i l d r e n ' s m a r r i a g e s i n Canada s h e had t h i s t o s a y : T h e y ' l l be p r o b a b l y C a n a d i a n t y p e d m o s t o f t h e m . . . . B o t h o f us a r e r e a l l y b r o a d m i n d e d . We j u s t w a nt t o s e e them happy t h a t ' s a l l . B u t s t i l l — i t s t r a n g e f o r u s . T h i s woman was d e s c r i b i n g a f e e l i n g o f n o t b e l o n g i n g t o e i t h e r c u l t u r e , i n d i c a t i n g t h a t she had g i v e n up h e r t r a d i t i o n a l E a s t I n d i a n c u l t u r e a n d was i n t h e p r o c e s s o f a d a p t i n g t o C a n a d i a n c u l t u r e . The o t h e r p a r t i c i p a n t s i n t h i s s t u d y d i d n o t f e e l d i s l o c a t e d f r o m t h e i r own c u l t u r e b u t r a t h e r c o n t i n u e d t o b e l i e v e t h a t a r r a n g i n g m a r r i a g e s was t h e a p p r o p r i a t e method o f mate s e l e c t i o n . The f a c t t h a t t h e m a r r i a g e s were a r r a n g e d and t h e women d i d n o t know t h e i r new s p o u s e s , c o m b i n e d w i t h t h e i r s h y n e s s a b o u t s e x u a l i t y , r e s u l t e d i n t h e women c o m i n g t o t h e m a r r i a g e w i t h v e r y l i t t l e k n o w l e d g e o f s e x , b i r t h c o n t r o l o r c o n c e p t i o n . T h i s i n t u r n i n f l u e n c e d t h e i r p e r c e p t i o n s o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s . They o f t e n e x p e r i e n c e d i m m e d i a t e r e p e r c u s s i o n s i n t h e f o r m o f an u n p l a n n e d p r e g n a n c y . F o r many o f t h e s u b j e c t s , s i s t e r s o r f r i e n d s were t h e m a i n s o u r c e s o f i n f o r m a t i o n a b o u t t h e i r s e x u a l i t y . One woman s a i d : Y e s , I t a l k w i t h f r i e n d s . We t e l l e a c h o t h e r . They t e l l me and I t e l l them a b o u t t h i s t h i n g s ( s e x u a l i t y ) . And a n o t h e r : Y e s , my f r i e n d s t o l d me t o o — a t t h e m a r r i a g e r i g h t — a n d some o f my f r i e n d s t h e y come t o my h o u s e , v i s i t i n g t o g e t h e r . Then t h e y t a l k e d a b o u t m a r r i e d l i f e . So t h e n t h e y t o l d me. S t i l l a n o t h e r : T h r o u g h my s i s t e r s , t h e y h a v e t e l l me a l o t when I had my f i r s t t i m e , my p e r i o d . And a f o u r t h woman s a i d : Y e a h , t a l k i n g , y e a h , b e c a u s e r e m e m b e r — m a y b e I t o l d y o u , o u r p e o p l e a r e v e r y s h y — a n d i f y o u have v e r y c l o s e f r i e n d s , I t h i n k n o b o d y ' s m i n d t h a t y o u ' r e t e l l i n g them y o u know, y o u a r e t e l l i n g them a b o u t h u s b a n d , y o u know, t h i s and t h a t , y o u know. T h i s woman's l i f e s t y l e and a t t i t u d e s p a r a l l e l e d C a n a d i a n b e l i e f s and a t t i t u d e s more c l o s e l y t h a n t h o s e o f t h e E a s t 53 I n d i a n c u l t u r e . She c o u l d i n t e l l e c t u a l l y u n d e r s t a n d t h e c o n c e p t o f s h y n e s s f r o m a C a n a d i a n v i e w p o i n t , b u t , i n many a r e a s o f h e r l i f e , s h e c o n t i n u e d t o d e f i n e h e r e x p e r i e n c e s t h r o u g h s h y n e s s . As t h e women t a l k e d o f t h e i r more r e c e n t e x p e r i e n c e s , t h e y d e s c r i b e d how s h y n e s s had c o n t i n u e d t o a f f e c t t h e i r l i v e s . One woman had no k n o w l e d g e o f h e r body o r s e x u a l i t y a t t h e t i m e o f h e r m a r r i a g e . She s a i d : No. N o t — b e f o r e I m a r r i e d I d i d n o t know a n y t h i n g . And t h e n a f t e r we m a r r i e d — I j u s t f o u n d b u t . The women t o l d o f how t h e y m a r r i e d w i t h l i t t l e , i f a n y , k n o w l e d g e o f t h e i r own o r t h e i r h u s b a n d s ' anatomy and p h y s i o l o g y . T hey r e l a t e d how s e x u a l i t y i s a s u b j e c t t h a t i s h i d d e n i n s h y n e s s and n o t d i s c u s s e d o p e n l y . B e c a u s e t h e m a r r i a g e s o f a l l t h e s u b j e c t s were a r r a n g e d , t h e y s p o k e o f b a r e l y k n o w i n g t h e i r new s p o u s e s . They i n i t i a l l y d i d n o t d i s c u s s s e x o r b i r t h c o n t r o l w i t h t h e i r h u s b a n d s . As a r e s u l t , t h e y d e s c r i b e d how t h e y s t a r t e d m a r r i e d l i f e w i t h o u t k n o w l e d g e , o r u s e , o f b i r t h c o n t r o l m e t h o d s . When a s k e d i f t h e y u s e d b i r t h c o n t r o l m e t h o d s when f i r s t m a r r i e d , one woman s a i d : N o t t h e f i r s t t i m e — n o n o t h i n g . A s e c o n d woman s a i d : I m a r r i e d a b o u t 2 7 t h F e b r u a r y and M a r c h I a l r e a d y p r e g n a n t — T h a t ' s why I d o n ' t u s e b i r t h c o n t r o l — n o c h a n c e , no c h a n c e . T h a t ' s r i g h t . T h a t t i m e I were a b o u t 15 d a y s a f t e r . Then I h a v e no p e r i o d . 5 4 When a s k e d o f h e r h u s b a n d ' s r e a c t i o n : Y e a h , he d o n ' t want one y e t . He d o n ' t want c h i l d . He t o l d me a f t e r one y e a r we c a n g e t b a b y , b u t a l r e a d y I h a v e b a b y . T h i s c o u p l e was i n I n d i a a t t h e t i m e o f t h i s f i r s t p r e g n a n c y . T hey h ad i n v e s t i g a t e d t h e p o s s i b i l i t y o f o b t a i n i n g an a b o r t i o n b u t t h e woman had d e c i d e d a g a i n s t i t a s she f e l t i t was h e r d u t y t o have t h e c h i l d . A t t h e t i m e o f t h i s s t u d y t h i s woman had j u s t d e l i v e r e d h e r t h i r d c h i l d i n f i v e y e a r s . N e i t h e r p a r t n e r had e v e r u s e d any b i r t h c o n t r o l m e thod d u r i n g t h e i r m a r r i a g e . T h i s woman had grown up i n a f a r m i n g v i l l a g e i n t h e P u n j a b , where s he had l i v e d i n an e x t e n d e d f a m i l y . A f t e r e m i g r a t i n g t o C a n a d a , s he had c o n t i n u e d t o l i v e i n a l a r g e e x t e n d e d f a r m i n g f a m i l y . She c o n t i n u e d t o s e e c h i l d b e a r i n g a s h e r d u t y and s p o k e o f how h e r c h i l d r e n w o u l d e v e n t u a l l y work on t h e f a r m . One s u b j e c t d e s c r i b e d t h e p r e d i c a m e n t t h a t s h y n e s s p u t h e r i n when s h e f i r s t m a r r i e d : I s h y o f h u s b a n d . No u s e b i r t h c o n t r o l . A f t e r I know h i m much we t a l k o f t h i s b u t I be p r e g n a n t ( a l r e a d y ) . One woman had had a s e r i o u s i l l n e s s f o l l o w i n g w h i c h h e r d o c t o r h a d a d v i s e d h e r a g a i n s t c o n c e i v i n g f o r one y e a r . She c o n t i n u e d h e r p r a c t i c e o f n o t u s i n g any method o f b i r t h c o n t r o l , d e s p i t e a p r i o r p r e g n a n c y r e s u l t i n g f r o m l a c k o f p r o t e c t i o n . F o l l o w i n g h e r t h i r d p r e g n a n c y , s he had begun t o use a method o f b i r t h c o n t r o l as she had d e c i d e d t o w a i t one y e a r b e f o r e h e r n e x t p r e g n a n c y . Then my h u s b a n d s a y s I am g o i n g t o s t a r t p i l l s . I d o n ' t l i k e p i l l s . I t was h e r h u s b a n d ' s d e c i s i o n w h e t h e r b i r t h c o n t r o l w o u l d be u s e d and what f o r m i t w o u l d t a k e . T h i s woman had had t h r e e c h i l d r e n b u t s t i l l f e l t t o o s h y t o d i s c u s s b i r t h c o n t r o l w i t h h e r h u s b a n d . She s i m p l y s u b m i t t e d t o h i s d e c i s i o n s . The woman i n t h e s t u d y who t a l k e d m o s t o p e n l y a b o u t h e r s e x u a l i t y came f r o m a c i t y and l i v e d a C a n a d i a n l i f e s t y l e i n a n u c l e a r f a m i l y . She had an i n t e r e s t i n g s t o r y a b o u t b i r t h c o n t r o l . B i r t h c o n t r o l , y o u know, oh g o s h . I was n o t u s i n g a n y — T h a t ' s r i g h t , b u t we were n o t w a n t i n g k i d s a n y w a y s , r i g h t away. No, me and my h u s b a n d d e c i d e d t h a t we were g o i n g t o ha v e b a b i e s a t t h e t i m e t h a t we want t o s h o u l d d o , y o u know. B u t I d o n ' t know, I a s k e d my s i s t e r and s h e s c a r e d me and s a i d t h a t t h e condoms a r e n o t g o o d — Y e a h , s he s a i d y o u know, t h a t y o u c a n have a p r o b l e m c o n c e i v i n g t h e p r e g n a n c y r i g h t , and I g o t s c a r e d a n d I was t e l l i n g my h u s b a n d I d o n ' t want t o t e l l ( u s e ) t h e m — a n d I went t o my d o c t o r r i g h t . When a s k e d i f s h e had t o l d h e r h u s b a n d why she d i d n o t want t o u s e condoms she s a i d : No. I was s h y . Sh e ' s my o l d e r s i s t e r r i g h t . F o l l o w i n g h e r f i r s t p r e g n a n c y , t h i s woman d i d a l l o w h e r h u s b a n d t o use condoms: 56 Oh God. B e c a u s e t h e n my h u s b a n d e x p l a i n e d t o me and my d o c t o r s a i d , i t ' s n o t y o u know, j u s t , y o u know, t h e r i g h t i n f o r m a t i o n , y o u know. N o t h i n ' s w r o ng w i t h i t . E v e r y b o d y was u s i n g i t , my f r i e n d s , and I a s k e d them, r i g h t and t h e y had a b a b y . So I t h o u g h t maybe my s i s t e r , y o u k n o w — s h e had s o m e t h i n g w r o n g , r i g h t . A l t h o u g h h a v i n g k n o w l e d g e o f b i r t h c o n t r o l and r e s o u r c e s f o r o b t a i n i n g a m e t h o d , t h i s woman had i n i t i a l l y f e l t s h y a b o u t d i s c u s s i n g t h i s t o p i c w i t h h e r h u s b a n d and d o c t o r and had f o l l o w e d i n c o r r e c t a d v i c e f r o m a f a m i l y member. I t i s a p p a r e n t f r o m t h e d a t a t h a t t h e women's p e r c e p t i o n s o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s b e g i n i n c h i l d h o o d , when t h e y a r e t a u g h t t o a t t a c h s h y n e s s t o m a t t e r s r e l a t e d t o t h e i r own b o d i e s . T h i s s h y n e s s c o n t r i b u t e s t o a l a c k o f k n o w l e d g e a b o u t t h e i r b o d i e s w h i c h l a t e r i s c a r r i e d o v e r i n t o t h e i r a r r a n g e d m a r r i a g e s and c h i l d b e a r i n g e x p e r i e n c e s . T h i s s h y n e s s and i g n o r a n c e seem t o h o l d t r u e r e g a r d l e s s o f how a c c u l t u r a t e d t h e women were i n t o C a n a d i a n s o c i e t y . A l t h o u g h , f o r p u r p o s e s o f t h i s s t u d y , t h e women's c h i l d b e a r i n g e x p e r i e n c e s had o c c u r r e d i n C a n a d a , t h e i r e a r l y y e a r s , when t h e i r t h o u g h t s and f e e l i n g s a b o u t t h e i r s e x u a l i t y had d e v e l o p e d , had b e e n i n I n d i a . One w o u l d e x p e c t i n g r a i n e d c u l t u r a l t r a i t s s u c h a s s h y n e s s t o p e r s i s t f o r a l o n g t i m e as t h e p r o c e s s o f a c c u l t u r a t i o n c o n t i n u e s ( C h a n c e , 1 9 6 5 ) . R e s p e c t f o r e l d e r s i s a n o t h e r c u l t u r a l t r a i t t h a t , f r o m t h e d a t a , a p p e a r e d t o be i n g r a i n e d and l a s t s o v e r t i m e and 57 d e s p i t e t h e p r o c e s s o f a c c u l t u r a t i o n . The women s p o k e o f how, b e c a u s e t h e i r m a r r i a g e s were a r r a n g e d , t h e y o f t e n d i d n o t know t h e i r new i n - l a w s . I n s p i t e o f t h i s , a f t e r m a r r y i n g and l e a v i n g t h e i r b i r t h f a m i l i e s , t h e y owed t h e i r p r i m a r y r e s p e c t and a l l e g i a n c e t o t h e i r new i n - l a w s . One woman s a i d : One must be v e r y good w i t h p a r e n t s , v e r y n i c e , t a k e c a r e and l i s t e n them. And a s e c o n d : My p a r e n t s were b o s s ; now I be m a r r i e d i s h i s p a r e n t s . T h i s i s how i t i s f o r u s . A t h i r d woman d e s c r i b e d how t h i s r e s p e c t a f f e c t e d h e r e v e r y d a y l i f e : L i k e , y o u know, i n I n d i a , we r e s p e c t o u r — y o u know, o u r p e o p l e , r i g h t . And i f we were t o go o u t r i g h t now t h e n b e c a u s e I'm g o i n g I h a v e t o t e l l them, r i g h t . I c a n ' t e v e n g o — y o u know, y o u c a n ' t w a l k o u t w i t h o u t t e l l i n g them. One woman i n t h e s a m p l e was l i v i n g i n a n u c l e a r f a m i l y i n C a n a d a . A t t h e t i m e o f b e i n g i n t e r v i e w e d s he was e x p e c t i n g h e r i n - l a w s t o pa$ h e r an e x t e n d e d v i s i t i n C a n a d a . She d e s c r i b e d how and why h e r l i f e w o u l d a l t e r w i t h h e r i n - l a w s ' p r e s e n c e i n h e r home. B e c a u s e a c t u a l l y , y o u know, I u s e d t o b e l o n g t o a b i g f a m i l y r i g h t . My mom and dad and my b r o t h e r s and t h e y ' r e a l l m a r r i e d a n d l i v e i n my f a m i l y . . . m y r e l a t i v e s a r e l i v i n g w i t h my p a r e n t s and t h e y have i t w i t h my p a r e n t s a n d I have i t w i t h h i s 58 ( h u s b a n d ' s ) p a r e n t s . I t ' s a c u l t u r a l t h i n g . . . I won't be a b l e t o d i s c u s s e v e r y t h i n g i n f r o n t o f them r i g h t . S o m e t i m e s i f y o u g o t a n y — y o u know l i k e a n y t h i n g b e t w e e n y o u and y o u r h u s b a n d r i g h t , I won't d i s c u s s c e r t a i n t h i n g s b e c a u s e we r e s p e c t them. T h i s woman e x p r e s s e d b e l i e f s and v a l u e s t h a t a r e c h a r a c t e r i s t i c o f C a n a d i a n s o c i e t y b u t she n e v e r t h e l e s s b e l i e v e d t h a t she owed h e r i n - l a w s p a r e n t a l r e s p e c t . She c o u l d d e s c r i b e i t a s a " c u l t u r a l t h i n g " t h a t she w o u l d f u l f i l , d e s p i t e i t s c a u s i n g c h a n g e s i n h e r l i f e s t y l e : Oh, i t w i l l be a b i g d i f f e r e n c e . I won't be a b l e t o do t h a t w i t h — y o u know, f r i e n d s , y o u know, i n f r o n t o f them r i g h t . S t i l l , I c a n t a l k t o e v e r y o n e , b u t n o t i n f r o n t o f them. S e v e r a l a u t h o r s (Ames & I n g l i s , 1976; S i d d i q u e , 1977; W a k i l , S i d d i q u e & W a k i l , 1981) h a v e c o n f i r m e d t h a t i n I n d i a , S i k h s f r o m t h e P u n j a b l i v e i n l a r g e e x t e n d e d f a m i l i e s a n d , a t m a r r i a g e , t h e women move i n t o t h e i r h u s b a n d s ' f a m i l y homes. S i d d i q u e ( 1 9 7 7 ) and W a k i l , S i d d i q u e and W a k i l ( 1 9 8 1 ) c o n f i r m t h a t t h e s e f a m i l y s t r u c t u r e s a r e c o n t i n u e d i n C a nada and t h e y p o i n t o u t t h e d i f f i c u l t i e s t h a t t h e v a l u e o f r e s p e c t f o r e l d e r s p o s e s a s t h e f a m i l y members a c c u l t u r a t e i n t o a h o s t c o u n t r y s u c h a s C a n a d a , where o l d e r p e o p l e a r e n o t g e n e r a l l y a c c o r d e d t h e same m e a s u r e o f r e s p e c t . Yu ( 1 9 8 4 ) , w r i t i n g o f " f i l i a l p i e t y " amongst t h e t r a d i t i o n a l C h i n e s e , p o i n t s o u t t h a t a s a c c u l t u r a t i o n p r o g r e s s e s , t h e v a l u e o f f i l i a l p i e t y 59 d e c l i n e s and t h i s p l a c e s t h e e l d e r a t a d i s t i n c t d i s a d v a n t a g e . A t a t i m e when o l d e r f a m i l y members r e q u i r e i n c r e a s e d a t t e n t i o n f r o m t h e i r c h i l d r e n , t h e c h i l d r e n , i n an a t t e m p t t o a d o p t an A m e r i c a n l i f e s t y l e , h ave l e s s t i m e and r e s p e c t t o g i v e t h e i r p a r e n t s . H o w e v e r , amongst t h i s s t u d y ' s s a m p l e , r e s p e c t f o r e l d e r s was s t i l l v i e w e d as an i m p o r t a n t c u l t u r a l v a l u e t h a t , f r o m t h e women's a c c o u n t s , d i d n o t seem t o be a f f e c t e d by t h e p r o c e s s o f a c c u l t u r a t i o n . The v a l u e p l a c e d on a c o n t i n u e d r e s p e c t f o r e l d e r s i s an i m p o r t a n t f i n d i n g f o r t h i s s t u d y as i t i m p l i e s t h a t t h e s e unknown e l d e r s h a d a u t h o r i t y o v e r t h e women a t t h e t i m e o f t h e i r a r r a n g e d m a r r i a g e and t h e n d u r i n g t h e i r c h i l d b e a r i n g e x p e r i e n c e s . T h i s r e s p e c t t h e r e f o r e i n f l u e n c e d t h e women's p e r c e p t i o n s o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s . The e l d e r s ' i n f l u e n c e b e g i n s e a r l y . The women t o l d o f b e i n g a ware o f t h e i r n e e d t o p r o d u c e s o n s and t h e i m p a c t t h e i r m o t h e r s - i n - l a w c o u l d h a v e on t h e i r l i v e s i f t h e y d i d n o t f u l f i l t h i s r e q u i r e m e n t . The women's p e r c e p t i o n s o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s were c o l o u r e d w i t h t h e need t o g i v e b i r t h t o m a l e c h i l d r e n . Sex P r e f e r e n c e o f O f f s p r i n g The women g a v e a c c o u n t s t h a t i n d i c a t e d t h e i r p r e f e r e n c e f o r m a l e o f f s p r i n g . They a t t a c h e d g r e a t i m p o r t a n c e t o h a v i n g s o n s and e x p l a i n e d t h e r e a s o n s f o r t h i s p r e f e r e n c e . They were a l s o a b l e t o e x p l a i n t h e i r d e s i r e f o r b o y s i n t e r m s o f 60-t h e i r p e r s o n a l w e l f a r e . The women's p e r c e p t i o n s o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s w e re a f f e c t e d by t h i s e m p h a s i s on m a l e b a b i e s . One woman had t h r e e d a u g h t e r s and no s o n s . She l i v e d i n h e r h u s b a n d ' s e x t e n d e d f a m i l y and h e r f a r m i n g l i f e s t y l e c l o s e l y r e s e m b l e d t h a t o f h e r p e o p l e s t i l l l i v i n g i n t h e P u n j a b . She d e s c r i b e d some o f t h e p r o b l e m s o f n o t h a v i n g b o r n e a s o n . Some f i r s t w i v e s — o n l y d a u g h t e r s and t h e n t h e man g o e s t o a n o t h e r m a r r i a g e and t h e n some g o t b o y s and s o m e t i m e s i t ' s l i k e t h a t , f i r s t l a d y no b a b y o r no boy and t h e n he g o e s t o t h e o t h e r m a r r i a g e a n d o t h e r l a d y h a s b o y s . . . . S o metimes I f e e l v e r y b a d b e c a u s e t h e n I t h i n k a b o u t t h a t I have no b o y s . So t h e n I f e e l v e r y b a d . Then s o m e t i m e s I t h i n k i s o k a y . My m o t h e r - i n - l a w i s good and s h e s a y s n o t h i n g a s I have o n l y g i r l s b u t t h e m o t h e r - i n - l a w s , s he c a n make t r o u b l e f o r womans o v e r t h i s . To l i v e w i t h s e c o n d w i f e a l l t o g e t h e r w o u l d be t o o much hard....When we g e t o l d , God knows where me and h u s b a n d l i v e i f no s o n s . I d o n ' t know. Y e a h , y e a h , t h a t be a p r o b l e m , maybe my d a u g h t e r s h a v e room f o r me... T h i s woman was e x p r e s s i n g h e r f e a r t h a t h e r h u s b a n d w o u l d t a k e a s e c o n d w i f e t o b e a r s o n s . She a l s o p o i n t e d o u t t h a t m o t h e r s - i n - l a w c a n c a u s e p r o b l e m s f o r t h e i r d a u g h t e r s - i n - l a w i f no s o n s a r e b o r n . T h i s i n d i c a t e s t h e power t h e women f e e l 61 t h e f e m a l e e l d e r s i n t h e f a m i l y h o l d o v e r them. T h i s woman t o l d t h e r e s e a r c h e r o f h e r d e s i r e t o w a i t 18 mon t h s b e f o r e a n o t h e r p r e g n a n c y and o f h e r h u s b a n d ' s a b i l i t y t o s a b o t a g e t h i s d e c i s i o n . She s a i d : I f he w a n t s baby b e f o r e t h i s I must no s a y no. I f she ( h e r t h i r d g i r l ) w e r e b o y , t h e n I c o u l d s a y no. T h i s c o n t r a s t e d w i t h two women who had b o r n e s o n s . When a s k e d i f t h e y c o u l d r e f u s e t o become p r e g n a n t a g a i n , one s a i d : I s a y no b e c a u s e I d o n ' t want b a b y now and I h a v e a l r e a d y two b o y s . And t h e o t h e r : I h a v e boy a l r e a d y s o I c a n s t o p h a v e b a b y ; boy i s i m p o r t a n t f o r name. F o r t h e s e women t h e number a nd t i m i n g o f p r e g n a n c i e s w ere p a r t i a l l y d e t e r m i n e d by t h e s e x o f t h e i r o f f s p r i n g . The b i r t h o f a m a l e g a v e them more c o n t r o l t o d e c i d e when and i f a n o t h e r c h i l d w o u l d be b o r n . One woman, who h e l d many c h i l d b e a r i n g b e l i e f s t h a t were c o n s i s t e n t w i t h C a n a d i a n b e l i e f s and v a l u e s , h a d an u r b a n l i f e s t y l e t h a t was more i n l i n e w i t h C a n a d i a n s o c i e t y t h a n E a s t I n d i a n . D e s p i t e h e r b e i n g a c c u l t u r a t e d i n C a n a d a , s he t a l k e d o f why i t was i m p o r t a n t t o b e a r a s o n o v e r a d a u g h t e r : T h a t ' s why e v e n t h e y ' r e t h i n k i n g t o o i t ' s a b o y , y o u know, he c a n h a n d l e t h e f a m i l y . He c a n h a n d l e t h e i r l a n d r i g h t . S o m e t h i n g l i k e t h a t . B u t t h e m a i n t h i n g i s t h e d o w r y s y s t e m . So t h a t ' s why i n I n d i a , p e o p l e , y o u know, a r e unhappy when t h e y ' r e h a v i n g g i r l s . . . . B e c a u s e when t h e y ' r e g e t t i n g m a r r i e d i t ' s e x p e n s i v e f o r t h e p a r e n t s . . . . A n d t h e n t h e y a r e h a v i n g t r o u b l e s . . . b e c a u s e t h e i n - l a w s and t h e i r h u s b a n d , t h e y ' r e a l w a y s t e l l i n g them y o u do n o t b r i n g a n y t h i n g .... I t ' s v e r y i m p o r t a n t t o h a v e s o n s , t h e g i r l s a r e g o i n g t o a n o t h e r h o u s e l i k e when t h e y ' r e g e t t i n g m a r r i e d , t h e y ' r e l i v i n g w i t h t h e i r h u s b a n d r i g h t a n d t h e s o n s a r e s t a y i n g w i t h t h e p a r e n t s and t h e y ' r e t a k i n g c a r e y o u know, t h e s o n s , when t h e y ' r e o l d . I n I n d i a t h e y ' r e n o t s e n d i n g them t o t h e r e s t h o u s e y o u know when t h e y ' r e s i c k and o l d . They a r e t a k i n g c a r e o f t h e p a r e n t s r i g h t . T h a t ' s t h e m a i n r e a s o n s . I n Canada t h e same t h i n g b e c a u s e p e o p l e a r e n o t c h a n g i n g h e r e l i k e i n o u r g e n e r a t i o n . L i k e o u r k i d s , maybe t h e y won't c a r e t h a t much b u t we do. A n o t h e r woman, who h e l d many b e l i e f s and v a l u e s c o n s i s t e n t w i t h t h o s e h e l d i n C a n a d i a n s o c i e t y , s u c h as w a n t i n g h e r d a u g h t e r t o e v e n t u a l l y c h o o s e h e r own s p o u s e , g a v e t h i s a c c o u n t o f h a v i n g a f e m a l e c h i l d : Oh n o , I was s o h a p p y . Me and my h u s b a n d , we j u s t h a d a — y o u know we d e c i d e d t h a t we w a n t e d t o have t h e b a b y . And no p r o b l e m , I n e v e r t h o u g h t y o u k n o w , — I was n o t s a d a t a l l . I w a s n ' t u p s e t a t 63 B u t : L i k e my h u s b a n d i s an o n l y s o n and y o u k n o w — M y h u s b a n d d o n ' t m i n d b u t I r e a l l y f e e l we s h o u l d h a v e one b oy t o o . You c a n k e e p t h e name w i t h t h e b o y , f a m i l y r i g h t . T h i s woman t r u l y p r e f e r r e d a m a l e o f f s p r i n g b u t w e l c o m e d a d a u g h t e r i n t o t h e f a m i l y and f e l t s h e n e e d e d t o j u s t i f y why she w a n t e d a s o n . T h i s n e e d t o j u s t i f y h e r c u l t u r a l t r a d i t i o n i n d i c a t e d t h a t t h i s woman was r e t h i n k i n g b e l i e f s and v a l u e s p a s s e d on f r o m h e r n a t i v e l a n d and t h a t t h e p r o c e s s o f a c c u l t u r a t i o n was o c c u r r i n g . The i m p a c t a m o t h e r - i n - l a w h a s on h e r s o n ' s w i f e e m p h a s i z e s t h e i n f l u e n c e t h a t t h e f a m i l y , e s p e c i a l l y e l d e r s , h a v e o v e r a woman's d a i l y l i f e (Ames & I n g l i s , 1976; W a k i l , S i d d i q u e & W a k i l , 1 9 8 1 ) . The I n d o - C a n a d i a n p r e f e r e n c e f o r m a l e c h i l d r e n i s c o n s i s t e n t w i t h c u l t u r e s t h a t h a v e an a g r a r i a n l a n d b a s e and a v a l u e p l a c e d on s o n s l o o k i n g a f t e r t h e i r e l d e r l y p a r e n t s ( D i n i t z , Dynes & C l a r k , 1 9 5 4 ) . Many c u l t u r e s v o i c e a p r e f e r e n c e f o r m a l e o f f s p r i n g ( A y r e s , 1967; B r o w n , 1976; W i l l i a m s o n , 1 9 7 9 ) , a n d , a l t h o u g h C a nada s u p p o r t s t h e t e n e t s o f f e m i n i s m , i n r e a l i t y t h e m a j o r i t y o f p e o p l e s t i l l h a ve a s e x p r e f e r e n c e f o r m a l e s ( W i l l i a m s o n , 1 9 7 9 ) . As t h e I n d o - C a n a d i a n women b e g i n t o g i v e up t h e i r s t r o n g p r e f e r e n c e f o r m a l e c h i l d r e n , t h e y c a n be e x p e c t e d t o a d o p t t h e b e l i e f s and v a l u e s o f t h e i r h o s t c o u n t r y . I f t h e h o s t c o u n t r y i s u n s u r e o f t h e s e b e l i e f s , an i m m i g r a n t i s l e f t w i t h c o n f u s i o n ( C h a n c e , 1965) and a t e n d e n c y t o r e v e r t t o e s t a b l i s h e d c u l t u r a l b e l i e f s ( S a l v e n d y , 1 9 8 3 ) . A l t h o u g h t h r o u g h t h e p r o c e s s o f a c c u l t u r a t i o n t h e women be g a n t o f e e l t h e need t o j u s t i f y t h e i r d e s i r e s f o r s o n s , t h e women i n t h i s s t u d y g a v e a c c o u n t s t h a t i n d i c a t e d t h e y w e re r e a l i s t i c i n w a n t i n g t o ha v e m a l e c h i l d r e n . A d a u g h t e r r e p r e s e n t e d e c o n o m i c h a r d s h i p ; t h i s meant t h e woman may have t o ha v e o t h e r p r e g n a n c i e s b e f o r e s he was r e a d y t o h ave a n o t h e r c h i l d . ; s h e e x i s t e d d a i l y a t t h e whim o f h e r m o t h e r - i n - l a w ' s g o o d n a t u r e and t h e p o s s i b i l i t y t h a t h e r h u s b a n d m i g h t l e a v e h e r f o r a s e c o n d w i f e . I n a d d i t i o n , i t meant t h a t t h e women had nowhere t o l i v e i n t h e i r o l d a g e . F o r a l l o f t h e s e r e a s o n s , t h e i s s u e o f t h e s e x o f t h e g r o w i n g f e t u s must w e i g h h e a v i l y on t h e s e women d u r i n g t h e i r p r e g n a n c i e s . I t i s w h i l e t h e women were p r e g n a n t t h a t t h e f u l l i m p o r t a n c e o f t h e i r f e m a l e i n - l a w s ' a u t h o r i t y was a p p a r e n t . From t h e t i m e t h e y f i r s t s u s p e c t e d t h e y m i g h t be p r e g n a n t , t h r o u g h t h e s h y n e s s o f t e l l i n g e l d e r s a n d r e c e i v i n g and f o l l o w i n g t h e a d v i c e o f f e m a l e r e l a t i v e s who had b o r n e c h i l d r e n , a l l t h e women s p o k e o f t h e f e m a l e f a m i l y members' i m p o r t a n c e i n t h e i r c h i l d b e a r i n g e x p e r i e n c e s . P r e g n a n c y The women s a i d t h a t t h e y r e l i e d on t h e f e m a l e e l d e r s i n t h e i r h o u s e h o l d s as a s o u r c e o f i n f o r m a t i o n and a d v i c e a b o u t p r e g n a n c y . The e l d e r s h a d a c q u i r e d t h e i r k n o w l e d g e f r o m 65 t h e i r own c h i l d b e a r i n g e x p e r i e n c e s and f r e e l y p a s s e d on t h e i r i n f o r m a t i o n . B e c a u s e t h e women h a d , t h r o u g h m a r r i a g e , become p a r t o f t h e i r h u s b a n d s ' f a m i l i e s , t h e e x p e r i e n c e d e l d e r s were u s u a l l y t h e i r i n - l a w s . They s a i d t h a t i n f o r m a t i o n f r o m t h e i r own b i r t h f a m i l i e s h a d o f t e n b e e n o b t a i n e d t h r o u g h d i r e c t o b s e r v a t i o n d u r i n g c h i l d h o o d . The women's a c c o u n t s o f t h e i r b e l i e f s and p r a c t i c e s s u r r o u n d i n g c h i l d b e a r i n g , e m b o d i e d a c o n t r a d i c t i o n : a l t h o u g h t h e y c l a i m e d t o f o l l o w t h e d o c t o r ' s a d v i c e t h e y i n f a c t f o l l o w e d t h e a d v i c e g i v e n t o them by t h e i r f a m i l y e l d e r s . D o c t o r s , as w i l l be r e c o u n t e d l a t e r , i n r e a l i t y were v i e w e d a s h a v i n g a d i f f e r e n t , more t e c h n o l o g i c a l p l a c e i n _ t h e i r c h i l d b e a r i n g e x p e r i e n c e . The women r e l a t e d how, when t h e y m i s s e d t h e i r p e r i o d and s u s p e c t e d a p r e g n a n c y , t h e y t u r n e d i n i t i a l l y t o t h e i r f e m a l e i n - l a w s f o r a d v i c e and s u p p o r t . They t a l k e d o f f e e l i n g s h y t o t e l l t h e i r own m o t h e r s o f t h e i r s u s p e c t e d p r e g n a n c y . One woman s a i d : I no t e l l my m o t h e r . I was s h y . I f my s i s t e r h e r e I t e l l h e r , b u t no m o t h e r . Maybe m o t h e r - i n - l a w o r s i s t e r - i n - l a w i s o k a y t o o . A n o t h e r , whose l i f e s t y l e i n a n u c l e a r f a m i l y p a r a l l e l e d p r e v a i l i n g l i f e s y l e s i n C a n a d i a n s o c i e t y , s a i d : I d i d n ' t t o l d my m o t h e r I'm p r e g n a n t r i g h t — s h e j u s t n o t i c e d l i k e when I went t o s l e e p and t h e f i r s t — l i k e t h e b e g i n n i n g , we d o n ' t l i k e t o do work r i g h t . I was ashamed r i g h t — l i k e we c a n ' t t a l k t h a t f r e e l y t o my p a r e n t s l i k e we do i n t h e f r i e n d . We c a n ' t ( t a l k ) a b o u t t h a t t o o u r p a r e n t s . Once h e r m o t h e r n o t i c e d t h e p r e g n a n c y symptoms, t h e two women c o u l d t a l k a b o u t what a c t i o n s were a p p r o p r i a t e . And s h e t o l d me i t ' s v e r y n i c e , what t o do. I went t o t h e d o c t o r a f t e r two w e e k s . The s t u d y p a r t i c i p a n t s whose h e a l t h b e l i e f s and a t t i t u d e s most c l o s e l y r e s e m b l e d t h o s e o f C a n a d i a n s o c i e t y a t l a r g e s a i d : No, I d i d n o t t e l l my m o t h e r i n t h e b e g i n n i n g r i g h t — b u t I t o l d my m o t h e r - i n - l a w — y o u know b e c a u s e I'm v e r y s h y . You d o n ' t t a l k a b o u t t h e s e t h i n g s i n f r o n t o f m e n . . . w i t h t h e m o t h e r - i n - l a w p e o p l e a r e a l i t t l e f r a n k t h a n t h e m o t h e r . T h i s woman, who d i d n o t want t o a r r a n g e h e r own d a u g h t e r ' s m a r r i a g e , who l i v e d i n a n u c l e a r f a m i l y , and who had good E n g l i s h s k i l l s , s t i l l f e l t s h y when t a l k i n g w i t h h e r m o t h e r and m a i n t a i n e d t h e E a s t I n d i a n p r a c t i c e o f t a l k i n g more o p e n l y w i t h h e r m o t h e r - i n - l a w . The one s u b j e c t i n t h e s t u d y who had b e e n t o l d a b o u t m e n s t r u a t i o n by h e r m o t h e r f e l t u n c o m f o r t a b l e t a l k i n g w i t h h e r m o t h e r - i n - l a w . Y e a h , b e c a u s e t h e n I came i n C a n a d a . When I came, e v e r y t h i n g i s new f o r me and I n e v e r t a l k e d a b o u t t h o s e t h i n g s w i t h h e r b e c a u s e I f e e l ashamed and s o m e t i m e s I have f e a r . B e c a u s e s h e i s my m o t h e r - i n - l a w . And I t a l k a b o u t t h a t , y o u know, what s h e i s t h i n k i n g , l i k e t h a t , I t h i n k — f e e l ashamed. Due t o h e r u p b r i n g i n g and o p e n n e s s w i t h h e r m o t h e r , h e r s t o r y s p o k e o f s h y n e s s and f e a r t o w a r d s h e r m o t h e r - i n - l a w . T h i s p u t h e r a t a d i s a d v a n t a g e i n t h e E a s t I n d i a n c u l t u r e where g i r l s m a r r y and l e a v e t h e i r b i r t h home t o l i v e w i t h t h e i r i n - l a w s ( N i c h t e r , 1 9 8 1 ) . The women's a c c o u n t s t o l d o f s e e k i n g i n f o r m a t i o n and h e l p f r o m i n - l a w s when t h e y f i r s t t h o u g h t t h e y w e re p r e g n a n t . One woman s a i d : I t a l k s w i t h my m o t h e r - i n - l a w and she t e l l s me "You p r e g n a n t , y o u go t o d o c t o r " and t h e n s he t e l l s my m o t h e r , I no t e l l h e r . A s e c o n d woman a p p r o a c h e d h e r s i s t e r - i n - l a w , w i t h whom she l i v e d : My s i s t e r - i n - l a w she t e l l s me. She h a v e baby a l r e a d y s o she knows. A t h i r d woman r e c o u n t e d : I t e l l my s i s t e r - i n - l a w . She t o l d me " y o u ' r e p r e g n a n t " a n d t h e n I t o l d my h u s b a n d t h a t n o t my m o n t h l y p e r i o d c o m i n g and t h e n I go t o t h e d o c t o r . T h i s woman came f r o m a c i t y i n t h e P u n j a b , l i v e d i n a n u c l e a r f a m i l y i n C a n a d a , s p o k e E n g l i s h f l u e n t l y and w o r k e d a s a r e a l e s t a t e a g e n t , h e r p a r e n t s and i n - l a w s a l l l i v e d i n I n d i a . She d e s c r i b e d h e r e x p e r i e n c e when she was f i r s t p r e g n a n t : F i r s t I t e l l my h u s b a n d y o u k n o w — I d o n ' t g o t s my p e r i o d . And he s a i d " l e t ' s go t o t h e d o c t o r " and when we f i n d o u t , y e s , I'm p r e g n a n t , my h u s b a n d 68 t e l l i m m e d i a t e l y h i s m o t h e r and she t e l l s m i n e . T h a t ' s how i t i s , t h e h u s b a n d ' s f a m i l y knows f i r s t i n o u r c u l t u r e . L i v i n g a t a d i s t a n c e f r o m h e r i n - l a w s h a d f o r c e d h e r t o c o n f i d e f i r s t i n h e r h u s b a n d ; b u t f o l l o w i n g t h a t , s h e u p h e l d t h e c u l t u r a l c u s t o m o f t e l l i n g i n - l a w s b e f o r e p a r e n t s . Some a u t h o r s ( G i d e o n , 1962; N i c h t e r , 1981) have d e s c r i b e d f a m i l y l i f e amongst E a s t I n d i a n s l i v i n g i n I n d i a a s p o i n t e d o u t p r e v i o u s l y , a woman, when she m a r r i e s , l e a v e s h e r b i r t h home and g o e s t o l i v e i n h e r h u s b a n d ' s e x t e n d e d f a m i l y . I n t h e s e homes, t h e f e m a l e e l d e r s w i e l d a g r e a t d e a l o f a u t h o r i t y and i n f l u e n c e o v e r t h e y o u n g e r women and r e c e i v e r e s p e c t f r o m t h e y o u n g e r f a m i l y members. Most o f t h e women i n t h i s s t u d y c o n t i n u e d t o l i v e i n t h e same f a m i l y c o n s t e l l a t i o n as i s e v i d e n c e d i n t r a d i t i o n a l I n d i a . I t i s t h e r e f o r e n o t s u r p r i s i n g t o l e a r n t h a t t h e y t e l l t h e f e m a l e e l d e r s f i r s t o f a p r e g n a n c y . I t i s i n t e r e s t i n g t o l e a r n t h a t t h e women w i t h o u t any p a r e n t s o r i n - l a w s i n Canada m a i n t a i n e d t h e c u s t o m o f t e l l i n g t h e i r i n - l a w s f i r s t . I t a p p e a r s t h a t , e v e n a t a d i s t a n c e , and d e s p i t e t h e p r o c e s s o f a c c u l t u r a t i o n , t h e c u s t o m r e m a i n s f i r m l y e n t r e n c h e d i n t h e women's b e l i e f s y s t e m . M a l i n o w s k i ( 1 9 4 8 ) a s s e r t s t h a t m a g i c i s o f t e n i n c o r p o r a t e d i n t o t h e b e l i e f s y s t e m i n o r d e r t o a l l e v i a t e a n x i e t y c o n c e r n i n g t h e outcome o f an e v e n t , s u c h as c h i l d b e a r i n g , o v e r w h i c h t h e i n d i v i d u a l h a s no c o n t r o l . 69 R a d c l i f f e - B r o w n ( 1 9 5 2) saw b i r t h r i t u a l , i n c l u d i n g p r e g n a n c y d i e t and p r a c t i c e s , a s a means o f e x p r e s s i n g and e m p h a s i z i n g t h e s o c i a l v a l u e o f an e v e n t t o t h e c o m m u n i t y , and Brown (1976) o b s e r v e d t h a t a l l r e p o r t e d c u l t u r e s show some k i n d o f r e c o g n i t i o n o f t h e c h i l d b e a r i n g e x p e r i e n c e . T h e r e f o r e i t a p p e a r s t h a t a l l c u l t u r e s h ave c e r t a i n b e l i e f s and p r a c t i c e s s u r r o u n d i n g t h e c h i l d b e a r i n g e x p e r i e n c e , t h a t a r e u s e d t o h e l p t h e i n d i v i d u a l m a i n t a i n some m e a s u r e o f power and c o n t r o l o v e r t h e s i t u a t i o n and t o r e a f f i r m t h e s o c i a l s i g n i f i c a n c e o f t h e b i r t h . G i d e o n ( 1 9 6 2 ) , i n d e s c r i b i n g a p r e g n a n c y and b i r t h i n t h e P u n j a b , t e l l s a s t o r y o f a c u l t u r e i n w h i c h t r a d i t i o n a l b i r t h p r a c t i c e s h ave c o n t i n u e d u n c h a n g e d f o r c e n t u r i e s . G i d e o n , G o r d o n , and Wyon (1964) d e s c r i b e e x c e p t i o n a l l y h i g h m o r b i d i t y and m o r t a l i t y r a t e s f o r m o t h e r and c h i l d i n I n d i a ; b e c a u s e o f t h e s e i n c r e a s e d d e a t h s t a t i s t i c s r e l a t e d t o c h i l d b e a r i n g , women f r o m I n d i a may be e x p e c t e d t o have h i g h a n x i e t y l e v e l s c o n c e r n i n g t h e s u c c e s s f u l o u t c o m e s o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s . ' One w o u l d e x p e c t many p r o s c r i p t i o n s and p r e s c r i p t i o n s f o r E a s t I n d i a n women t o f o l l o w d u r i n g c h i l d b e a r i n g . P a r k e r and Neumann (1979) c o n f i r m a c o n t i n u e d h i g h m o r b i d i t y and m o r t a l i t y i n I n d i a and t h e y a l s o r e l a t e how t h e c h i l d b e a r i n g e x p e r i e n c e i n I n d i a i s l a r g e l y l o o k e d a f t e r by f e m a l e f a m i l y members. T h i s f a m i l y i n v o l v e m e n t seems t o be c o n t i n u e d i n C a n a d a . Once t h e p r e g n a n c y had b e e n c o n f i r m e d by t h e w e s t e r n 70 p h y s i c i a n , t h e women no l o n g e r t a l k e d o f s h y n e s s i n r e l a t i o n t o e l d e r s o r s e x u a l i t y . T h e i r a c c o u n t s s p o k e o f a s h i f t t o d i s c u s s i n g p r a c t i c a l m a t t e r s s u c h as d i e t a r y and p h y s i c a l p r a c t i c e s d u r i n g p r e g n a n c y . P r e g n a n c y p r a c t i c e s and k n o w l e d g e a b o u t d i e t a r y r e q u i r e m e n t a r e p a s s e d on f r o m f e m a l e e l d e r s t o t h e p r e g n a n t woman e i t h e r v e r b a l l y o r t h r o u g h o b s e r v a t i o n . One woman s a i d : I l i s t e n f r o m my m o t h e r - i n - l a w . She t e l l me " e a t t h i s , do t h i s " and t h e n I knows. And a n o t h e r : No one t e l l s me, b u t when I was i n I n d i a , s o I was w a t c h i n g what t h e y w e re g i v i n g t o my s i s t e r - i n - l a w and my s i s t e r y o u know. A t h i r d r e c o u n t e d : My s i s t e r - i n - l a w , b e c a u s e s he a l r e a d y h a v e two b a b i e s a n d s h e know e v e r y t h i n g and she t e l l me, y o u do l i k e t h i s , l i k e t h i s , t h a t ' s why. T h i s f i n d i n g a p p a r e n t l y c o n t r a d i c t e d a n o t h e r p e r c e p t i o n t h a t t h e women t a l k e d o f — t h a t o f h a v i n g t h e i r d o c t o r s as t h e i r p r i m a r y s o u r c e s o f i n f o r m a t i o n . I t a p p e a r s t h a t t h e i n f o r m a t i o n r e c e i v e d f r o m d o c t o r s was g e n e r a l l y t e c h n o l o g i c a l and m e d i c a l i n n a t u r e , w h i l e t h e k n o w l e d g e p a s s e d on f r o m f a m i l y members was o f t e n b a s e d on common s e n s e and t h e p a s t c h i l d b e a r i n g e x p e r i e n c e s o f t h e e l d e r s . One s u b j e c t , who l i v e d on a f a r m i n a l a r g e e x t e n d e d f a m i l y , s a i d : My f a m i l y members t e l l me " w a l k a l o t and d o n ' t p i c k up h e a v y t h i n g s and d o n ' t w a l k f a s t . J u s t s l o w y o u know." Wear t h e l o o s e c l o t h e s . N o t t i g h t . N o t t i g h t . And y o u t h i n k — n o t t h i n k t o o m u c h — i t n o t g o o d — t h i n k good t h i n g s a b o u t b a b y — i t n o t good f o r b a b y ' s h e a l t h o r n a t u r e . I f y o u t h i n k t h i n g s , t o o much f i g h t o r . . . i t ' s n o t g o o d f o r b a b y ' s n a t u r e . " I t h i n k — I t h i n k i t ' s good f o r me and my b a b i e s . I w a l k a l o t a n d m o s t l y I am happy and k e e p h a p p y . A s e c o n d woman, who s p o k e E n g l i s h w e l l and was a r e a l e s t a t e a g e n t i n Canada r e c o u n t e d : B u t my m o t h e r - i n - l a w t o l d me what I s h o u l d d o , y o u know she was a d v i s i n g me, y o u know, what y o u s h o u l d do and y o u ' r e g o i n g t o be i n t h a t many months r i g h t . Be c a r e f u l y o u know. J u s t t a k e p r e c a u t i o n s y o u k n o w . . . b e c a u s e t h e y t o l d me, y o u know, d o n ' t l i f t s o many h e a v y t h i n g s . One woman t o l d o f h a v i n g edema o f t h e a n k l e s i n h e r l a s t t r i m e s t e r . T h i s was d u r i n g t h e t i m e t h a t a l l t h e women i n t h e h o u s e h o l d were h a r v e s t i n g b l u e b e r r i e s i n t h e f i e l d . H e r e l d e r s i s t e r - i n - l a w had i n s i s t e d she s t a y home and l o o k a f t e r t h e home and c h i l d r e n i n s t e a d o f w o r k i n g i n t h e f i e l d s . She s a i d : L ook a f t e r t h r e e , f o u r c h i l d r e n . A l l t h e t i m e c o o k i n g , w a s h i n g c l o t h e s , d o i n g e v e r y t h i n g . Too much h a r d , t o o much h a r d . T h i s woman p e r c e i v e d t h a t an o v e r t p h y s i c a l s i g n had e x c u s e d h e r f r o m f i e l d work b u t an e l d e r h a d j u d g e d h e r s t i l l c a p a b l e o f c h i l d c a r e and h o u s e w o r k . D e s p i t e f e e l i n g i t was t o o h a r d , 72 she had c o m p l i e d and done t h e w o r k . The p a r t i c i p a n t who s p o k e E n g l i s h w e l l , l i v e d i n a n u c l e a r f a m i l y , and i n t e n d e d t o l e t h e r d a u g h t e r c h o o s e h e r own s p o u s e , t o l d o f b e i n g a ware t h a t t h e w a r n i n g s i s s u e d t o h e r were b a s e d on h e r r e l a t i v e s ' p a s t e x p e r i e n c e s . She s a i d : B u t t h e y s a i d y o u know, t h e s e months a r e v e r y d a n g e r o u s . You have t o be more c a r e f u l . T h a t ' s r i g h t . When y o u ' r e i n y o u r l i k e n i n t h m onth b e c a u s e my m o t h e r - i n - l a w she had s o many m i s c a r r i a g e s on t h e l a s t month r i g h t , b e c a u s e s h e ' s g o t h e r p e r s o n a l e x p e r i e n c e s o t h a t ' s why. P r e g n a n c y c u s t o m s and p r a c t i c e s o f t e n a p p e a r s u b j e c t i v e and a r e p a s s e d on by w o r d o f mouth and o b s e r v a t i o n . As t h e women became more a c c u l t u r a t e d i n t o C a n a d i a n s o c i e t y , t h e y seemed t o become aware t h a t some p r a c t i c e s were b a s e d on p e r s o n a l e x p e r i e n c e , a n d , a l t h o u g h t h e y c o n t i n u e d t o c o n f o r m t o many E a s t I n d i a n p r a c t i e s , t h e y t o l d o f b e i n g more a b l e t o l o o k a t t r a d i t i o n a l p r a c t i c e s and d e c i d e , o f t e n w i t h t h e i r d o c t o r ' s h e l p , w h e t h e r a p a r t i c u l a r p r a c t i c e was s a f e f o r them and t h e i r f e t u s . The woman l a s t q u o t e d s a i d : You knows, s o m e t i m e s I ' s e g o t t o d e c i d e — d o i t t h e way m o t h e r - i n - l a w s a y s — b u t maybe t h a t be b a d f o r b aby b e c a u s e a s I t o l d y o u , i s h e r p e r s o n a l e x p e r i e n c e r i g h t ? So t h e n I a s k d o c t o r and she t e l l me what t o do. The women's a b i l i t y t o make d e c i s i o n s u s i n g a d v i c e f r o m b o t h t h e p o p u l a r and p r o f e s s i o n a l e x p l a n a t o r y m o d e l s , was a l s o e v i d e n t i n m a t t e r s c o n c e r n i n g d i e t i n p r e g n a n c y . D u r i n g p r e g n a n c y , women who l i v e d i n l a r g e e x t e n d e d f a m i l i e s and d i d n o t s p e a k E n g l i s h w e l l , t o l d o f how t h e y d i d n o t a l t e r t h e i r d i e t s s i g n i f i c a n t l y t o p r o v i d e f o r t h e g r o w i n g f e t u s . I n f o r m a t i o n a b o u t d i e t s a p p e a r s t o come f r o m e x p e r i e n c e d e l d e r s , a n d , as i n o t h e r p r a c t i c e s and b e l i e f s , i s q u i t e s u b j e c t i v e . When t h e y do o c c u r , d i e t a r y c h a n g e s a r e b a s e d on E a s t I n d i a n n o t i o n s o f " h o t " and " c o l d " f o o d s . One woman s a i d : No. Somebody who l i k e s t o e a t , l e t them e a t what t h e y c a n e a t . D i f f e r e n t p e o p l e , y e a h , what y o u w o u l d l i k e . I d o n ' t l i k e t o o much t e a and l i k e t o o much meat. I d o n ' t l i k e t o o much r e d c h i l i . I d o n ' t l i k e t o o much s p i c e s . And a n o t h e r : O l d m o t h e r - i n - l a w s a y what were good t o e a t . Hot s p i c y f o o d s no g o o d . . . b e c a u s e t h e y b u r n my t h r o a t , y e a h , and a r e no good f o r h e a l t h . No good f o r t h e baby b e c a u s e t h e y a r e t o o much h o t . . . I d o n ' t know what h a p p e n s t o t h e baby i f I e a t b u t t h e y s a y i s no g o o d . A t h i r d woman t o l d t h e i n v e s t i g a t o r : We d o n ' t e a t h o t f o o d s when p r e g n a n t . H u r t t h e baby and t o o me. Baby and m e . . . . I t ' s n o t good f o r baby b e c a u s e n o t good f o r b a b y ' s h e a l t h . I d o n ' t know what i t d o e s , s o m e t h i n g . Some h u r t . My s i s t e r - i n - l a w t e l l me. 74 On e x a m i n a t i o n , t h e m a i n s t a y o f c o l d f o o d s a r e d a i r y p r o d u c t s , s o t h e t a b o o on h o t f o o d s and s t r e s s p l a c e d on c o l d , a r e r e a l l y d i e t a r y c h a n g e s t o a l l o w f o r f e t a l g r o w t h , a l t h o u g h t h e women c o u l d n o t t e l l t h e r e s e a r c h e r why t h e y w e r e m a k i n g t h e s e c h a n g e s . As women came t o h o l d b e l i e f s and v a l u e s more s i m i l a r t o t h o s e e x p r e s s e d i n C a n a d i a n s o c i e t y , t h e y t a l k e d more a b o u t t h e i r e x p e r i e n c e w i t h d i e t i n p r e g n a n c y . One woman t a l k e d o f t h e r e a s o n s f o r e a t i n g s p e c i f i c f o o d s . She s a i d : D u r i n g p r e g n a n c y , e a t what y o u w a n t s . B u t be c a r e f u l y o u know. E a t e g g s f o r p r o t e i n , and l e n t i l s a s I i s v e g e t a r i a n . E a t v e g e t a b l e s and d r i n k much m i l k . My m o t h e r - i n - l a w t e l l s me b u t m o s t l y t h e d o c t o r g i v e s me a boo k . I n f o r m a t i o n h a d come f r o m a t r a d i t i o n a l c u l t u r a l s o u r c e b u t , i n a d d i t i o n , b e c a u s e t h i s woman's E n g l i s h r e a d i n g s k i l l s w e r e a d e q u a t e , s he d e s c r i b e d how she b e n e f i t e d f r o m i n f o r m a t i o n g a i n e d d i r e c t l y f r o m t h e h e a l t h c a r e p r o f e s s i o n a l . One woman had had a p r e g n a n c y i n I n d i a a n d one i n C a n a d a . H e r c h i l d b o r n i n I n d i a w e i g h e d f i v e p o u n d s and i n Can a d a h e r newborn w e i g h e d o v e r s e v e n p o u n d s . She a t t r i b u t e d t h e d i f f e r e n c e i n w e i g h t t o a d i f f e r e n t d i e t . She r e c o u n t e d : Maybe i n h e r e I a l r e a d y e a t b e t t e r . I d o n ' t t h i n k s o I e a t ' i n I n d i a . I d o n ' t e a t v e r y w e l l i n I n d i a . . . . T h e n I come h e r e . So o t h e r s go t o M c D o n a l d ' s and I e a t m i l k s h a k e and w o r k i n g i n A.&W. So maybe I t h i n k i t ' s g o o d . I n I n d i a h e r d i e t had c o n s i s t e d o f r i c e , v e g e t a b l e s and s w e e t s . I n C a n a d a , m i l k and meat had been a d d e d t o h e r d i e t . She h a d a d d e d t h e s e f o o d s when she became i n t e r e s t e d i n and f r e q u e n t e d f a s t f o o d r e s t a u r a n t s . H e r d i e t a r y i m p r o v e m e n t s had n o t b e e n c o n s c i o u s l y t h o u g h t o u t b u t r a t h e r a r e s u l t o f h e r a c q u i r i n g t h e N o r t h A m e r i c a n t a s t e f o r f a s t f o o d s . Two women w i t h g ood E n g l i s h s k i l l s , h a d a t t e n d e d p r e n a t a l c l a s s e s i n E n g l i s h a t t h e h e a l t h u n i t . They d e s c r i b e d d i e t s t h a t b l e n d e d i n f o r m a t i o n f r o m b o t h t h e p o p u l a r and p r o f e s s i o n a l s e c t o r . One woman s a i d : The h e a l t h u n i t s a y s , and I d o , l i k e maybe I need l o t s o f t h i n g s f o r b a b y ' s h e a l t h , l i k e m i l k , e g g s , m e a t , good f o o d s . A l s o my o l d e r m o t h e r l i k e , s h e t o l d me y o u e a t l o t s o f m i l k and d o n ' t e a t h o t t h i n g s — h o t s t u f f , s p i c e s , when y o u a r e p r e g n a n t . . . b e c a u s e i t ' s n o t g o o d f o r b a b i e s and me. Y e a h , maybe baby h u r t t h i s way. And a n o t h e r woman t o l d t h e r e s e a r c h e r : My m o t h e r - i n - l a w w r o t e , i f someone's h a v i n g a baby y o u know, l i k e when somebody's p r e g n a n t , a l l k i n d s o f f o o d s l i k e a r e g o o d f o r t h e m o t h e r a nd t h e m i l k i s p r e t t y g o o d and t h e n b u t t e r i s t h e m a i n t h i n g — I d o n ' t know why. Oh y e s , s h e ( m o t h e r - i n - l a w ) t o l d me a b o u t m e a t . Oh, I c a n e a t m e a t . . . a l l k i n d s o f meat I am e a t i n g . . . I d o n ' t t h i n k t h a t t h e y a r e s a y i n g a n y t h i n g a b o u t t h e s p i c e s b e c a u s e i n I n d i a , i n t h a t c a s e , t h e y a l l e a t s p i c e y . B u t s p i c e y 76 g i v e s me y o u know, t h e h e a r t b u r n , s o I d o n ' t e a t . T h i s woman s t a t e d t h a t s h e f o l l o w e d t h e C a n a d i a n Food G u i d e d u r i n g p r e g n a n c y and she d i d i n d e e d know t h e e s s e n t i a l f o o d g r o u p s and recommended a m o u n t s . She had some c o n c e r n s a b o u t t h e i n f o r m a t i o n s h e r e c e i v e d f r o m h e r m o t h e r - i n - l a w , and t o l d t h e i n v e s t i g a t o r how she h a n d l e d t h e s e c o n c e r n s : Okay, I j u s t a s k e d a b o u t t h e b u t t e r t o my d o c t o r b e c a u s e I was n o t b e l i e v i n g s o many t h i n g s y o u know what my m o t h e r ( i n - l a w ) w r o t e me, r i g h t . So I t h o u g h t y o u know, I s h o u l d a s k t h e d o c t o r . She i s t h e b e s t r i g h t . T h i s woman was s e e k i n g i n f o r m a t i o n f r o m two h e a l t h c a r e s e c t o r s i n s o c i e t y , t h e p o p u l a r and t h e p r o f e s s i o n a l , b u t she p l a c e d a g r e a t e r f a i t h i n what t h e p r o f e s s i o n a l s e c t o r s a i d i n t e r m s o f h e r p r e g n a n c y d i e t . D u r i n g p r e g n a n c y , f e m a l e e l d e r s a p p e a r t o p l a y a m a j o r r o l e i n g i v i n g t h e women i n f o r m a t i o n a b o u t d i e t and a c t i v i t y . I n i t i a l l y t h e women s p o k e o f f e e l i n g s h y when t e l l i n g t h e i r m o t h e r s o f t h e p r e g n a n c y , b u t c o m f o r t a b l e i n t a l k i n g w i t h t h e i r i n - l a w s . From t h e t i m e t h a t t h e e l d e r s l e a r n o f t h e p r e g n a n c y , t h e e l d e r s g u i d e t h e women t h r o u g h t h e t r a d i t i o n a l p e r s o n a l h e a l t h b e l i e f s and p r a c t i c e s r e l a t e d t o p r e g n a n c y . The s t r i c t p r o s c r i p t i o n s and p r e s c r i p t i o n s s u r r o u n d i n g c h i l d b e a r i n g t h a t one w o u l d e x p e c t t o f i n d i n c u l t u r e s w i t h h i g h m o r b i d i t y and m o r t a l i t y r a t e s ( M a l i n o w s k i , 1948; P a r k e r & Neumann, 1979) were n o t d e s c r i b e d by t h e s e women p a r t i c i p a n t s , p e r h a p s i n d i c a t i n g a d e c r e a s e i n a n x i e t y l e v e l r e l a t e d t o C a n a d a ' s l o w m o r b i d i t y and m o r t a l i t y r a t e s a s s o c i a t e d w i t h b i r t h . As t h e women a d o p t e d b e l i e f s and p r a c t i c e s t h a t were more C a n a d i a n t h a n I n d i a n i n n a t u r e , t h e y b e g an t o q u e s t i o n t h e i r e l d e r s ' i n f o r m a t i o n and s e e k o u t a n s w e r s f r o m w e s t e r n p r o f e s s i o n a l h e a t h c a r e w o r k e r s . The women r e t a i n e d many o f t h e i r t r a d i t i o n a l p r a c t i c e s as l o n g a s t h e y were r e a s s u r e d by p h y s i c i a n s , t h a t t h e i r b a b i e s were n o t b e i n g p u t a t r i s k . T h i s v i v i d b l e n d i n g o f p o p u l a r and p r o f e s s i o n a l e x p l a n a t o r y m o d e l s was a l s o e v i d e n t i n t h e women's a c c o u n t s o f t h e i r p o s t - p a r t u m e x p e r i e n c e s . P o s t - P a r t u m I n t h e p o s t - p a r t u m p e r i o d , t h e women's h e a l t h b e l i e f s and p r a c t i c e s c o n t i n u e d t o be i n f l u e n c e d by f a m i l y e l d e r s . The p r o c e s s o f a c c u l t u r a t i o n a l s o had a c o n t i n u e d e f f e c t on t h e women a t t h i s t i m e . The i n f l u e n c i n g f a c t o r s o f r e s p e c t f o r e l d e r s and s h y n e s s c o n t i n u e d t o i m p a c t t h e women's p e r c e p t i o n s o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s . D u r i n g t h e p o s t - p a r t u m p e r i o d , t h e women d e s c r i b e d how d i e t a r y r e s t r i c t i o n s w e r e o f t e n b a s e d on t h e same p r i n c i p l e s a p p l i e d i n p r e g n a n c y . T h i s was e s p e c i a l l y t r u e i f t h e woman was b r e a s t f e e d i n g . As b e f o r e , t h e women d e s c r i b e d how t h e y d i d n o t know t h e s p e c i f i c r e a s o n s f o r d i e t a r y r e s t r i c t i o n s . • One woman s a i d : B u t I e a t l i g h t f o o d s . N ot l i k e h o t . . . . B e c a u s e I was b r e a s t f e e d i n g t h i s o n e . Hot h u r t s b a b y . 78 And a n o t h e r : Not t o o h o t , l i k e c h i l l i e s , n o t t o o m u c h . . . . S p i c e y , n o t s p i c e y . I d o n ' t know w h y — m a y b e b e c a u s e o f t h e b r e a s t f e e d i n g . Women who had made more d i e t a r y c h a n g e s t o p r o v i d e f o r t h e i r g r o w i n g f e t u s and who had c o n s u l t e d t h e i r p h y s i c i a n s i f t h e y h a d any q u e s t i o n s a b o u t t h e i r f a m i l y e l d e r s a d v i c e , t o l d how t h e y d i d have an i d e a o f why a b r e a s t f e e d i n g d i e t w o u l d be r e s t r i c t e d . A p a r t i c i p a n t d e s c r i b e d t h e r e a s o n s : Oh my God. I f t h e m o t h e r s a r e , y o u know, b r e a s t f e e d i n g , r i g h t , t h e n t h e y ' r e s u p p o s e d t o e a t y o u know, t h i n g s l i k e c e r t a i n f o o d s y o u know, w h i c h won't h u r t t h e b a b y ' s tummy, r i g h t . When I e a t a v e r y h a r d f o o d , t h e n he c a n g e t i n t o t r o u b l e . B e c a u s e when I e a t any l a r g e t h i n g s , i t c a n p o s s i b l e h u r t t h e b a b y ' s tummy. I d o n ' t know i n C a n a d a , b u t i n I n d i a t h e y do t a k e l i g h t f o o d . . . w h e n t h e y a r e n u r s i n g , t h e y a r e s a y i n g maybe t h e baby c a n h a v e — l i k e d i a r r h e a o r t h i s k i n d o f t h i n g . As t h e women came t o c o n s u l t w e s t e r n h e a l t h c a r e p r o f e s s i o n a l s i n m a t t e r s s u c h as d i e t , t h e i r u n d e r s t a n d i n g o f a b r e a s t f e e d i n g d i e t a l t e r e d s l i g h t l y b u t was s t i l l f r a u g h t w i t h m i s c o n c e p t i o n s . Women t a l k e d o f a l t e r i n g t h e i r d i e t s s o t h a t t h e y d i d n o t h u r t t h e b a b y , b u t t h e y d i d n o t s p e a k o f d i e t a r y m o d i f i c a t i o n s i n o r d e r t o e n s u r e g r o w t h and d e v e l o p m e n t . H o w e v e r , t h e s t u d y p a r t i c i p a n t s d i s c u s s e d p u n j e e r i , a 79 a m i x t u r e o f b u t t e r , f l o u r and a l m o n d s g i v e n t o t h e women d a i l y w i t h m i l k . P u n j e e r i was t h o u g h t t o s p e e d r e c o v e r y and t h e r e t u r n o f s t r e n g t h . When a s k e d why she a t e i t one woman s a i d : W e l l , i t ' s s t r o n g f o r t h e b o d y . I t makes y o u h e a l t h y . . . . M y m o t h e r - i n - l a w made t h a t f o r me. I t a k e f o r two m o n t h s . A n o t h e r woman d e s c r i b e d how she had f i r s t become aware o f p u n j e e r i . She s a i d : You know when I was i n I n d i a , s o I was w a t c h i n g what t h e y w e r e g i v i n g t o my s i s t e r - i n - l a w and my s i s t e r y o u know. So t h e y were t e l l i n g u s , t h i s i s t h e g ood s t u f f , y o u know, a f t e r t h e b a b y , f o r t h e s t r e n g t h . A f r i e n d h a d made t h e p u n j e e r i f o r t h i s woman a s h e r r e l a t i v e s w e r e a l l i n I n d i a . T h i s woman's l i f e s t y l e was more c o n s i s t e n t w i t h C a n a d i a n t h a n E a s t I n d i a n s o c i e t y , f o r e x a m p l e , s he d r e s s e d i n C a n a d i a n c l o t h e s , a t e m a i n l y C a n a d i a n f o o d , s p o k e E n g l i s h t o h e r h u s b a n d w i t h i n t h e home and p r e f e r r e d l i v i n g i n a n u c l e a r r a t h e r t h a n e x t e n d e d , f a m i l y . F o l l o w i n g h e r f i r s t p r e g n a n c y t h i s woman had n o t had p u n j e e r i . She had f e l t weak and t i r e d f o r a l o n g t i m e . No I d i d n o t e a t a t a l l t h e f i r s t t i m e b u t t h i s t i m e I a t e and f e l t g o o d . . . y o u t a k e r i g h t a f t e r t h e b a b y . . . y o u c a n s t o p maybe a f t e r f i f t e e n d a y s , i t ' s g o od f o r t h e body y o u know. Y o u r m u s c l e c a n be s t r o n g y o u k n o w . . . . I t i s l i k e what y o u t a k e 80 v i t a m i n s . . . I t ' s n o t c o m p u l s o r y . I t ' s j u s t i t ' s my m o t h e r s h e t o l d me. B e r r y ( 1 9 8 0 ) d i s c u s s e s t h e phenomenon t h i s woman was d e s c r i b i n g when he t a l k s o f i m m i g r a n t s m a i n t a i n i n g t h e i r c u l t u r a l i n t e g r i t y a t t h e same t i m e as t h e y c h a n g e t o become a p a r t o f t h e new, l a r g e r s o c i e t a l f r a m e w o r k . T h i s woman had a t t e m p t e d t o aban d o n an E a s t I n d i a n t r a d i t i o n , b u t had f e l t i l l ; d u r i n g h e r n e x t c h i l d b e a r i n g e x p e r i e n c e s h e had u p h e l d t h e c u s t o m o f e a t i n g p u n j e e r i and had f e l t b e t t e r . K n o w l e d g e a b o u t d i e t f o r b r e a s t f e e d i n g m o t h e r s a s w e l l as p u n j e e r i was g a i n e d t h r o u g h o b s e r v a t i o n o r d i r e c t a d v i c e f r o m e l d e r s . As i n p r e g n a n c y , t h e i n f l u e n c e o f t h e f a m i l y members i n t h e p o s t - p a r t u m p e r i o d , i s g r e a t , a l t h o u g h d i m i n i s h e d s l i g h t l y by t h e p r o c e s s o f a c c u l t u r a t i o n as t h e women be g a n t o c o n s u l t w i t h h e a l t h c a r e p r o f e s s i o n a l s i n m a t t e r s s u c h as d i e t . The e f f e c t s o f a c c u l t u r a t i o n c o u l d be h e a r d more c l e a r l y when t h e women t a l k e d o f b r e a s t f e e d i n g i n h o s p i t a l . S h y n e s s a t t h i s t i m e was a m a j o r i n f l u e n c i n g f a c t o r . One woman s a i d : I b r e a s t f e e d i n h o s p i t a l u n d e r b l a n k e t s . I t p r i v a t e and I s h y f r o m t h e p e o p l e . When a s k e d why some women d i d n o t want t o n u r s e i n h o s p i t a l b u t d i d s o e a g e r l y a t home, one woman, who f e l t c o m f o r t a b l e n u r s i n g i n t h e h o s p i t a l r e p l i e d : Now o k a y , maybe t h e y ' r e s h y . T h a t c o u l d have b e e n t h e r e a s o n o t h e r w i s e t h e r e a r e no o t h e r r e a s o n . A n o t h e r s a i d : 81 L o t s o f p e o p l e a r e d o i n g l i k e t h a t . Y e a h , i t i s h a r d b e c a u s e t h e b a b y , h e ' s n o t g e t t i n g u s e d t o i t . One woman, who came f r o m a v i l l a g e and l i v e d i n a s m a l l e x t e n d e d f a m i l y , s a i d : I d o n ' t know, maybe t h e y want t o , t h e y s t a y f o r f o u r d a y s i n h o s p i t a l , t h e y f e e l t h e y want t o r e s t , t h e n I t h i n k t h e y come t o home and t h e y want t o n u r s e t h e m — Y e s , I t h i n k s o ( t h a t i t i s r e l a t e d t o s h y n e s s ) , b u t I d o n ' t s h y . I t ' s n o t g o o d — s h y n e s s i s n o t g o o d . The s u b j e c t who had b e e n t o l d a b o u t m e n s t r u a t i o n by h e r m o t h e r , e n j o y e d b r e a s t f e e d i n g h e r i n f a n t s and f e l t no s h y n e s s : I am n o t f e e l i n g n o t b a d — I l i k e t o b r e a s t f e e d . T h i s woman was an e x c e p t i o n amongst t h e s t u d y s u b j e c t s and t h i s i s c o n s i s t e n t w i t h h e r b e i n g r a i s e d w i t h l e s s c u l t u r a l s h y n e s s e v i d e n t amongst h e r a d u l t r o l e m o d e l s . The m a j o r i t y o f t h e women i n t h i s s t u d y a p p e a r e d r e l u c t a n t t o e x p o s e t h e i r p r i v a t e body p a r t s i n a s e m i - p u b l i c s e t t i n g . T h i s t o o i s c o n s i s t e n t w i t h t h e i r u p b r i n g i n g and e x p e r i e n c e w i t h c u l t u r a l s h y n e s s . H o w e v e r , a s t h e p r o c e s s o f a c c u l t u r a t i o n o c c u r r e d t h e women a p p e a r e d t o u n d e r s t a n d t h a t s h y n e s s i n t e r m s o f b r e a s t f e e d i n g was a n e g a t i v e t r a i t t h a t d e l a y e d t h e i r s u c c e s s i n f e e d i n g t h e i r n e w b o r n s . An i n t e r e s t i n g f i n d i n g i s t h a t , a l t h o u g h t h e women t a l k e d o f b r e a s t f e e d i n g i n t h e h o s p i t a l , t h e y d i s c u s s e d s h y n e s s i n r e l a t i o n t o p e o p l e i n g e n e r a l and n o t i n r e l a t i o n t o h e a l t h 82 c a r e p r o f e s s i o n a l s i n p a r t i c u l a r . Women i n t h i s s t u d y were a l s o a b l e t o o b s e r v e and d i s c u s s t h e l i m i t a t i o n t h e i r c u l t u r e p l a c e d on p h y s i c a l a c t i v i t y i n t h e p o s t - p a r t u m p e r i o d . The same p a t t e r n o f s l o w movement f r o m one b e l i e f s y s t e m t o a n o t h e r d u r i n g t h e p r o c e s s o f a c c u l t u r a t i o n was a g a i n e v i d e n t . Women t a l k e d o f r e s t r i c t i n g t h e i r p h y s i c a l a c t i v i t y f o r s i x weeks a f t e r a b a b y i s b o r n . G i d e o n ( 1 9 6 2 ) c o n f i r m s t h a t t h i s i s done i n t h e P u n j a b i n an a t t e m p t t o i s o l a t e m o t h e r and b a b y f r o m p o s s i b l e d i s e a s e , and r e d u c e t h e woman's h e a v y w o r k l o a d . T h i s s i x - w e e k p e r i o d o f r e s t i s c o n s i s t e n t w i t h w e s t e r n o b s t e t r i c a l p r a c t i c e , w h i c h d o e s n o t c o n s i d e r women p h y s i c a l l y r e c o v e r e d u n t i l s i x weeks p o s t - p a r t u m ( L y t l e , 1 977; M c K i n l a y , 1 9 7 2 ) . The women i n t h i s s a m p l e d e s c r i b e d how t h e y v a r i e d i n t h e amount o f r e s t t h e y r e c e i v e d p o s t - p a r t u m and t h e y g a v e d i f f e r e n t e x p l a n a t i o n s f o r t h i s r e s t p e r i o d . One woman s a i d : I s p e n t l i k e 2 0 , o r more t h a n 20 d a y s i n my mom's home a f t e r h i s b i r t h and she h e l p e d me t h e r e . And a n o t h e r : My a u n t was t h e r e . She came a t my h o u s e f o r two weeks and she do my wo r k . T h e s e women d e s c r i b e d t h e h e l p g i v e n them i n t h e p o s t - p a r t u m p e r i o d , b u t d i d n o t e x p l a i n why t h e i r e l d e r s g ave s u c h h e l p . As t h e women i n c r e a s e d t h e i r E n g l i s h s k i l l s and began t o c o n s u l t t h e i r p h y s i c i a n s f o r a d v i c e on a c t i v i t y and n u t r i t i o n , t h e y c o u l d e x p l a i n t h e r e a s o n s why t h e y n eeded 83 h e l p . A s t u d y p a r t i c i p a n t s a i d : M o s t l y one month f r o m h o s p i t a l I r e s t . I s t a y i n h o u s e . B e c a u s e some t h i n k t h a t w e a k n e s s . T h a t ' s r i g h t . . . h e a l t h r e a s o n s m o s t l y . I f I do f e e l w e l l , s o ' s I c a n go o u t , i t ' s o k a y , b u t I s t a y h o m e — r e s t . And a n o t h e r : When I come home I r e s t . F a m i l y members l o o k a f t e r e v e r y t h i n g . B e c a u s e i t ' s h a r d f o r t h e s t i t c h e s . Maybe I t w i s t t h e s t i t c h e s and maybe i t ' s h a r d when I p i c k up, o v e r l i f t . So I r e s t maybe s i x w e e k s . One woman, l i v i n g i n a n u c l e a r f a m i l y s a i d : M...hm. A f t e r a week o r s o , t h e n y o u f e e l b e t t e r , y o u l i k e t o o r y o u c a n w a l k . I n I n d i a t h e y s p e n d I t h i n k s i x weeks a t home, b u t I d o n ' t a b l e t o . T h i s woman's e x p e r i e n c e was, o u t o f n e c e s s i t y , d i f f e r e n t f r o m t h e o t h e r women's. N o t h a v i n g r e l a t i v e s h e r e t o c a r e f o r h e r s e l f o r h e r f a m i l y , she had n o t s p e n t t h e c u s t o m a r y t i m e r e c o v e r i n g . C h ance (1965) p o i n t s o u t t h a t o l d c u l t u r a l p r a c t i c e s a r e d i s c a r d e d more q u i c k l y and new o n e s t a k e n on when i t i s b e n e f i c i a l t o do s o o r s u c h c h a n g e s a r e r e q u i r e d o f t h e a c c u l t u r a t i n g g r o u p o r i n d i v i d u a l . The woman who had n o t had p u n j e e r i f o l l o w i n g h e r f i r s t b a b y b u t f o u n d t h a t i t h e l p e d h e r r e c o v e r y a f t e r h e r s e c o n d , had t h i s t o s a y : Y e a h , w e ' r e k e e p i n g same c u s t o m s most o f t e n , b u t t h a t ' s c h a n g i n g t o o . I n I n d i a , ... f o r t y d a y s t h e women a r e n o t g o i n g o u t o f t h e h o u s e , s i x weeks t h e y a r e s t a y i n g i n , y o u know and l o t s o f p e o p l e a r e n o t c o m i n g t o v i s i t them b e c a u s e t h e y ' r e t h i n k i n g t h e b a b y ' s g o i n g t o g e t germs y o u know. B u t h e r e nobody m i n d s and I t h i n k t h e women a r e g o i n g o u t a f t e r t w o , t h r e e d a y s . I t h i n k i n I n d i a , oh God, t h e r e a r e s o many s u p e r s t i t i o n s r i g h t , t h a t p e o p l e s t i l l b e l i e v e t h a t r i g h t b u t I d o n ' t t h i n k t h e y s h o u l d s t a y i n bed f o r f o r t y d a y s y o u know....No I d i d n o t go m y s e l f . I d i d n o t f e e l g ood t h a t t i m e , I t h o u g h t I s h o u l d s t a y i n b e c a u s e my baby was, y o u know, s m a l l and I t h o u g h t e v e n i f I'm g o i n g t o s t a y i n , he w i l l be much b e t t e r . A l s o , b e c a u s e when y o u a r e g o i n g t o go o u t , t h a t p e o p l e come and h o l d y o u r b a b y , r i g h t b e c a u s e i n o u r c u l t u r e y o u c a n ' t s t o p and s o m e t i m e s t h e p e o p l e , t h e y ' v e g o t d i r t y h a n d s and t h e y p u t them i n t h e mouth a f t e r a n d I d i d n o t want my baby t o g e t a n y t h i n g r i g h t . S o , I d i d n o t go. T h i s woman v e r b a l i z e d h e r b e l i e f t h a t t h e o l d c u s t o m o f s t a y i n g i n f o r s i x weeks p o s t - p a r t u m was n o t n e c e s s a r y and was a mere s u p e r s t i t i o n . H o w e v e r , s he d i d s t a y i n and she r a t i o n a l i z e d h e r d e c i s i o n i n t e r m s o f " g e r m s " — a m o d e r n , w e s t e r n h e a l t h c a r e c o n c e p t . I n t e g r a t i o n ( B e r r y , 1980) o f t h e two c u l t u r e s was o c c u r r i n g f o r t h i s woman a t t h i s t i m e . I t a p p e a r s f r o m t h e d a t a t h a t t h e p r o c e s s o f a c c u l t u r a t i o n a f f e c t s t h e women's d i e t and b e h a v i o u r i n 85 p r e g n a n c y and p o s t - p a r t u m . The e x p e r i e n c e d e l d e r s i n t r a d i t i o n a l s o c i e t i e s a r e i n f l u e n t i a l s o u r c e s o f i n f o r m a t i o n d u r i n g t h e c h i l d b e a r i n g e x p e r i e n c e , a n d , i n C a n a d a , t h e s e e l d e r s a p p e a r t o c o n t i n u e t o be i n f l u e n t i a l d u r i n g t h i s t i m e . As t h e women i n t h e s t u d y became more a c c u l t u r a t e d i n t o C a n a d i a n s o c i e t y , t h e y b egan t o s e e k o u t t h e a d v i c e o f t h e p r o f e s s i o n a l s e c t o r more o f t e n . B u t t h e y r e m a i n e d c o m m i t t e d t o many p r a c t i c e s t h e y l e a r n e d f r o m t h e p o p u l a r s e c t o r o f h e a l t h c a r e . M a c C l a i n ( 1 9 8 2 ) c o n f i r m s t h a t c u l t u r a l c h a n g e r a r e l y e c l i p s e s t r a d i t i o n a l p r a c t i c e s b u t r a t h e r p r o v i d e s an a d d i t i o n a l a l t e r n a t i v e and s o u r c e o f c o n t r o l o v e r t h e c h i l d b e a r i n g e x p e r i e n c e . T h i s a p p e a r s t o be t r u e f o r t h e women i n t h i s s t u d y . The p o p u l a r e x p l a n a t o r y m o d e l s o f t h e women i n t h i s s t u d y i n r e l a t i o n t o t h e i r c h i l d b e a r i n g e x p e r i e n c e s d i f f e r f r o m b o t h t h e p o p u l a r and t h e p r o f e s s i o n a l m o d e l s o f C a n a d i a n s o c i e t y a t l a r g e . A g r o w i n g number o f C a n a d a ' s p o p u l a r e x p l a n a t o r y m o d e l s p e r c e i v e t h a t t h e " p r e g n a n t c o u p l e " must t a k e c o n t r o l o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s ( A r m s , 1977; K o r t e & S c a e r , 1 9 8 4 ) , w h i l e many c o u p l e s y i e l d c o n t r o l c o m p l e t e l y t o h e a l t h c a r e p r o f e s s i o n a l s . I n g i v i n g up c o n t r o l o v e r t h e i r own e x p e r i e n c e s t h e s e c o u p l e s ' h e a l t h b e l i e f s and p r a c t i c e s i n a r e a s s u c h as d i e t a r e d i c t a t e d by h e a l t h c a r e p r o f e s s i o n a l s and c l i e n t c o m p l i a n c e i s h i g h ( L y t l e , 1 9 7 7 ) . R e g a r d l e s s o f w h i c h p o p u l a r C a n a d i a n e x p l a n a t o r y m o d e l i s a d h e r e d t o , p r e g n a n c y and b r e a s t f e e d i n g a r e c e l e b r a t e d ( K i t z i n g e r , 1 9 7 8 ) , and s h y n e s s i n r e l a t i o n t o 86 t h e s e s u b j e c t s i s n o t an i s s u e . F a m i l y e l d e r s a r e s e l d o m c o n s u l t e d f o r i n f o r m a t i o n a n d a d v i c e on h e a l t h b e l i e f s and p r a c t i c e s a n d r e s p e c t f o r t h e e l d e r l y i s d e c l i n i n g ( M a c C l a i n , 1982) . S i m i l a r l y , t h e p r o f e s s i o n a l h e a l t h c a r e e x p l a n a t o r y m o d e l s o f t e n p e r c e i v e t h a t k n o w l e d g e o f t h e c h i l d b e a r i n g e x p e r i e n c e i s t h e i r e x c l u s i v e d o m a i n ( A r m s , 1977; Cameron, 1979; K i t z i n g e r , 1 9 7 8 ) . A l t h o u g h t h i s i s c h a n g i n g s l o w l y t o a l l o w f o r more c l i e n t c o n t r o l o v e r t h e i r own e x p e r i e n c e s ( L y t l e , 1977; M a c C l a i n , 1982; M e r c e r , H a c k l e y & B o s t r o m , 1983) , h e a l t h c a r e p r o f e s s i o n a l s s t i l l f e e l t h e y a r e t h e a u t h o r i t i e s on m a t t e r s s u c h a s p r e g n a n c y d i e t s . The d i f f e r e n c e b e t w e e n t h e p r o f e s s i o n a l and E a s t I n d i a n p o p u l a r e x p l a n a t o r y m o d e l s h a s i m p l i c a t i o n s f o r t h e E a s t I n d i a n women's h e a l t h c a r e as c o n f l i c t may a r i s e b e t w e e n t h e a d v i c e g i v e n by t h e h e a l t h c a r e p r o f e s s i o n a l and t h e f a m i l y e l d e r s . As t h e women i n t h i s s t u d y became a c c u l t u r a t e d i n t o C a n a d i a n s o c i e t y , i t i s i n t e r e s t i n g t h a t t h e i r a c c o u n t s r e v e a l e d t h a t t h e y c o n t i n u e d t h e i r o l d p r a c t i c e s b u t e x p l a i n e d them d i f f e r e n t l y . I n a d d i t i o n , t h e y b e g a n t o a d o p t c h i l d b e a r i n g p r a c t i c e s c h a r a c t e r i s t i c o f C a n a d i a n s o c i e t y . Summary o f t h e S u b j e c t s ' R e l a t i o n s h i p s w i t h t h e i r F a m i l i e s R e g a r d l e s s o f t h e d e g r e e o f a c c u l t u r a t i o n t h a t had o c c u r r e d f o r t h e women i n t h i s s t u d y , t h e y a l l s a i d t h a t s h y n e s s had had a n e g a t i v e i m p a c t on t h e i r l i v e s . The women c l e a r l y e x p r e s s e d d i s t r e s s a t t h e i r l a c k o f k n o w l e d g e o f t h e i r own anatomy and p h y s i o l o g y i n t h e a r e a s o f s e x u a l i t y , s e x and p r e g n a n c y ; and i n d e e d t h e y had p l a n s t o a l t e r t h i s e x p e r i e n c e f o r t h e i r own d a u g h t e r s . One woman s a i d : I am g o i n g t o t e l l h e r o f t h e s e t h i n g s . I t be i m p o r t a n t . Some t h i n g s a r e t o o s c a r y , t o o s c a r y i f no know. And a n o t h e r : Some g i r l s do t h a t ( t a l k ) a b o u t l o t s o f t h e s e t h i n g s . Some maybe s h y , t h a t ' s why n o t . Y e a h , I l i k e t h a t ( t o t a l k ) . I t ' s k n o w l e d g e t h a t ' s why. And a t h i r d : W e l l , I'm g o i n g t o t e l l h e r ( d a u g h t e r ) e v e r y t h i n g . . . I t ' s b e t t e r r i g h t — I f e e l v e r y d i f f i c u l t when I g e t my p e r i o d t h e f i r s t t i m e . A s k e d how she w o u l d f e e l t e l l i n g h e r d a u g h t e r , one woman o b s e r v e d : I t h i n k n o t bad b e c a u s e now, i n C a n a d a , y o u know, we know t h i s c o u n t r y i s c o m p l e t e l y d i f f e r e n t f r o m I n d i a . E v e n y o u c a n k i s s and s o many t h i n g s , e v e n on t h e s t r e e t , b u t i n I n d i a , nobody i s d o i n g t h a t t h e r e . . . . E v e n my h u s b a n d ' s f r i e n d s , l i k e m a l e , t h e y ' r e t a l k i n g a b o u t t h i n g s i n f r o n t o f e v e r y o n e b u t we d o n ' t . We a r e v e r y open r i g h t . We a r e j u s t l i k e — y o u know, when I'm h a v i n g some g u e s t s , t h e y ' r e C a n a d i a n , I w i l l be l i k e them. I f t h e y ' r e E a s t I n d i a n , I w i l l be l i k e them, r i g h t . S o , when 88 t h e y a r e c o m i n g a t o u r p l a c e , i t ' s v e r y o p e n . E v e n t h e y ' r e d i s c u s s i n g s e x , e v e r y t h i n g , i n f r o n t o f e v e r y o n e , r i g h t . B u t i n o u r c u l t u r e , l i k e when I was h a v i n g a b a b y , y o u know, t h e men t h e y w e re a s k i n g me t o s e e how t h e b a b y ' s d o i n g , b u t C a n a d i a n , t h e y w e re s a y i n g , c a n I s e e y o u r tummy. Can I do t h i s ? They were d o i n g l i k e t h a t . So t h a t ' s t h e d i f f e r e n c e . T h i s woman p e r c e i v e d t h a t h e r new l i f e i n a n o t h e r c o u n t r y w o u l d e n t a i l c h a n g e s i n b e h a v i o u r and a d a p t a t i o n s t h a t s h e had a l r e a d y b e g un t o make i n an e f f o r t t o be a p a r t o f h e r c h o s e n s o c i e t y . I n a d d i t i o n , s h e c o u l d s e e t h e b e n e f i t s t h a t t h i s new o p e n n e s s w o u l d have f o r h e r c h i l d . Yu ( 1 9 8 4 ) p o i n t s o u t t h a t v a l u e s f r o m d i f f e r e n t c u l t u r e s o f t e n c l a s h , and t h e i m m i g r a n t , i n o r d e r t o l i v e p e a c e f u l l y i n t h e new c u l t u r e , must g i v e up some o l d v a l u e s . C hance (1965) p o i n t s o u t t h a t i n t h e p r o c e s s o f a c c u l t u r a t i o n , o l d v a l u e s a r e g i v e n up more r e a d i l y i f t h e new v a l u e s a r e c l e a r l y p e r c e i v e d and c a p a b l e o f b e i n g i n t e g r a t e d i n t o e x i s t i n g s o c i a l and c u l t u r a l p a t t e r n s . A l l o f t h e women made s e n s e o f t h e i r w o r l d t h r o u g h s h y n e s s . T h i s c u l t u r a l t r a i t was an i m p o r t a n t and m a j o r p a r t o f t h e i r e x p l a n a t o r y m o d e l and a s s h y n e s s i n f l u e n c e d t h e i r c h i l d b e a r i n g e x p e r i e n c e s , t h e y c o u l d s e e t h e v a l u e o f h e l p i n g t h e i r d a u g h t e r s t o a l t e r t h e i r e x p l a n a t o r y m o d e l s . R e g a r d l e s s o f t h e l e v e l o f s h y n e s s t h e women r e c o u n t e d when t h e y t o l d o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s i n C a n a d a , 89 t h e y had a l l had c o n t a c t w i t h and r e c e i v e d c a r e f r o m t h e p r o f e s s i o n a l h e a l t h c a r e s e c t o r . The d e g r e e o f t h e i r c o n t a c t , a s w e l l as t h e b e n e f i t s t h e y r e c e i v e d f r o m t h i s c o n t a c t w e r e a f f e c t e d by t h e p r o c e s s o f a c c u l t u r a t i o n . The S u b j e c t s ' R e l a t i o n s h i p s w i t h H e a l t h C a r e P r o f e s s i o n a l s and I n f l u e n c i n g F a c t o r s I n t h i s s e c t i o n t h e women's p e r c e p t i o n s o f t h e w e s t e r n h e a l t h c a r e r e s o u r c e s t h e y u t i l i z e d d u r i n g t h e i r c h i l d b e a r i n g e x p e r i e n c e s w i l l be d e s c r i b e d and d i s c u s s e d . On t h e s u b j e c t o f t h e i r r e l a t i o n s h i p s w i t h h e a l t h c a r e p r o f e s s i o n a l s d u r i n g t h e i r c h i l d b e a r i n g e x p e r i e n c e s , t h e s u b j e c t s ' d i s c u s s i o n s were f r a u g h t w i t h c o n t r a d i c t i o n s . A l t h o u g h t h e y c l a i m e d t h a t t h e p h y s i c i a n was t h e i r p r i m a r y s o u r c e o f i n f o r m a t i o n , t h e i r a c t u a l p r a c t i c e s w e r e b a s e d on i n f o r m a t i o n o b t a i n e d f r o m f a m i l y members; and a l t h o u g h t h e y e x p e r i e n c e d d i s c r i m i n a t i o n by t h e h o s p i t a l n u r s i n g s t a f f , t h e y p r e f e r r e d d e l i v e r i n g t h e i r b a b i e s and s p e n d i n g t h e i r p o s t - p a r t u m t i m e i n C a n a d i a n h o s p i t a l s . T h r o u g h o u t t h e c h i l d b e a r i n g e x p e r i e n c e t h e y seemed t o p e r c e i v e t h e h e a l t h c a r e p r o f e s s i o n a l s as a b s o l u t e h e a l t h a u t h o r i t i e s and p l a c e d t h e i r t r u s t and r e s p e c t i n them. The women d e s c r i b e d t h e i r r e l a t i o n s h i p s w i t h t h e i r p h y s i c i a n s , t h e c o m m u n i t y h e a l t h n u r s e s , t h e h o s p i t a l s t a f f n u r s e s i n t h e p o s t - p a r t u m p e r i o d , a n d , i n a g e n e r a l way, t h e i r p e r c e p t i o n s o f t h e w e s t e r n h o s p i t a l s where t h e i r b a b i e s 90 were b o r n . I n t h e women's d e s c r i p t i o n s o f t h e i r r e l a t i o n s h i p s w i t h h e a l t h c a r e p r o f e s s i o n a l s , t h e i n f l u e n c i n g f a c t o r s o f a u t h o r i t y , r e s p e c t and l a c k o f k n o w l e d g e , were o n c e a g a i n p r o m i n e n t i n t h e i r e x p l a n a t o r y m o d e l s . They were a l s o i n f l u e n c e d by t h e d i s c r i m i n a t i o n t h e y f e l t was d i r e c t e d a t them by h o s p i t a l n u r s e s . D e s p i t e t h i s , t h e y s p o k e o f t h e s a f e t y f a c t o r t h a t a h o s p i t a l d e l i v e r y o f f e r e d b o t h m o t h e r and b a b y . The women's r e l a t i o n s h i p s w i t h h e a l t h c a r e p r o f e s s i o n a l s , t o g e t h e r w i t h t h e i d e n t i f i e d i n f l u e n c i n g f a c t o r s i n t h e s e r e l a t i o n s h i p s , a f f e c t e d and were a f f e c t e d by t h e p r o c e s s o f a c c u l t u r a t i o n . T h e s e r e l a t i o n s h i p s , i n t u r n , f o r m e d a s e c o n d m a j o r p o r t i o n o f t h e women's e x p l a n a t o r y m o d e l s o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s . T a b l e 2. Theme: The S u b j e c t s ' R e l a t i o n s h i p s w i t h H e a l t h C a r e P r o f e s s i o n a l s R e l a t i o n s h i p s / P r e f e r e n c e s I n f l u e n c i n g F a c t o r s P h y s i c i a n Community H e a l t h N u r s e ^ — P o s t - P a r t u m H o s p i t a l N u r s e H o s p i t a l A u t h o r i t y R e s p e c t L a c k o f k n o w l e d g e I n t h i s s e c t i o n t h e s u b j e c t s ' a c c o u n t s w i l l be p r e s e n t e d a c c o r d i n g t o t h e theme: r e l a t i o n s h i p s , a n d i n f l u e n c i n g f a c t o r s . 91 The R e l a t i o n s h i p w i t h t h e P h y s i c i a n A l l t h e s u b j e c t s c l a i m e d t h a t t h e d o c t o r was t h e i r p r i m a r y s o u r c e o f i n f o r m a t i o n a b o u t t h e i r p r e g n a n c y , l a b o u r and d e l i v e r y a n d a b o u t a p p r o p r i a t e a c t i o n s t o t a k e d u r i n g t h i s t i m e . One woman s a i d : The d o c t o r — s h e g a v e me a book. T h e r e i s a l o t o f t h i n g s a b o u t p r e g n a n c y a n d b a b y ' s b i r t h . And a n o t h e r : I t h i n k j u s t my d o c t o r g a v e i n f o r m a t i o n . N o t e v e n f r i e n d s . A t h i r d woman s a i d : W e l l , t h e d o c t o r g a v e me some b o o k s . And a f o u r t h d e s c r i b e d how she p e r c e i v e d h e r d o c t o r : I t h o u g h t o f h i m ( t h e d o c t o r ) as my good f r i e n d . A l l b u t one o f t h e women i n t h e s t u d y d i d n o t a c t i v e l y q u e s t i o n t h e d o c t o r s a b o u t c h i l d b e a r i n g b u t r a t h e r a c c e p t e d i n f o r m a t i o n g i v e n t o them. H o w e v e r , when a s k e d a b o u t t h e i r a c t u a l p r a c t i c e s , m o s t a l t e r a t i o n s were b a s e d n o t on a c c e p t e d w e s t e r n m e d i c a l p r a c t i c e b u t on i n f o r m a t i o n r e c e i v e d f r o m f a m i l y members. T h i s c o n t r a s t e d w i t h t h e t r u s t p l a c e d i n t h e d o c t o r s by women, b u t i s c o n s i s t e n t w i t h t h e w r i t i n g s o f M a c C l a i n ( 1 9 8 2 ) and O a k l e y ( 1 9 7 7 ) w h i c h d e s c r i b e t h e e a s e w i t h w h i c h a t r a d i t i o n a l c u l t u r e p i c k s up t h e t e c h n o l o g i c a l a s p e c t s o f w e s t e r n m e d i c a l c a r e a s o p p o s e d t o a W e s t e r n b e l i e f s y s t e m . The women d e s c r i b e d s i t u a t i o n s i n w h i c h t h e y p l a c e d 92 o b v i o u s t r u s t i n t h e i r d o c t o r s . S e v e r a l o f t h e women s a i d t h a t t h e y t r u s t e d t h e i r d o c t o r as t h e y c o n s i d e r e d t h e p h y s i c i a n as t h e a u t h o r i t y . T h e s e women h e l d b e l i e f s and v a l u e s s i m i l a r t o t h o s e f o u n d i n E a s t I n d i a n c u l t u r e . Women who h e l d b e l i e f s and v a l u e s a s s o c i a t e d w i t h C a n a d i a n c u l t u r e , s u c h as c o n s u l t i n g t h e i r d o c t o r a b o u t d i e t i n p r e g n a n c y , p l a c e d t h e i r t r u s t i n t h e i r d o c t o r s a c c o r d i n g t o t h e i r k n o w l e d g e o f what was h a p p e n i n g t o them. A c c u l t u r a t i o n a p p e a r e d t o a f f e c t t h e r e a s o n s b e h i n d t h e i r t r u s t i n t h e i r p h y s i c i a n . One woman had had l a b o u r i n d u c e d and had f e l t c o m f o r t a b l e g i v i n g c o n t r o l o v e r t o t h e d o c t o r u n q u e s t i o n i n g l y . I d i d n o t s t a r t p a i n . The d o c t o r — y e a h , I had t o go t o t h e d o c t o r . . . h e moved s o m e t h i n g . Y e a h , t h e n he t o l d me t h a t " y ou s t a r t p a i n o t h e r w i s e y o u phone me." I d i d n o t s t a r t p a i n . I pho n e d t o t h e d o c t o r and he s a i d "You go i n t h e h o s p i t a l . " I go i n t h e h o s p i t a l t h a t d a y . . . t h e d o c t o r came o v e r t h e r e . . . t h e n t h e y s t a r t p a i n i n g w i t h t h e m a c h i n e . G i v e some m e d i c i n e and I s t a r t p a i n . T h i s woman had no i d e a o f what was done i n t h e p r o c e s s o f i n d u c i n g l a b o u r n o r d i d she f e e l a need t o q u e s t i o n t h e d o c t o r a s s h e t r u s t e d and r e s p e c t e d h i s j u d g m e n t and a u t h o r i t y . A n o t h e r s u b j e c t t a l k e d o f b e i n g i n t h e d e l i v e r y room w i t h o u t any r e l a t i v e s p r e s e n t . She s a i d : I t d o e s n ' t m a t t e r . I f d o c t o r i s g o o d , I know 93 b e c a u s e my b r o t h e r ' s w i f e a l r e a d y g o t two b a b i e s w i t h t h a t d o c t o r s o I know t h e d o c t o r . Two women had had b i r t h s by e m e r g e n c y c a e s a r i a n s e c t i o n . The f i r s t woman had n o t a t t e n d e d p r e n a t a l c l a s s e s and had n e v e r h e a r d o f a c a e s a r i a n b i r t h p r i o r t o h e r own o p e r a t i o n . S o , t h a t ' s when she ( t h e d o c t o r ) t o l d me, y o u m i g h t have a c a e s a r i a n s e c t i o n . S o , I d i d n ' t know t h e r e was a c a e s a r i a n s e c t i o n . A s k e d i f she was s c a r e d o r had a s k e d f o r more i n f o r m a t i o n , she r e p l i e d "No" and t h a t s h e t r u s t e d h e r d o c t o r t o do what was b e s t f o r h e r . The s e c o n d woman had g o o d E n g l i s h s k i l l s , l i v e d i n a n u c l e a r f a m i l y , and had a t t e n d e d p r e n a t a l c l a s s e s . Then I was i n l a b o u r y e a h . When I was i n h o s p i t a l , y o u know, I went f o r my n o r m a l d e l i v e r y . B u t i n t h e m o r n i n g t i m e , j u s t a f t e r 13 h o u r s , t h e y s a i d , t h e d o c t o r , y o u know, she was v e r y s c a r e d and s h e t o l d me t h a t I g o t some p r o b l e m . My b a b y was n o t b r e a t h i n g p r o p e r l y and I was h a v i n g c o n t r a c t i o n s . I was c u t t i n g o x y g e n f r o m my ba b y . . . . A n d t h e n t h e y s a i d , we want t o o p e r a t e y o u r i g h t . So t h a t t i m e I was v e r y g l a d y o u know s o I s a y s y e s . I t means my baby was f i n e and I was f i n e . T h i s woman had a s k e d f o r and been g i v e n t h e i n f o r m a t i o n she n e eded t o p e r s u a d e h e r t h a t t h e s u r g i c a l p r o c e d u r e was n e c e s s a r y . She t o o t r u s t e d h e r d o c t o r , b u t she a l s o had t h e k n o w l e d g e t o make a j u d i c i o u s d e c i s i o n . The women i n t h i s s a m p l e a l l p e r c e i v e d t h a t t h e i r p h y s i c i a n s were t h e a u t h o r i t i e s i n h e a l t h c a r e t h a t h a d a w e s t e r n t e c h n o l o g i c a l b a s e . Women i n t h e s a m p l e who had become more a c c u l t u r a t e d , seemed t o have t o t a l t r u s t i n t h e i r p h y s i c i a n b u t t h e i r t r u s t was b a s e d n o t o n l y on " b l i n d f a i t h " b u t a l s o on t h e i r a b i l i t y t o u n d e r s t a n d v a r i o u s p r a c t i c e s i n t h e i r new c u l t u r e . T h i s f i n d i n g i s c o n s i s t e n t w i t h t h e w o r k s o f B e r r y ( 1 9 8 0 ) and Chance (1965) who b o t h p o i n t o u t t h a t , as t h e p r o c e s s o f a c c u l t u r a t i o n o c c u r s , t h e i n d i v i d u a l i s b e t t e r a b l e t o q u e s t i o n and u n d e r s t a n d new c u l t u r a l p r a c t i c e s . The women i n t h i s s a m p l e a p p e a r e d t o t r u s t t h e i r d o c t o r s on p h y s i o l o g i c a l and t e c h n o l o g i c a l m a t t e r s , b u t i t was w i t h c o m m u n i t y h e a l t h n u r s e s t h a t t h e y f e l t more c o m f o r t a b l e d i s c u s s i n g b e l i e f s and p r a c t i c e s . The R e l a t i o n s h i p w i t h Community H e a l t h N u r s e s Two o f t h e e i g h t s t u d y s u b j e c t s and t h e i r h u s b a n d s had a t t e n d e d p r e n a t a l c l a s s e s a t t h e l o c a l h e a l t h u n i t . B o t h o f t h e s e women l i v e d i n n u c l e a r f a m i l i e s i n Canada and t h e i r c l o s e r e l a t i v e s l i v e d i n I n d i a and were t h u s u n a v a i l a b l e as d i s p e n s e r s o f i n f o r m a t i o n and a d v i c e . One o f t h e women had grown up i n a c i t y and n o t a v i l l a g e i n t h e P u n j a b ; b o t h s p o k e E n g l i s h f l u e n t l y and had b e l i e f s and a t t i t u d e s commonly h e l d i n C a n a d i a n c u l t u r e . F o r e x a m p l e , b o t h had c o n s u l t e d t h e i r p h y s i c i a n s a b o u t a n u t r i t i o u s p r e g n a n c y d i e t and one had a s k e d h e r d o c t o r ' s a d v i c e b e f o r e s h e had u n d e r t a k e n a 95 t r a d i t i o n a l p r a c t i c e t o l d t o h e r by a f a m i l y e l d e r . When a s k e d where t h e y had l e a r n e d o f t h e c l a s s e s , one r e p l i e d : D o c t o r t o l d me. I went c a u s e I want t o . The s e c o n d r e p l i e d : Oh, I went t o my d o c t o r and she t o l d me a b o u t t h e h e a l t h u n i t and s o I go t h e r e . A t h i r d woman had a l s o b e e n t o l d a b o u t p r e n a t a l c l a s s e s by h e r d o c t o r . She s a i d : No, I d i d n ' t went t h e r e b e c a u s e I d i d n ' t h a v e t h e t i m e . I was w o r k i n g . I n f a c t , s h e w o r k e d f o u r h o u r s p e r day t h r e e d a y s a week and h e r h u s b a n d w o r k e d d a y s h i f t . T h i s woman's m o t h e r l i v e d w i t h h e r d u r i n g h e r p r e g n a n c y and t h e woman d e s c r i b e d how h e r m o t h e r h ad p r o v i d e d t h e i n f o r m a t i o n s h e f e l t she r e q u i r e d a b o u t c h i l d b e a r i n g . The f i v e o t h e r women i n t h i s s a m p l e h ad n o t h e a r d a b o u t p r e n a t a l c l a s s e s and seemed g e n u i n e l y s u r p r i s e d t o l e a r n o f t h e i r e x i s t e n c e . T h i s f i n d i n g i s s u r p r i s i n g when one r e a l i z e s t h a t t h r e e o f t h e s e women had t h e same p h y s i c i a n a s t h e two who had a t t e n d e d c l a s s e s on t h e r e c o m m e n d a t i o n o f t h e i r d o c t o r s . I t i s d i f f i c u l t t o a s s e s s what a c t u a l l y h a p p e n e d b e t w e e n t h i s g r o u p o f c l i e n t s and t h e i r p r a c t i t i o n e r s , h o w e v e r , i t seems o b v i o u s t h a t a m i s u n d e r s t a n d i n g o c c u r r e d on one o r b o t h s i d e s o f t h e r e l a t i o n s h i p . One o f t h e women who, b e c a u s e o f t h i s m i s c o m m u n i c a t i o n , had n o t a t t e n d e d p r e n a t a l c l a s s e s , w i s h e d she h a d b e e n a b l e t o a t t e n d : 96 To l e a r n f r o m t h e s e t h i n g s w o u l d be n i c e . And a n o t h e r : Oh y e s , I w o u l d g o . I s i m p o r t a n t . I d o n ' t t h i n k f o r h u s b a n d t o go t h o u g h — h e no go as i s f o r women t h i s — I be s h y w i t h men a t t h a t p l a c e . The p u b l i c h e a l t h u n i t f r o m w h i c h t h i s s t u d y ' s p a r t i c i p a n t s were d r a w n , h a s b e e n o f f e r i n g P u n j a b i - l a n g u a g e p r e n a t a l c l a s s e s f o r a p p r o x i m a t e l y two y e a r s . D e s p i t e e x t e n s i v e a d v e r t i s i n g , t h e s e c l a s s e s a r e p o o r l y a t t e n d e d (G. G r e e n s t o n e , p e r s o n a l c o m m u n i c a t i o n , J u l y 2 1 , 1 9 8 5 ; P. P u l l e n , p e r s o n a l c o m m u n i c a t i o n , M a r c h 1 9 8 5 ) . T h i s i s i n c o n s i s t e n t w i t h t h e f i n d i n g s g a i n e d f r o m t h e women i n t h i s s t u d y , who e i t h e r a t t e n d e d o r s a i d t h e y w o u l d h a v e l i k e d t o a t t e n d c l a s s e s . The p r e n a t a l c l a s s e s a r e , h o w e v e r , c o - e d , and a s ha s b e e n shown i n t h i s s t u d y ' s f i n d i n g s , t h e women's e x p l a n a t o r y m o d e l s p e r c e i v e c h i l d b e a r i n g as a p u r e l y f e m a l e e x p e r i e n c e . The women who d i d a t t e n d c l a s s e s f e l t t h a t t h e y were h e l p f u l . They t a l k e d o f how t h e y p e r c e i v e d t h e community h e a l t h n u r s e s . The f i r s t woman s a i d : They t e l l me t h i n g s — t h e y h e l p me t o know. And t h e s e c o n d : T hey a r e v e r y n i c e . You know e v e n when I s t a r t e d p r e n a t a l c l a s s e s , I was h a v i n g l o t s o f h e l p f r o m them and I r e a l l y a d m i r e d , y o u know, and I'm t e l l i n g e v e r y o n e — y o u know. L i k e some p e o p l e t h e y d o n ' t know a n y t h i n g a b o u t p r e g n a n c y o r a n y t h i n g . They s h o u l d go t o t h e h e a l t h u n i t . And t h e y a r e v e r y f r i e n d l y , t h e y ' r e e x p l a i n i n g i t and b e h a v i n g v e r y n i c e . The p r e n a t a l c l a s s e s b e n e f i t e d t h i s woman g r e a t l y when, a f t e r a l o n g l a b o u r , h e r baby went i n t o f e t a l d i s t r e s s and she u n d e r w e n t an e m e r g e n c y c a e s a r i a n s e c t i o n . I t i s e n c o u r a g i n g t o l e a r n t h a t t h e com m u n i t y h e a l t h n u r s e s a r e p e r c e i v e d a s h a v i n g b o t h t h e k n o w l e d g e and t h e i n t e r p e r s o n a l s k i l l s t o p r o v i d e r e l e v a n t c a r e f o r t h i s g r o u p o f women. T h i s i s p a r t i c u l a r l y i m p o r t a n t i n v i e w o f t h e work o f J o h n s o n , Snow and Mayhew ( 1 9 7 8 ) , who s t a t e t h a t women f r o m a l o w income m u l t i - e t h n i c b a c k g r o u n d a r e a t r i s k as c h i l d b e a r e r s due t o t h e i r l i m i t e d k n o w l e d g e . The com m u n i t y h e a l t h n u r s e may be i n a p r i v i l e g e d p o s i t i o n t o work e f f e c t i v e l y w i t h I n d o - C a n a d i a n women. The c h a l l e n g e now f o r t h e co m m u n i t y h e a l t h n u r s e s h o u l d be t o work w i t h c h i l d b e a r i n g women who a r e l e s s a c c u l t u r a t e d i n t o C a n a d i a n s o c i e t y and who hav e e x p l a n a t o r y m o d e l s t h a t p r e v e n t them f r o m a p p r o a c h i n g t h e c o m m u n i t y h e a l t h n u r s e s f o r p h y s i c a l c a r e and e m o t i o n a l s u p p o r t (G. G r e e n s t o n e , p e r s o n a l c o m m u n i c a t i o n , J u l y 2 1 , 1985; B. M e e k i s o n , p e r s o n a l c o m m u n i c a t i o n , November, 1984; P. P u l l e n , p e r s o n a l c o m m u n i c a t i o n , M a r c h , 1 9 8 5 ) . F o l l o w i n g c o n t a c t w i t h c o m m u n i t y h e a l t h n u r s e s , t h e women t a l k e d f r e e l y o f t h e i r r e l a t i o n s h i p s w i t h t h e n u r s e s on t h e p o s t - p a r t u m w a r d o f t h e h o s p i t a l . T h e i r r e l a t i o n s h i p s w i t h t h i s segment o f t h e p r o f e s s i o n a l h e a l t h c a r e s e c t o r c o n t r a s t e d s h a r p l y w i t h any o t h e r a c c o u n t s t h e y g a v e . 98 The R e l a t i o n s h i p w i t h N u r s e s i n t h e P o s t - P a r t u m P e r i o d D u r i n g t h e i r p o s t - p a r t u m t i m e i n h o s p i t a l t h e women were i n c l o s e c o n t a c t w i t h t h e h o s p i t a l n u r s e s . The women e x p l a i n e d how t h e i r h o s p i t a l s t a y was c h a r a c t e r i z e d by f e e l i n g s o f b e i n g d i s c r i m i n a t e d a g a i n s t by t h e n u r s i n g s t a f f . A l l o f t h e women t a l k e d o f f e e l i n g s o f u n h a p p i n e s s a n d / o r a n g e r a t t h i s d i s c r i m i n a t i o n . The women s p o k e f r e e l y a b o u t t h e r e a s o n s t h e y f e l t t h e i r e t h n i c g r o u p was b e i n g d i s c r i m i n a t e d a g a i n s t . The women d i d n o t u n i f o r m l y u s e t h e t e r m " d i s c r i m i n a t i o n " t o d e s c r i b e t h e n u r s e s ' a t t i t u d e s and b e h a v i o u r s . Women who were l e s s e d u c a t e d w i t h p o o r E n g l i s h s k i l l s d i d n o t d e s c r i b e t h e phenomena o f d i s c r i m i n a t i o n i n t h e same way as t h e more e d u c a t e d women w i t h b e t t e r E n g l i s h v e r b a l a b i l i t y and w i t h a t t i t u d e s more s i m i l a r t o C a n a d i a n c u l t u r e , a l t h o u g h a l l o f t h e s u b j e c t s r e l a t e d t h a t l a c k o f E n g l i s h s k i l l s was a s i g n i f i c a n t c a u s e o f t h i s d i s c r i m i n a t i o n . A g a i n , h o w e v e r , women w i t h h i g h e r e d u c a t i o n and good E n g l i s h s k i l l s , c o u l d i d e n t i f y b r o a d e r u n d e r p i n n i n g s f o r t h e f e l t d i s c r i m i n a t i o n . I n t h e i r a c c o u n t s , a l l t h e s u b j e c t s r e l a t e d t h a t t h i s f e l t d i s c r i m i n a t i o n by t h e h o s p i t a l n u r s e s , a f f e c t e d t h e n u r s i n g c a r e t h e y r e c e i v e d . They r e l a t e d a r a n g e o f c o p i n g b e h a v i o u r s t o d e a l w i t h d i s c r i m i n a t i o n . The c o p i n g b e h a v i o u r s v a r i e d f r o m i g n o r i n g t h e n u r s e s , t o y e l l i n g a t them, t o c o n t a c t i n g t h e h o s p i t a l a d m i n i s t r a t i o n . A g a i n , t h e 99 women who c o p e d i n an a p p r o p r i a t e , e f f e c t i v e manner by s p e a k i n g t o t h e a d m i n i s t r a t o r s , by s p e e c h , b a c k g r o u n d and e d u c a t i o n , w e re more s i m i l a r t o t h e C a n a d i a n t h a n E a s t - I n d i a n c u l t u r e . R e g a r d l e s s o f t h e f e l t d i s c r i m i n a t i o n , a l l o f t h e s u b j e c t s saw t h e h o s p i t a l n u r s e a s t h e h e a l t h c a r e a u t h o r i t y and r e s p e c t e d h e r i n c e r t a i n a r e a s o f t h e i r c a r e and t h e women u n i f o r m l y p r e f e r r e d a C a n a d i a n h o s p i t a l d e l i v e r y t o home b i r t h i n I n d i a . The women were c l e a r l y a b l e t o s a y t h a t t h e y p e r c e i v e d t h a t h o s p i t a l n u r s e s d i d n o t l i k e t h e I n d o - C a n a d i a n c o m m u n i t y . One woman s a i d : I s p r o b l e m i f n u r s e s no l i k e as I am E a s t I n d i a n — i s n o t n i c e f o r me. And a n o t h e r : They ( t h e n u r s e s ) no l i k e u s . . . t h e y be d i f f e r e n t w i t h u s . I t i s h a r d f o r me. A t h i r d woman d e s c r i b e d h e r p r e f e r e n c e f o r a h o s p i t a l d e l i v e r y and p o s t p a r t u m s t a y b e c a u s e : Then I c a n r e s t a l l t h e t i m e . . . i f I ne e d s o m e t h i n g , r i n g f o r t h e n u r s e . N u r s e comes t o me s l o w l y , b u t s h e come. To o t h e r p e o p l e s s he come q u i c k . When a s k e d why she f e l t t h i s d i f f e r e n c e i n r e s p o n s e t i m e o c c u r r e d s h e s a i d : T h ey ( t h e n u r s e s ) do same t o a l l E a s t I n d i a n . They no l i k e u s . As t h e women moved t h r o u g h t h e p r o c e s s o f a c c u l t u r a t i o n 100 and became more c o n s i s t e n t i n d r e s s , a t t i t u d e , and behaviour with Canadian s o c i e t y , they were able to i d e n t i f y the nurses' d i s l i k e f o r t h e i r c u l t u r a l group as d i s c r i m i n a t i o n . At the same time, they became aware that d i s c r i m i n a t i o n l e v e l l e d at them was d e c r e a s i n g . One s u b j e c t d i d not f e e l d i s c r i m i n a t e d a g a i n s t p e r s o n a l l y but observed i t d i r e c t e d at o t h e r s and had f e e l i n g s about i t : I do not f e e l i t because I know how to be i n h o s p i t a l , but others do not and i t b r i n g s much sadness. When asked to e x p l a i n "how to be i n h o s p i t a l " she continued: Be more l i k e Canadian you see, do more l i k e they say to do and l i s t e n what they say you to do. Th i s woman was c l e a r l y s u c c e s s f u l l y t r y i n g to become l i k e the l a r g e r s o c i e t y i n an attempt to decrease d i s c r i m i n a t i o n d i r e c t e d at her. One woman had two babies i n the same h o s p i t a l ward at an i n t e r v a l of two y e a r s . When asked about her h o s p i t a l stays she r e p l i e d : S h a l l I t e l l you t r u t h ? See, the f i r s t time, I don't know, I d i d not l i k e the nurses behaviour very w e l l . When I went the f i r s t time, I don't know. They were r e a l l y rude. The second time, oh my god, they were n i c e to me, but s t i l l to other East Indian womans they were rude. T h i s i s d i s c r i m i n a t i o n you know. I get so mad at t h i s . 101 I n the two y e a r s s i n c e her f i r s t c h i l d b e a r i n g e x p e r i e n c e , t h i s woman had moved f o r w a r d i n the p r o c e s s of a c c u l t u r a t i o n and now c a r r i e d out many more Canadian than E a s t I n d i a n p r a c t i c e s r e l a t e d t o c h i l d b e a r i n g . She was an educated woman who d e s c r i b e d and gave a name t o the n u r s e s ' b e h a v i o u r . I n a d d i t i o n , she c o u l d t a k e a c t i o n s i n h o s p i t a l t o reduce o r e l i m i n a t e d i s c r i m i n a t i o n . A l l of the women spoke f r e e l y about why t h e i r c u l t u r a l group was d i s c r i m i n a t e d a g a i n s t . One woman s a i d : The ( n u r s e s ) j u s t no l i k e ( u s ) . I know no, maybe as no speak E n g l i s h . And a second: No l i k e E a s t I n d i a n p e o p l e , I don't know why. I s hard t o speak one t o a n o t h e r . A t h i r d t r i e d t o e x p l a i n : Maybe...maybe i t i s hard f o r us yes? We don't u n d e r s t a n d the E n g l i s h language and so not und e r s t a n d e v e r y t h i n g v e r y w e l l . We d o n ' t — w e j u s t don't f e e l c o m f o r t a b l e a f t e r baby. And f o r t h i s maybe the nur s e s don't l i k e u s, so i s hard t o be i n h o s p i t a l sometimes a f t e r baby. One woman who came from a c i t y i n the Punjab and l i v e d i n a n u c l e a r f a m i l y i n Canada, t a l k e d o f d i s c r i m i n a t i o n as a br o a d e r i s s u e t h a n language. She s a i d : M o s t l y i n Canada nurses t r e a t you same. I f don't speak E n g l i s h i t i s p r o b l e m — t h e n they i g n o r e you. But i s b i g g e r problem than language, i t i s about 102 how t h e y f e e l f r o m u s — t h e y a f r a i d f r o m us and we be a f r a i d f r o m them. I s s i l l y y e s ? A s e c o n d woman who a l s o came f r o m a l a r g e c i t y and l i v e d i n a n u c l e a r f a m i l y d e s c r i b e d t h e p r o b l e m o f d i s c r i m i n a t i o n more f u l l y : R e a l l y i t i s b e c a u s e o f a l a n g u a g e p r o b l e m . . . i t ' s n o t t h e i r ( t h e n u r s e s ) f a u l t t h e y a r e l i k e t h a t w i t h u s . . . t h e y d o n ' t u n d e r s t a n d and s o t h e y d o n ' t c a r e . . . O h my g o d , i t r e a l l y i s more t h a n l a n g u a g e r i g h t ? Me, I n e v e r f e e l d i s c r i m i n a t i o n f r o m a n y o n e , b u t my f r i e n d s t e l l me and I s e e . C a n a d i a n s y o u know t h e y d o n ' t u n d e r s t a n d ; t h e y a f r a i d f r o m t h e i r j o b s a n d t h e i r c h i l d r e n , and t h e n maybe we do t h i n g s d i f f e r e n t , some l i t t l e t h i n g s maybe, b u t t h e y s e e and t h e n oh my god t h e y d i s c r i m i n a t e . A t t h i s t i m e y o u know, s o much t o t h i n k and f e e l , i t i s more d i f f i c u l t f o r them ( t h e women) t o s p e a k E n g l i s h . And t h e n i t ' s h a r d y o u know, t h e l a d i e s a r e v e r y t e n d e r , e m o t i o n a l y o u know. A l l t h e women c o u l d i d e n t i f y a l a n g u a g e p r o b l e m as a c o n t r i b u t i n g f a c t o r t o t h e i r d i s c r i m i n a t i o n . When t h e women were more e d u c a t e d and more c o n s i s t e n t w i t h C a n a d i a n b e l i e f s and p r a c t i c e s , t h e y were a b l e t o d e f l e c t d i s c r i m i n a t i o n f r o m t h e m s e l v e s and t o d e s c r i b e o t h e r c o r e r e a s o n s f o r t h e e x i s t e n c e o f d i s c r i m i n a t i o n . B e r r y & T i s c h l e r ( 1 9 7 8 ) v i e w d i s c r i m i n a t i o n a s t h e 103 u n e q u a l t r e a t m e n t o f e q u a l s , e i t h e r by b e s t o w i n g o f f a v o u r s o r i m p o s i n g o f b u r d e n s . D i s c r i m i n a t i o n t o u c h e s e v e r y a s p e c t o f l i f e . Aboud a nd S k e r r y ( 1 9 8 4 , p. 3) d e f i n e e t h n i c a t t i t u d e s a s a " p r e d i s p o s i t i o n t o r e s p o n d i n a f a v o u r a b l e o r u n f a v o u r a b l e manner t o w a r d p e o p l e o f d i f f e r e n t e t h n i c g r o u p s " and i n a c r i t i c a l r e v i e w o f t h e l i t e r a t u r e , t h e y s u g g e s t t h a t e t h n i c a t t i t u d e s emerge a t a b o u t t h e age o f f o u r a n d , as t i m e p a s s e s , d i f f e r e n t g r o u p s b e g i n t o show more own g r o u p p r e f e r e n c e and o t h e r g r o u p r e j e c t i o n . A l l o f t h e women i n t h e s t u d y d e l i v e r e d t h e i r b a b i e s a t t h e same l a r g e c o m m u n i t y h o s p i t a l . On t h e p o s t - p a r t u m w a r d t h e n u r s i n g s t a f f c o n s i s t e d p r e d o m i n a n t l y o f C a u c a s i a n C a n a d i a n s . The I n d o - C a n a d i a n i m m i g r a n t s d e l i v e r i n g b a b i e s i n t h i s w a r d were an e t h n i c m i n o r i t y w i t h c h i l d b e a r i n g b e l i e f s and v a l u e s t h a t d i f f e r e d m a r k e d l y f r o m t h o s e o f W h i t e C a n a d i a n s . The s i t u a t i o n on h i s war d e x i s t e d f o r p o t e n t i a l d i s c i m i n a t i o n and t h e s t u d y p a r t i c i p a n t s c o n f i r m e d t h a t t h e y d i d i n d e e d f e e l d i s c r i m i n a t i o n on t h e p a r t o f t h e h o s p i t a l n u r s i n g s t a f f . K n o w l e d g e o f a l a n g u a g e h a s c o n s i s t e n t l y b e e n m e n t i o n e d as a f a c t o r f a c i l i t a t i n g a s s i m i l a t i o n ; t h e f i n a l s t e p i n a c c u l t u r a t i o n ( E i s e n s t a d t , 1970; S i m p s o n & Y i n g e r , 1972; W a r n e r & S r o l e , 1945.) When a s s i m i l a t i o n o c c u r s , t h e i n d i v i d u a l i s a f u l l y f u n c t i o n i n g member o f t h e g r o u p i n t o w h i c h h e / s h e i s a c c u l t u r a t i n g , and t h e r e f o r e d i s c r i m i n a t i o n d e c r e a s e s . The s u b j e c t s ' p e r c e p t i o n s t h a t t h e i r i n a b i l i t y t o s p e a k E n g l i s h c o n t r i b u t e s t o d i s c r i m i n a t i o n by t h e l a r g e r 104 s o c i e t y , i s t h e r e f o r e c o n s i s t e n t w i t h t h e l i t e r a t u r e . C o n s i s t e n t t o o , i s t h e more a c c u l t u r a t e d women's v i e w t h a t l a n g u a g e i s o n l y one f a c t o r ; r a c e and e d u c a t i o n a r e a l s o m e n t i o n e d i n t h e l i t e r a t u r e ( F r i e d m a n , 1 973; H a n d l i n , 1 9 4 1; Hannan, 1 9 7 9 ) . The s o - c a l l e d " v i s i b l e m i n o r i t i e s " a r e c o n s t a n t l y a t t h e r i s k o f b e i n g d i s c r i m i n a t e d a g a i n s t by t h e p r e d o m i n a n t r a c e i n t h e s o c i e t y . E d u c a t i o n i s o f t e n m e n t i o n e d a s a p o w e r f u l f o r c e b e c a u s e e d u c a t e d i m m i g r a n t s a r e g e n e r a l l y more a c c e p t a b l e t o members o f t h e l a r g e r g r o u p and b e c a u s e e d u c a t i o n h e l p s i m m i g r a n t s t o ov e r c o m e l a n g u a g e and c u l t u r a l b a r r i e r s w h i c h o b s t r u c t a c c e s s i n t o b r o a d e r s o c i a l c i r c l e s ( H e i s s , 1969; P o r t e s , 1984; R a g i n , 1 9 7 9 ) . Women i n t h i s s t u d y who p e r c e i v e d a b r o a d e r r e a s o n t h a n l a n g u a g e f o r t h e f e l t d i s c r i m i n a t i o n , had b e t t e r E n g l i s h l a n g u a g e s k i l l s , a t t a i n e d h i g h e r l e v e l s o f e d u c a t i o n t h a n o t h e r s t u d y p a r t i c i p a n t s and had become more s i m i l a r i n b e l i e f s and v a l u e s t o C a n a d i a n t h a n E a s t I n d i a n c u l t u r e . The woman who s p o k e o f C a n a d i a n s b e i n g a f r a i d o f l o s i n g t h e i r j o b s and o f c u l t u r a l d i f f e r e n c e s , was r e f l e c t i n g on d i s c r i m i n a t i o n r e s u l t i n g f r o m I n d o - C a n a d i a n s b e i n g a v i s i b l e r a c e m i n o r i t y . R e g a r d l e s s o f t h e i r r e a s o n s f o r t h e f e l t d i s c r i m i n a t i o n t h e women's a c c o u n t s showed t h a t t h e d i s c r i m i n a t i o n by h o s p i t a l n u r s e s became p a r t o f t h e i r e x p l a n a t o r y m o d e l s o f t h e c h i l d b e a r i n g e x p e r i e n c e . A l l t h e s u b j e c t s d e s c r i b e d t h e e f f e c t t h i s f e l t d i s c r i m i n a t i o n h a d on t h e h o s p i t a l n u r s i n g c a r e t h e y r e c e i v e d . The women c o u l d l o o k b a c k and c l e a r l y s e e t h a t t h e y were n e g a t i v e l y a f f e c t e d . One woman s a i d : 105 They (the nurses) leave me alone; I leave them. Is b e t t e r f o r me but too hard f o r t a k i n g care of f i r s t baby. I no know how to take care of baby. One woman e x p l a i n e d t h a t , although being ignored was not the nurses' " f a u l t " , i t s t i l l a f f e c t e d her and her baby. Is no one's f a u l t . I no understand, others no understand, so they (the nurses) no b o t h e r — i s hard f o r them t o o — b u t then f o r f i r s t baby, i s hard to understand what to d o — a n d the nurses no bother to he l p . A second woman d e s c r i b e d her expe r i e n c e : Is d i f f i c u l t i n h o s p i t a l see, because I have c a e s a r i a n but s t i l l the nurses say "do t h i s , do th a t " a l l by myself; and I can't because i s hard a f t e r baby. And I see they h e l p other women with the same t h i n g and t h i s i s no g o o d — b u t mostly you know they were very n i c e to me. Th i s same s u b j e c t l a t e r s a i d : They make me go to washroom by myself and they make me care f o r baby by myself. T h i s i s r e a l l y too hard r i g h t , I can't do t h i s r i g h t , take care of baby by myself r i g h t , 'cause I have s e c t i o n , and then i t i s not f a i r to baby, so r e a l l y i t not f a i r to a l l my people. T h i s woman was not aware t h a t accepted western o b s t e t r i c p r a c t i c e s r e q u i r e d women to be up and s e l f - s u f f i c i e n t i n the p o s t - o p e r a t i v e p e r i o d . She a t t r i b u t e d the nurses' 106 i n s t r u c t i o n s t o d i s c r i m i n a t i o n when t h e s i t u a t i o n d i d n o t w a r r a n t i t . She b e l i e v e d i n t h e E a s t I n d i a n p r a c t i c e o f p o s t - p a r t u m b e d r e s t f o r t h e m o t h e r ( G i d e o n , 1962) and t h i s p r o v i d e s a good e x a m p l e o f t h e c o n f l i c t p h a s e i n t h e p r o c e s s o f a c c u l t u r a t i o n ( B e r r y , 1 9 8 0 ) , where t h e b e l i e f s , v a l u e s and p r a c t i c e s o f t h e a c c u l t u r a t i n g g r o u p c l a s h w i t h t h o s e o f t h e d o m i n a n t g r o u p . T h i s c o n f l i c t b e t w e e n n u r s e s and c l i e n t s , i n c r e a s e s when n u r s e s do no e x p l a i n t h e r a t i o n a l e f o r t h e i r a c t i o n s o r p r o c e d u r e s . One s u b j e c t , h a v i n g had h e r f i r s t b a b y i n a h o s p i t a l i n I n d i a , was i n a u n i q u e p o s i t i o n t o v i e w h e r n u r s i n g c a r e d u r i n g h e r p o s t - p a r t u m h o s p i t a l s t a y i n a C a n a d i a n h o s p i t a l . She s a i d : I s no d i f f e r e n t , same f r o m C a n a d a , same f r o m I n d i a . The n u r s e s t r e a t us same a s C a n a d i a n s ; maybe i f t h e y d o n ' t u n d e r s t a n d E n g l i s h i s a p r o b l e m . Maybe t h a t ' s why t h e E a s t I n d i a n womans d o n ' t l i k e n u r s e s i n C a n a d a . F o r me i s no p r o b l e m , b u t s e e , t h i s t i m e I g e t s my s e c o n d b a b y s o I know t o t a k e - c a r e . I f n u r s e s and womans d o n ' t l i k e ( e a c h o t h e r ) and d o n ' t s p e a k l a n g u a g e t h e same, f o r s u r e i s p r o b l e m w i t h f i r s t b a by e s p e c i a l l y . T h i s woman was a d a p t i n g t o l i f e i n C a n a d a . She had n o t f e l t d i s c r i m i n a t i o n d i r e c t l y b u t saw i t a i m e d a t o t h e r s . She c o u l d u n d e r s t a n d t h a t l a c k o f c o m m u n i c a t i o n w i t h n u r s e s was i n v o l v e d i n d i s c r i m i n a t i o n and was a p r o b l e m f o r women h a v i n g t h e i r f i r s t b a b i e s . 107 The women f e l t t h a t t h e e f f e c t d i s c r i m i n a t i o n h a d on t h e i r n u r s i n g c a r e was a p a r t i c u l a r p r o b l e m f o r t h e f i r s t -t i m e m o t h e r . H e a l t h c a r e p r o f e s s i o n a l s c o n s i s t e n t l y r e c o g n i z e t h e i m p o r t a n c e o f p r o v i d i n g s u p p o r t and e d u c a t i o n f o r t h e woman h a v i n g h e r f i r s t c h i l d ( L y t l e , 1977; R e e d e r , M a s t r o i a n n i & M a r t i n , 1 9 8 0 ) . I t i s n o t e d t h a t women h a v i n g t h e i r f i r s t b a b y need e m o t i o n a l and p r a c t i c a l s u p p o r t t o make t h e t r a n s i t i o n f r o m p r e g n a n t woman t o c o m f o r t a b l e p a r e n t ( C a r t e r - J e s s o p , 1 9 8 1 ; Cameron, 1 9 7 9 ; K i t z i n g e r , 1977; R e e d e r e t a l , 1 9 8 0 ) . A n t h r o p o l o g i s t s ( M a c C l a i n , 1 9 82; Newman, 1972) have a l s o n o t e d t h a t i n many c u l t u r e s t h e b i r t h o f a f i r s t c h i l d i s an i m p o r t a n t r i t e o f p a s s a g e a s t h e woman t a k e s on t h e f o r m a l r o l e o f m o t h e r . I t i s e v i d e n t t h a t women i n t h i s s t u d y f e l t t h a t b i r t h i s a phenomenon i n w h i c h s p e c i a l c a r e and e d u c a t i o n o f t h e m o t h e r were r e q u i r e d and f o r t h i s r e a s o n t h e women who were f i r s t - t i m e m o t h e r s s u f f e r e d most f r o m t h e e f f e c t s o f d i s c r i m i n a t i o n by h o s p i t a l n u r s e s . T h i s f i n d i n g i s n o t s u r p r i s i n g when one c o n s i d e r s t h a t t h e women's p e r c e p t i o n s o f t h e i r u p b r i n g i n g were s h r o u d e d i n s h y n e s s and t h a t t h e y a r r i v e d a t t h e i r c h i l d b e a r i n g e x p e r i e n c e s l a c k i n g a d e q u a t e k n o w l e d g e o f what was h a p p e n i n g t o them o r t h e i r i n f a n t s . I t a p p e a r s t h a t t h i s e t h n i c g r o u p r e q u i r e s a g r e a t amount o f e x t r a n u r s i n g c a r e w h e r e a s i n f a c t t h e i r p e r c e p t i o n s were t h a t t h e y r e c e i v e d n u r s i n g c a r e t h a t i n c l u d e d d i s c r i m i n a t o r y p r a c t i c e s . I n t h e s t u d y s a m p l e , t h e woman who a p p e a r e d t o have b e l i e f s and v a l u e s most c o n s i s t e n t w i t h C a n a d i a n v a l u e s , 108 t a l k e d e l o q u e n t l y o f d i s c r i m i n a t i o n i n the h o s p i t a l . One o f the Ea s t I n d i a n women, she had a d a u g h t e r , you know, she was c r y i n g so much, maybe she was ha v i n g cramps o r a n y t h i n g , r i g h t ? And she c a l l e d the nurse and she ( t h e nurse) d i d not c a r e , you know. She d i d not com f o r t h er and then the woman came i n my room and she s a i d "Can you h e l p me, you know, my baby i s c r y i n g and t h e y ' r e not t e l l i n g me a n y t h i n g r i g h t . " And then I c a l l e d the n u r s e . I s a i d "what's g o i n g on, r i g h t ? Why are you not go i n g i n her room?" And she s a i d "She's not f e e d i n g her enough, r i g h t . " And the East I n d i a n woman was ha v i n g a second baby, so she knew, and they were j u s t a c c u s i n g h e r , you know and t h a t ' s not n i c e . I t i s a problem from the language, s u r e , but i t i s a l s o a problem from how they t h i n k we a r e and, oh my god, everyone s u f f e r s , the baby, the womans—maybe even the nurses r i g h t ? T h i s woman p e r c e i v e d t h a t members of her c u l t u r a l group were b e i n g g i v e n d i f f e r e n t c a r e from o t h e r g r o u p s , t h a t t h i s c a r e was based on the n u r s i n g s t a f f s ' f e e l i n g s about Indo-Canadian women and t h a t a l l the i n d i v i d u a l s concerned s u f f e r e d n e g a t i v e p h y s i c a l o r e m o t i o n a l r e p e r c u s s i o n s from these f e e l i n g s . The women spoke o f d e a l i n g w i t h d i s c r i m i n a t i o n i n v a r i o u s ways. G e n e r a l l y t h e i r c o p i n g b e h a v i o u r s appeared t o the Canadian-born i n v e s t i g a t o r , as c o n s t r u c t i v e o r 109 n o n - c o n s t r u c t i v e . Many o f t h e women, h o w e v e r , saw t h e i r c o p i n g b e h a v i o u r s a s a way o f l i v i n g t h r o u g h t h e i r h o s p i t a l e x p e r i e n c e w i t h t h e l e a s t amount o f o v e r t c o n f l i c t . S p e a k i n g o f c o p i n g w i t h d i s c r i m i n a t i o n one woman s a i d : I i g n o r e p r e t t y g ood y e s . Spend f o u r , f i v e d a y s i n h o s p i t a l and no l i s t e n — i s no u s e b e c a u s e t h e y ( t h e n u r s e s ) t r e a t l i k e t h i s and I no change ( t h e m ) . A f t e r my t i m e I go home and i t be f i n i s h e d . T h i s woman i s t h e y o u n g e s t d a u g h t e r - i n - l a w i n a l a r g e e x t e n d e d f a m i l y d o m i n a t e d by t h e m o t h e r - i n - l a w . She a c k n o w l e d g e s h e r l a c k o f a u t h o r i t y and r e s p e c t w i t h i n t h e f a m i l y s t r u c t u r e . A n o t h e r s u b j e c t d i s c u s s e d how d i f f i c u l t i t was t o d e a l w i t h d i s c r i m i n a t i o n . What g o o d t o s a y a n y t h i n g ? T hey ( t h e n u r s e s ) no l i s t e n , t h e y j u s t be w o r s e a f t e r and t h e y no u n d e r s t a n d when I s p e a k — s o I j u s t l e a v e a l o n e . I s no l o n g t i m e i n h o s p i t a l s o i s b e t t e r t o l e a v e . One s u b j e c t t r i e d t o d e a l w i t h d i s c r i m i n a t i o n by d i r e c t c o n f r o n t a t i o n : One t i m e I y e l l a t them f o r d o i n g l i k e t h a t — t h e n t h e y y e l l w o r s e a t me "Do t h i s , do t h a t , " s o i s no u s e . I t g e t w o r s e y e s . How come i t be l i k e t h i s ? T h i s woman had E n g l i s h l a n g u a g e s k i l l s t h a t a l l o w e d h e r t o r e s p o n d t o t h e n u r s e s . She r e a l i z e d t h a t t h i s method o f d e a l i n g w i t h d i s c r i m i n a t i o n was n o t e f f e c t i v e b u t she was u n a b l e t o f i n d a more s u i t a b l e c o p i n g b e h a v i o u r . 110 One woman d i d n o t e x p e r i e n c e d i s c r i m i n a t i o n p e r s o n a l l y b u t o b s e r v e d i t d i r e c t e d a t o t h e r s and r e i t e r a t e d how s h e t o o k s t e p s t o p r e v e n t h e r own e x p e r i e n c e o f i t . They ( t h e n u r s e s ) n o t be l i k e t h a t w i t h me b e c a u s e I t r y t o be l i k e t h e o t h e r s ( W h i t e C a n a d i a n s ) i n h o s p i t a l . A l s o s e e , l i k e I go t o p r e n a t a l c l a s s e s y e s , b e c a u s e t h e n I know how t o be s o t h e y no a c t l i k e t h a t t o me. B u t I s e e them a c t t h a t way w i t h o t h e r E a s t I n d i a n s t h a t ' s f o r s u r e . T h i s woman c l e a r l y f e l t t h a t she d e a l t w i t h d i s c r i m i n a t i o n e f f e c t i v e l y by c o n s c i o u s l y a s s u m i n g C a n a d i a n b e l i e f s and p r a c t i c e s s u c h a s a t t e n d i n g p r e n a t a l c l a s s . T h i s s u b j e c t l i v e d a l o n e w i t h h e r h u s b a n d and two s m a l l c h i l d r e n . A l l t h e i r r e l a t i v e s l i v e d i n I n d i a , she l i v e d i n a n u c l e a r f a m i l y a n d , by n e c e s s i t y , made many d e c i s i o n s s h e w o u l d n o t be p e r m i t t e d t o make i n an e x t e n d e d f a m i l y . I n h e r f i r s t p o s t - p a r t u m h o s p i t a l s t a y t h e r e a l e s t a t e a g e n t w i t h g o o d E n g l i s h l a n g u a g e s k i l l s , and a h i g h e r l e v e l o f e d u c a t i o n t h a n o t h e r s t u d y p a r t i c i p a n t s , d i d e x p e r i e n c e d i s c r i m i n a t i o n . She t o o k s t e p s t o a l t e r t h i s f o r h e r n e x t h o s p i t a l s t a y . She e x p l a i n e d : W i t h my f i r s t b a b y , t h e r e were f o u r l a d i e s i n t h e room, and two were C a n a d i a n and two w e r e E a s t I n d i a n , and t h e y ( t h e n u r s e s ) were m o s t l y g i v i n g more a t t e n t i o n i t seemed, t o o t h e r p e o p l e . I was c r y i n g m o s t o f t i m e and I was t e l l i n g my h u s b a n d y o u know, how t h e y be l i k e t h a t , my h u s b a n d f e l t I l l b a d . He s a i d " I w i s h y o u ' d c o m p l a i n y o u know, t o t h e h e a d n u r s e . You s h o u l d t e l l them b e c a u s e t h e y a r e d o i n g l i k e t h a t . " And t h i s t i m e my h u s b a n d t o l d them y o u know. We d i d i t v e r y n i c e l y y o u know. " F i r s t t i m e we were t r e a t e d l i k e t h i s and t h i s t i m e we d o n ' t want i t l i k e t h a t . " Y e a h , we t o l d them y o u know. And I t h i n k maybe t h i s t i m e I was v e r y f r i e n d l y y o u know and t a l k i n g t o them and t h e y were v e r y n i c e t o me. And t h i s t i m e we a s k f o r p r i v a t e room r i g h t ? And t h i s h e l p s t o n o t h a v e C a n a d i a n s t o g e t t h e i r a t t e n t i o n , y o u know. So t h e n t h e y a r e n ' t r u d e t o me. T h i s woman had c h a r a c t e r i s t i c s t h a t t h e l i t e r a t u r e s t a t e s f a c i l i t a t e a s s i m i l a t i o n ( E i t z e n , 1 9 73; Hannan, 1979; S i m p s o n and Y i n g e r , 1972) and i n d e e d , s h e t o o k p o s i t i v e , e f f e c t i v e s t e p s t o e n s u r e s he d i d n o t e x p e r i e n c e d i s c r i m i n a t i o n . As d e s c r i b e d by P o r t e s ( 1 9 8 4 ) , i n d i v i d u a l s w i t h l e s s e d u c a t i o n do n o t a l w a y s l a b e l t h e i r e x p e r i e n c e s a s d i s c r i m i n a t i o n , w h i l e t h o s e w i t h h i g h e r e d u c a t i o n a l l e v e l s do l a b e l t h e i r e x p e r i e n c e s as d i s c r i m i n a t i o n . P o r t e s ' w r i t i n g s a r e c o n s i s t e n t w i t h t h e f i n d i n g s o f t h i s s t u d y . A l t h o u g h a l l t h e s t u d y s u b j e c t s f e l t d i s c r i m i n a t i o n by t h e n u r s i n g s t a f f d i r e c t e d a t t h e i r c u l t u r a l g r o u p d u r i n g t h e i r p o s t - p a r t u m h o s p i t a l s t a y , women who u s e d t h e t e r m " d i s c r i m i n a t i o n " t o d e s c r i b e t h e i r e x p e r i e n c e s h a d a t t a i n e d h i g h e r e d u c a t i o n l e v e l s . F u r t h e r m o r e , t h e r e a s o n s g i v e n f o r t h e e x i s t e n c e o f d i s c r i m i n a t i o n , t h e e f f e c t i t had on t h e i r h o s p i t a l s t a y , as 112 w e l l a s t h e i r s t r a t e g i e s f o r c o p i n g w i t h d i s c r i m i n a t i o n , d i f f e r e d a c c o r d i n g t o e a c h woman's d e g r e e o f a c c u l t u r a t i o n i n t o C a n a d i a n s o c i e t y . S e v e r a l a u t h o r s have w r i t t e n a b o u t c l i e n t s ' p e r c e p t i o n and a p p r o a c h e s t o c h i l d b i r t h ( K i t z i n g e r , 1977; Snow, J o h n s o n & Mayhew, 1978) and how d i v e r g e n c e s f r o m p r o f e s s i o n a l s ' v i e w s a r e r e s p o n s i b l e f o r n o n - c o m p l i a n c e w i t h s t a f f r e c o m m e n d a t i o n s . Shaw (1974) p o i n t s o u t t h a t p a t i e n t s ' a c c e s s t o a l t e r n a t i v e s o u r c e s and metho d s o f o b s t e t r i c c a r e i s s i g n i f i c a n t l y r e l a t e d t o t h e n u r s i n g s t a f f ' s p e r c e p t i o n s o f t h e i r s o c i a l w o r t h , w i t h t h e r e s u l t t h a t , p o o r , m i n o r i t y women have l e s s c o n t o l o v e r t h e i r h o s p i t a l e x p e r i e n c e t h a n do o t h e r women. Women i n t h i s s a m p l e , h a v i n g l i t t l e a c c e s s t o t h e t r a d i t i o n a l home b i r t h s t h a t t h e y a r e f a m i l i a r w i t h i n t h e i r c o u n t r y , and b e i n g members o f a p o o r m i n o r i t y g r o u p , e x p e r i e n c e d l i t t l e c o n t r o l o v e r t h e i r h o s p i t a l e x p e r i e n c e . P r o f e s s i o n a l n u r s i n g l i t e r a t u r e h a s a d d r e s s e d i t s e l f t o t h e need f o r a s s e s s i n g c l i e n t s ' c u l t u r a l b e l i e f s and v a l u e s i n o r d e r t o p r o v i d e r e l e v a n t , c l i e n t - c e n t r e d c a r e ( B r o w n , 1976; D a v i s & Y o s h i d a , 1 9 8 1 ; T r i p p - R e i m e r , B r i n k & S a u n d e r s , 1 9 8 4 ) . H o w e v e r , t h e l i t e r a t u r e has n o t d e s c r i b e d t h e p r o b l e m o f c l i e n t s ' e x p l a n a t o r y m o d e l s i n c l u d i n g d i s c r i m i n a t i o n d i r e c t e d a t them by t h e n u r s i n g s t a f f . T h i s l a c k i n t h e l i t e r a t u r e may i n d i c a t e t h a t n u r s e s do n o t s e e t h e m s e l v e s as d i s c r i m i n a t i n g a g a i n s t c e r t a i n g r o u p s o f p e o p l e , w h i l e t h e p o p u l a r s e c t o r a t t a c h e s t h e m e a n i n g o f d i s c r i m i n a t i o n t o t h e i r i n t e r a c t i o n w i t h some h e a l t h c a r e p r o f e s s i o n a l s . 113 D e s p i t e t h i s f e l t d i s c r i m i n a t i o n , t h e s t u d y s u b j e c t s ' a c c o u n t s i n d i c a t e d t h a t t h e y t r u s t e d and b e l i e v e d i n what t h e h o s p i t a l n u r s e s t o l d them. T h i s i s e s p e c i a l l y e v i d e n t i n t h e a r e a o f b r e a s t f e e d i n g . I t i s i n t e r e s t i n g t h a t , d e s p i t e t h e f e l t d i s c r i m i n a t i o n , t h e women d e s c r i b e d t h e h o s p i t a l n u r s e s a s t h e i r m a i n s o u r c e o f i n f o r m a t i o n a b o u t t h e c a r e o f t h e i r new b a b i e s . I n d i s c u s s i n g d i s c r i m i n a t i o n and c o m m u n i c a t i o n p r o b l e m s w i t h t h e n u r s e s , t h e women r e a l i z e d t h e n e g a t i v e e f f e c t t h i s had on h e l p i n g them t o c a r e f o r t h e i r i n f a n t s . T h e i r c o n f i d e n c e i n t h e n u r s e s ' k n o w l e d g e as h e a l t h c a r e p r o f e s s i o n a l s r e m a i n e d i n t a c t , h o w e v e r , d e s p i t e t h e f e l t d i s c r i m i n a t i o n . T h i s b e l i e f i n t h e n u r s e s ' k n o w l e d g e was e v i d e n t i n t h e a r e a o f b r e a s t f e e d i n g and t h e v a l u e o f c o l o , s t r u m f o r t h e n e w b o r n . One woman s a i d : T h e r e i s j u s t w a t e r i s c o m i n g , b u t I know h o w — t h a t t h e w a t e r i s good f o r b a b i e s . The n u r s e s t e l l me t h i s . And a n o t h e r : I n h o s p i t a l t h e y ( t h e n u r s e s ) t e l l y o u i t ' s v e r y g o od f o r t h e baby s o I g i v e i t . One woman, who had t h e a b i l i t y t o r e a d E n g l i s h , h a d done h e r own r e a d i n g on c o l o s t r u m and had l a t e r had h e r f a c t s c o n f i r m e d by t h e n u r s e s . F i r s t I r e a d t h a t i t i s g o o d — t h e n i n h o s p i t a l t h e n u r s e s t e l l me s o I g i v e i t t o b a b y . The p a r t i c i p a n t who s p o k e E n g l i s h f l u e n t l y and had 114 a t t e n d e d p r e n a t a l c l a s s e s d i d n o t ha v e an e x p l a n a t i o n o f what c o l o s t r u m was, b u t s h e t r u s t e d t h e n u r s e s ' a d v i c e . When a s k e d why she g a v e h e r baby c o l o s t r u m , s h e s a i d : I d o n ' t know. J u s t t h e y t o l d me t o — y o u know, y o u s h o u l d n u r s e l i k e t h i s , t h e n u r s e s t o l d me. Oh, e v e n t h e y a r e t e l l i n g t h e p r e n a t a l c l a s s e s t o o . Y e a h , i n t h e b e g i n n i n g — w a t e r y l i k e — i t was y e l l o w . . . . Y e a h , t h a t when i t ' s c o m i n g i n , s o r t o f f e e d t h e b a b y w i t h t h a t and t h e n . . . I d i d t h e n u r s i n g maybe one day a f t e r t h a t . I n h o s p i t a l t h i s woman had c o n f i r m a t i o n o f i n f o r m a t i o n g i v e n i n p r e n a t a l c l a s s e s . She a c t e d w i l l i n g l y on t h i s i n f o r m a t i o n as d i d t h e o t h e r women, i n t h e b e l i e f t h a t t h e h e a l t h c a r e p r o f e s s i o n a l was t h e a u t h o r i t y . The women i n t h i s s a m p l e had e x p l a n a t o r y m o d e l s w h i c h c o n f e r r e d t h e s t a t u s o f " a u t h o r i t y " on t h e h o s p i t a l n u r s e s . T h i s r e m a i n e d t r u e d e s p i t e c o n f l i c t and f e l t d i s c r i m i n a t i o n b e t w e e n t h e n u r s e s and women. I f t h e b a r r i e r s t o c o m m u n i c a t i o n were r e d u c e d and t h e c o n f l i c t n e g o t i a t e d , h o s p i t a l n u r s e s w o u l d be i n an e x c e l l e n t p o s i t i o n t o p r o v i d e more e f f e c t i v e and m e a n i n g f u l c a r e t o t h e s e I n d o - C a n a d i a n women. The P r e f e r e n c e f o r H o s p i t a l B i r t h s A l l o f t h e women s p o k e o f p r e f e r r i n g t o ha v e d e l i v e r e d t h e i r b a b i e s i n Canada and n o t i n I n d i a . T h e i r e x p l a n a t i o n s 115 f o r t h e i r p r e f e r e n c e s a r o s e f r o m t h e i r k n o w l e d g e o f t h e d a n g e r s a t t a c h e d t o d e l i v e r y i n I n d i a and t h e i r a p p r e c i a t i o n o f t h e p o s t - p a r t u m t i m e i n h o s p i t a l . One woman s a i d s h e p r e f e r r e d a C a n a d i a n h o s p i t a l d e l i v e r y : B e c a u s e o v e r t h e r e , t h e r e ' s t o o many s o s i c k . Some women a p p r e c i a t e d b o t h t h e s a f e h o s p i t a l e n v i r o n m e n t and t h e l u x u r y o f b e i n g l o o k e d a f t e r . One woman s a i d : I s g o o d , i s s a f e f o r me and b a b y . A l l t h e t i m e t h a t was c r i b , b o t t l e s and t o w e l s and a n y t h i n g . . . e v e r y t h i n g . And a n o t h e r : H a v i n g n u r s e s t h e r e t o h e l p i s g o o d . Y e a h , i n t h e h o u s e h e l p i n g . . . y e a h , b u t s o m e t i m e s t h e y a r e b u s y and t h e w o r k , i t ' s t o o h a r d . The two women who had had c a e s a r i a n b i r t h s w e r e m o s t c o n v i n c e d o f t h e d e s i r a b i l i t y o f a h o s p i t a l d e l i v e r y i n C a n a d a . The f i r s t s a i d : B e c a u s e c e r t a i n — t h e y d e l i v e r a t home r i g h t ? . . . I f t h e r e ' s a p r o b l e m l i k e me. T h a t ' s why I'm s c a r e d t h e r e . I f t h e r e ' s no l i k e h o s p i t a l n e a r , what a r e y o u g o i n g t o do r i g h t . . . L i k e m o s t o f t h e p e o p l e i n I n d i a , t h e y a r e n o t i n t h e c i t y , s o t h e r e ' s no h o s p i t a l h e r e . And t h e s e c o n d : And I was v e r y g l a d b e c a u s e i n I n d i a t h e r e a r e n o t t o o many, y o u know, t h a t y o u c a n s a y — n i c e 116 h o s p i t a l . B e c a u s e i n I n d i a , e s p e c i a l l y t h e l a d i e s , m o s t o f t h e l a d i e s a r e h a v i n g k i d s a t home and my c a s e , y o u know, when I g o t my b a b y , my c a s e was c o m p l e t e l y d i f f e r e n t b e c a u s e t h e y n e v e r t o l d me t h a t I was g o i n g t o ha v e a s e c t i o n , y o u know...One o f us c o u l d have d i e d , my b a b y o r me. Y e a h , s o I'm v e r y g l a d t h a t I g o t my baby i n C a n a d a . T h i s woman, who h e l d b e l i e f s and p r a c t i c e s more s i m i l a r t o C a n a d i a n t h a n E a s t I n d i a n c u l t u r e , was a b l e t o u s e h e r own e x p e r i e n c e a s an e x a m p l e t o p o i n t o u t h e r r e a s o n s f o r p r e f e r r i n g w e s t e r n h e a l t h c a r e p r a c t i c e s . A l l o f t h e women had s e e n , f i r s t h a n d , t h e d a n g e r s i n h e r e n t i n c h i l d b e a r i n g i n I n d i a , and t h e y were g r a t e f u l t o be i n a c o u n t r y where m e d i c a l f a c i l i t i e s d e c r e a s e t h e m o r b i d i t y a n d m o r t a l i t y r a t e s . The women a l s o s a i d t h a t t h e i r e x p e r i e n c e i n Canada was i m p r o v e d by t h e i r b e i n g c a r e d f o r i n h o s p i t a l . B o t h t h e s e r e a s o n s p r o v i d e e x a m p l e s o f a p e o p l e g i v i n g up t h e i r o l d p r a c t i c e s t o t a k e on new c u l t u r a l p r a c t i c e s when t h e y c a n s e e t h e a d v a n t a g e s t h e new p r a c t i c e s \have f o r them ( C h a n c e , 1 9 6 5 ) . The women's p r e f e r e n c e s f o r h o s p i t a l d e l i v e r i e s , r e g a r d l e s s o f t h e i r d e g r e e o f a c c u l t u r a t i o n , a l s o i l l u s t r a t e how i n d i v i d u a l s ' e x p l a n a t o r y m o d e l s may a l t e r a s t h e y s e e t h e b e n e f i t o f t a k i n g on new b e l i e f s and p r a c t i c e s . I t i s o b v i o u s f r o m t h e d a t a , t h a t h e a l t h c a r e p r o f e s s i o n a l s h a v e e x p l a n a t o r y m o d e l s a b o u t c h i l d b e a r i n g t h a t d i f f e r f r o m t h e e x p l a n a t o r y m o d e l s o f t h e I n d o - C a n a d i a n women 117 i m m i g r a n t s i n t h i s s t u d y . The p r o f e s s i o n a l h e a l t h c a r e w o r k e r s h a v e an i m p a c t on t h e c h i l d b e a r i n g e x p e r i e c e s o f t h e s e I n d o - C a n a d i a n women i m m i g r a n t s . T h i s i m p a c t i s n o t a l w a y s p o s i t i v e , as i n t h e c a s e o f f e l t d i s c r i m i n a t i o n . A t t i m e s t h e women s t a t e d t h e p r o f e s s i o n a l d i d have an i n f l u e n c e when o n l y a m i n i m a l i n f l u e n c e e x i s t e d , a s i n t h e c a s e o f v e r b a l i z i n g f o l l o w i n g d o c t o r s d i e t a r y a d v i c e w h i l e r e a l l y l i s t e n i n g t o e l d e r s a d v i c e . As t h e women came t o h o l d b e l i e f s and a t t i t u d e s more p r e v a l e n t i n C a n a d i a n s o c i e t y , t h e i r p r a c t i c e s came more i n t o a l i g n m e n t w i t h t h o s e o f t h e h e a l t h c a r e p r o f e s s i o n a l s and t h e i r a b i l i t y t o d e f l e c t o r c o p e w i t h d i s c r i m i n a t i o n i n c r e a s e d . R e g a r d l e s s o f t h e i r a c c u l t u r a t i o n , t h e s e women's p e r c e p t i o n s o f h e a l t h c a r e p r o f e s s i o n a l s d u r i n g t h e i r c h i l d b e a r i n g e x p e r i e n c e was b a s e d on t r u s t i n t e c h n o l o g i c a l a r e a s , a n d , f o r r e a s o n s o f s a f e t y and c o m f o r t t h e y p r e f e r r e d d e l i v e r y i n a C a n a d i a n h o s p i t a l . Summary I n t h i s c h a p t e r , t h e s u b j e c t s ' e x p e r i e n c e s o f c h i l d b e a r i n g i n Canada have been p r e s e n t e d i n r e l a t i o n t o t h e p r o c e s s o f a c c u l t u r a t i o n . The s u b j e c t s ' a c c o u n t s have c o n t a i n e d t h e i r e x p l a n a t o r y m o d e l s and t h e s e e x p l a n a t o r y m o d e l s have been c o m p a r e d t o p e r t i n e n t l i t e r a t u r e . S i m i l a r i t i e s and d i s s i m i l a r i t i e s amongst a nd b e t w e e n t h e a c c o u n t s h a v e b e e n e x p l a i n e d i n r e l a t i o n t o a c c u l t u r a t i o n . 118 CHAPTER 5 SUMMARY, CONCLUSIONS AND IMPLICATIONS FOR NURSING Summary The p u r p o s e o f t h i s s t u d y was t o g a i n k n o w l e d g e o f t h e h e a l t h b e l i e f s and p r a c t i c e s o f I n d o - C a n a d i a n women i m m i g r a n t s d u r i n g t h e c h i l d b e a r i n g e x p e r i e n c e . The s t u d y was d i r e c t e d by t h e f o l l o w i n g q u e s t i o n s : What a r e t h e I n d o - C a n a d i a n women's b e l i e f s a b o u t c h i l d b e a r i n g ? What a r e t h e I n d o - C a n a d i a n women's p e r c e p t i o n s o f t h e i r t r a d i t i o n a l p r a c t i c e s , i n t h e i r e t h n i c c o m m u n i t y , s u r r o u n d i n g c h i l d b e a r i n g ? and f i n a l l y , how a r e t h e s e w e s t e r n h e a l t h c a r e r e s o u r c e s p e r c e i v e d by t h e women? As o u t l i n e d i n C h a p t e r 1, t h e I n d o - P a k i s t a n i p o p u l a t i o n i n C anada h a s i n c r e a s e d i n r e c e n t y e a r s , f r o m 13,200 i n 1971 ( S t a t i s t i c s C a n a d a , 1971) t o 43,070 i n 1981 ( S t a t i s t i c s C a n a d a , 1 9 8 1 ) . P u n j a b i - s p e a k i n g p e o p l e i n t h a t y e a r numbered 76% o f t h e I n d o - P a k i s t a n i p o p u l a t i o n ( S t a t i s t i c s C a n a d a , 1 9 8 1 ) . As t h e i r numbers h a v e g r o w n , t h i s i m m i g r a n t g r o u p h a v e made up a g r e a t e r p e r c e n t a g e o f n u r s i n g ' s c l i e n t e l e . T h e r e i s , h o w e v e r , a p a u c i t y o f r e s e a r c h and w r i t i n g s a b o u t t h e c h i l d b e a r i n g e x p e r i e n c e s o f I n d o - C a n a d i a n women i m m i g r a n t s , d e s p i t e t h e h e a l t h c a r e p r o f e s s i o n a l s ' a c k n o w l e d g e m e n t t h a t I n d o - C a n a d i a n women u n d e r u t i l i z e t h e 119 p r e n a t a l programmes a v a i l a b l e t o them ( T . J o h n s t o n e , p e r s o n a l c o m m u n i c a t i o n , May, 1982; P. P u l l e n , p e r s o n a l c o m m u n i c a t i o n , May, 1982) and t h a t t h e s e women a r e a t r i s k f o r d e l i v e r i n g l o w b i r t h w e i g h t b a b i e s w i t h c o n c o m i t a n t b i o - p h y s i o l o g i c a l p r o b l e m s ( B r i t i s h C o l u m b i a G o v e r n m e n t , 1982; G. G r e e n s t o n e , p e r s o n a l c o m m u n i c a t i o n , J u n e , 1 9 8 4 ) . H e a l t h p r o f e s s i o n a l s do n o t know en o u g h a b o u t t h e c h i l d b e a r i n g e x p e r i e n c e f o r t h i s c u l t u r a l g r o u p . T h i s may l e a d t o c o n f l i c t s a n d d i s c r e p a n c i e s o f v i e w p o i n t s b e t w e e n c l i e n t s and p r o f e s s i o n a l s , r e s u l t i n g i n n u r s i n g c a r e t h a t i s n o t a c c e p t a b l e t o t h e i n d i v i d u a l . I n t h i s s t u d y t h e s t a n c e was t a k e n t h a t n o t i o n s o f h e a l t h and i l l n e s s a r e s o c i o - c u l t u r a l l y c o n s t r u c t e d and t h a t p e o p l e i n t e r p r e t and e x p l a i n h e a l t h and i l l n e s s i n d i f f e r e n t w a y s . Many a u t h o r s ( C h r i s m a n , 1977; F a b r e g a , 1975; K l e i n m a n , 1978; L i p o w s k i , 1969) h a v e d i s c u s s e d t h e p r o b l e m o f d i s c r e p a n c i e s and c o n f l i c t s b e t w e e n t h e v i e w s o f h e a l t h c a r e p r o f e s s i o n a l s and c l i e n t s . K l e i n m a n ( 1 9 7 8 ) , i n h i s c u l t u r a l s y s t e m o r e x p l a n a t o r y m o d e l , s t a t e s t h a t i n d i v i d u a l s i n t e r p r e t h e a l t h and i l l n e s s a c c o r d i n g t o t h e s o c i a l p o s i t i o n s t h e y o c c u p y and t h e s y s t e m o f m e a n i n g s t h e y e m p l o y . The c l i e n t , i n t h e p o p u l a r s e c t o r o f h e a l t h c a r e , e x p l a i n s h e a l t h and i l l n e s s i n a d i f f e r e n t way f r o m t h e p r o f e s s i o n a l s . The p o t e n t i a l f o r d i s c o r d a n c e i n c r e a s e s when t h e h e a l t h c a r e p r o f e s s i o n a l s and c l i e n t s a r e f r o m d i f f e r e n t e t h n i c a n d / o r c u l t u r a l g r o u p s . I n o r d e r t o p l a n and i m p l e m e n t e f f e c t i v e c l i e n t - c e n t r e d c a r e , p r o f e s s i o n a l s must e l i c i t and u n d e r s t a n d t h e c l i e n t s ' v i e w p o i n t s o f t h e i r s i t u a t i o n s . I t 120 i s o n l y a f t e r m a k i n g e x p l i c i t b o t h t h e p r o f e s s i o n a l and t h e p o p u l a r e x p l a n a t i o n s o f h e a l t h and i l l n e s s , t h a t n e g o t i a t i o n c a n t a k e p l a c e t o r e d u c e o r remove c o n f l i c t . T h i s p r o v i d e s d i r e c t i o n f o r e f f e c t i v e n u r s i n g c a r e . I n o r d e r t o e l i c i t t h e s u b j e c t s ' e x p l a n a t o r y m o d e l o f t h e i r c h i l d b e a r i n g e x p e r i e n c e , t h e p h e n o m e n o l o g i c a l method o f r e s e a r c h was u s e d . T h i s q u a l i t a t i v e a p p r o a c h t o t h e r e s e a r c h p r o b l e m e n a b l e d t h e r e s e a r c h e r t o c o l l e c t d a t a by e n t e r i n g i n t o t h e " l i f e w o r l d " o f I n d o - C a n a d i a n women i m m i g r a n t s . T h i s m e t h o d o l o g y assumes t h a t t o g e t h e r , t h e i n v e s t i g a t o r and t h e p a r t i c i p a n t s c o n s t r u c t a c c o u n t s o f t h e phenomena u n d e r s t u d y . D a t a were c o l l e c t e d t h r o u g h i n d e p t h , a u d i o - t a p e d i n t e r v i e w s w i t h e i g h t I n d o - C a n a d i a n women i m m i g r a n t s who had had r e c e n t c h i l d b e a r i n g e x p e r i e n c e s i n C a n a d a . A l l o f t h e women were d r a w n f r o m one p r o v i n c i a l h e a l t h u n i t l o c a t e d 35 m i l e s f r o m V a n c o u v e r , B r i t i s h C o l u m b i a . A u d i o - t a p e d i n t e r v i e w s were t r a n s c r i b e d v e r b a t i m and s e r v e d as t h e m a i n s o u r c e o f d a t a . A l l p a r t s o f t h e d a t a w e re i n c l u d e d f o r a n a l y s i s . D a t a c o l l e c t i o n and a n a l y s i s o c c u r r e d s i m u l t a n e o u s l y t h r o u g h t h e p r o c e s s o f c o n s t a n t c o m p a r a t i v e a n a l y s i s . I n t e r v i e w i n g and d a t a a n a l y s i s c o n t i n u e d u n t i l s u c h t i m e a s t h e r e s e a r c h e r f e l t t h a t t h e c o n c e p t u a l c a t e g o r i e s a r i s i n g f r o m t h e o n g o i n g a n a l y s e s had been s a t u r a t e d a n d t h e r e s e a r c h q u e s t i o n s a n s w e r e d . The women's a c c o u n t s were a n a l y z e d s o a s t o make e x p l i c i t t h e i r e x p l a n a t o r y m o d e l s o f t h e i r c h i l d b e a r i n g 121 e x p e r i e n c e s . The i n v e s t i g a t o r had e x p e c t e d t o f i n d t h a t t h e s e e x p e r i e n c e s w o u l d be f a i r l y u n i f o r m . The p a r t i c i p a n t s h a d s a t i s f i e d c e r t a i n c r i t e r i a f o r i n c l u s i o n i n t h e s t u d y , and t h e r e s e a r c h e r had assumed t h a t b e c a u s e t h e s u b j e c t s met t h e s e c r i t e r i a , t h e y w o u l d be s i m i l a r , r e s u l t i n g i n common c h i l d b e a r i n g e x p e r i e n c e s . D i s s i m i l a r i t i e s i n t h e phenomena u n d e r i n v e s t i g a t i o n w e r e , h o w e v e r , more e v i d e n t t h a n s i m i l a r i t i e s . D u r i n g t h e e a r l y s t a g e s o f i n t e r v i e w i n g and s i m u l t a n e o u s d a t a a n a l y s i s , t h e r e s e a r c h e r became aware t h a t t h e c o n c e p t o f a c c u l t u r a t i o n was h e l p i n g h e r t o make s e n s e o f t h e d a t a . R e f l e c t i o n on t h e d a t a and v e r i f i c a t i o n w i t h s t u d y s u b j e c t s made t h e i n v e s t i g a t o r aware t h a t t h e c o n c e p t o f a c c u l t u r a t i o n a c c o u n t e d f o r t h e i n d i v i d u a l d i f f e r e n c e s i n t h e women's a c c o u n t s o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s . As t h e women t a l k e d o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s , i t became e v i d e n t t h a t , a s t h e y a d o p t e d v a r i o u s a s p e c t s o f C a n a d i a n c u l t u r e , t h e y b e g a n t o a c q u i r e C a n a d i a n b e l i e f s and p r a c t i c e s . I n a c y c l i c a l p r o c e s s , as t h e i r b e l i e f s and p r a c t i c e s became more C a n a d i a n i n c h a r a c t e r , t h e i r a c c u l t u r a t i o n i n t o C a n a d i a n s o c i e t y a c c e l e r a t e d . A l t h o u g h t h e r e s e a r c h q u e s t i o n s g u i d i n g t h i s s t u d y d e a l t w i t h c h i l d b e a r i n g s p e c i f i c a l l y , t h e women t a l k e d o f t h e i r e x p e r i e n c e s i n a b r o a d e r c o n t e x t w h i c h i n c l u d e d s e x u a l i t y , a r r a n g e d m a r r i a g e , a u t h o r i t y , r e s p e c t , s h y n e s s , and l a c k o f k n o w l e d g e . Two themes emerged f r o m t h e d a t a and r e l a t e d t o t h i s l a r g e r c o n t e x t a s w e l l as t o t h e p r o c e s s o f a c c u l t u r a t i o n . T h e s e themes e x i s t e d t h r o u g h o u t t h e 122 e x p e r i e n c e , v a r y i n g i n p r o m i n e n c e a t d i f f e r e n t t i m e s . The two themes w e r e , t h e s u b j e c t s ' r e l a t i o n s h i p s w i t h t h e i r f a m i l i e s , and t h e s u b j e c t s ' r e l a t i o n s h i p s w i t h h e a l t h c a r e p r o f e s s i o n a l s . The women's a c c o u n t s made i t c l e a r t h a t t h e i r h e a l t h b e l i e f s and p r a c t i c e s s u r r o u n d i n g c h i l d b e a r i n g were l o c a t e d w i t h i n a b r o a d e r c o n t e x t o f m e a n i n g s r e l a t e d t o t h e r e p r o d u c t i v e c y c l e and were l e a r n e d and e x p r e s s e d w i t h i n t h e c o n t e x t o f t h e f a m i l y . I n t u r n , t h e p r o c e s s o f a c c u l t u r a t i o n b o t h a f f e c t e d and was a f f e c t e d by t h e s u b j e c t s ' r e l a t i o n s h i p s w i t h t h e i r f a m i l i e s . The c o n c e p t o f a c c u l t u r a t i o n t h e r e f o r e i m p a c t e d on t h e h e a l t h b e l i e f s and p r a c t i c e s r e l a t e d t o t h e c h i l d b e a r i n g e x p e r i e n c e . Women i n t h e s t u d y e x p e r i e n c e d m e n s t r u a t i o n f o r t h e f i r s t t i m e w i t h o u t h a v i n g b e e n t o l d o f t h i s p h y s i o l o g i c a l e v e n t . The women a l l e x p l a i n e d t h i s l a c k o f k n o w l e d g e i n r e l a t i o n t o s h y n e s s , w h i c h was d e s c r i b e d a s a c u l t u r a l phenomenon. Out o f r e s p e c t f o r e l d e r s , t h e y d i d n o t a s k f o r i n f o r m a t i o n . The c o n c e p t o f a c c u l t u r a t i o n a p p e a r e d t o a f f e c t t h i s s h y n e s s , a s one s t u d y p a r t i c i p a n t w i t h v i e w s a n d b e l i e f s s i m i l a r t o t h o s e f o u n d i n C a n a d i a n c u l t u r e , had been f o r e w a r n e d a b o u t t h e o n s e t o f m e n s t u a t i o n . None o f t h e women i n t h e s t u d y h a d b e e n t o l d why t h e y w o u l d m e n s t r u a t e and t h r e e o f t h e s t u d y p a r t i c i p a n t s r e m a i n e d i g n o r a n t o f b a s i c anatomy and p h y s i o l o g y . S h y n e s s and r e s p e c t , a s t h e y i n f l u e n c e how o r what t h e women l e a r n e d a b o u t t h e i r b o d i e s and m e n s t r u a t i o n , s e t up a 123 s i t u a t i o n o f i g n o r a n c e when t h e women s u b s e q u e n t l y m a r r i e d . I t a p p e a r s t h a t , as women became more a c c u l t u r a t e d i n t o C a n a d i a n s o c i e t y , t h e y l e a r n e d more a b o u t t h e i r b o d i e s , b u t t h i s k n o w l e d g e was o f t e n f r a g m e n t a r y and p a s s i v e l y r e c e i v e d . M o s t o f t h e p a r t i c i p a n t s l e a r n e d e a r l y i n l i f e t h a t i t was a p p r o p r i a t e t o be s h y a b o u t a l l a r e a s o f t h e i r s e x u a l i t y and n o t t o a s k q u e s t i o n s . A l l o f t h e women i n t h e s t u d y s p o k e o f t h e c o n t i n u e d r e s p e c t t h e y had f o r t h e i r p a r e n t s and how t h e y t r u s t e d t h e i r p a r e n t s t o c h o o s e t h e r i g h t s p o u s e s f o r them. A l l o f t h e women had had t h e i r m a r r i a g e s a r r a n g e d and a l l owed t h e i r p r i m a r y r e s p e c t t o t h e i r i n - l a w s . The women's a r r a n g e d m a r r i a g e s had an i n f l u e n c e on t h e i r c h i l d b e a r i n g e x p e r i e n c e s . B e c a u s e t h e women d i d n o t know t h e i r new s p o u s e s , and b e c a u s e o f t h e i r s h y n e s s a b o u t s e x u a l i t y , t h e women came t o m a r r i a g e w i t h v e r y l i t t l e k n o w l e d g e o f s e x o r b i r t h c o n t r o l . T h i s o f t e n l e d t o u n p l a n n e d p r e g n a n c i e s w h i c h a f f e c t e d t h e i r p e r c e p t i o n s o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s . Women who h e l d b e l i e f s t h a t were more c o n s i s t e n t w i t h C a n a d i a n b e l i e f s s o o n l e a r n e d a b o u t b i r t h c o n t r o l ; o t h e r women e i t h e r f e l t i t was t h e i r d u t y t o p r o d u c e c h i l d r e n o r e l s e l o o k e d t o t h e i r h u s b a n d s t o d i c t a t e t h e i r b i r t h c o n t r o l d e c i s i o n s . R e g a r d l e s s o f t h i r d e g r e e o f a c c u l t u r a t i o n i n t o C a n a d i n s o c i e t y , a l l o f t h e women s t i l l d i s c u s s e d s h y n e s s i n r e l a t i o n t o t h e i r own s e x u a l i t y . The women's e x p l a n a t o r y m o d e l s a l l i n c l u d e d t h e need t o p r o d u c e m a l e o f f s p r i n g . They a t t a c h e d g r e a t i m p o r t a n c e t o 124 h a v i n g s o n s a n d were a b l e t o make s e n s e o f t h e i r d e s i r e f o r s o n s i n t e r m s o f t h e i r own p e r s o n a l w e l f a r e . The women d e s c r i b e d how, i f t h e y d i d n o t b e a r s o n s , t h e i r h u s b a n d s m i g h t t a k e s e c o n d w i v e s ; t h e i r m o t h e r s - i n - l a w m i g h t c a u s e p r o b l e m s ; t h e i r h u s b a n d s w o u l d c o n t r o l t h e number and t i m i n g o f f u t u r e p r e g n a n c i e s , and t h e y w o u l d h a v e nowhere t o l i v e i n t h e i r o l d a g e . The nee d f o r m a l e o f f s p r i n g c l e a r l y i n f l u e n c e d t h e women's p e r c e p t i o n s o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s . The p r o c e s s o f a c c u l t u r a t i o n was e v i d e n t h e r e when one o f t h e s t u d y p a r t i c i p a n t s j u s t i f i e d w a n t i n g a s o n i n an a c c e p t a b l e C a n a d i a n m a n n e r — t o k e e p t h e f a m i l y name. D u r i n g p r e g n a n c y a n d t h e p o s t - p a r t u m p e r i o d , t h e women l e a r n e d a b o u t d i e t and a c t i v i t y f r o m t h e i r f e m a l e i n - l a w s . H e a l t h b e l i e f s and p r a c t i c e s s u r r o u n d i n g d i e t and a c t i v i t y a p p e a r e d t o be p a s s e d on i n an i n d i v i d u a l and f r a g m e n t a r y manner w i t h v e r y l i t t l e m o d i f i c a t i o n made f o r p r e g n a n c y . Few o f t h e women i n t h e s t u d y c o u l d g i v e t h e r e a s o n s b e h i n d t h e m o d i f i c a t i o n s t h e y made. Women who had b e l i e f s and a t t i t u d e s more c o n s i s t e n t w i t h C a n a d i a n o n e s t e n d e d t o s e e k o u t t h e r e a s o n s b e h i n d t h e p r a c t i c e s , were more aware t h a t t h e a d v i c e p a s s e d on was i n d i v i d u a l l y b a s e d and s o u g h t o u t p r o f e s s i o n a l h e a l t h c a r e a d v i c e t o be u s e d i n c o n j u n c t i o n w i t h t h e i r e l d e r s ' i n f o r m a t i o n . I t was d u r i n g t h e p o s t - p a r t u m p e r i o d t h a t women who were more C a n a d i a n i z e d r e v e r t e d t o t h e i r E a s t I n d i a n p r a c t i c e s . A l t h o u g h t h e y j u s t i f i e d t h e p r a c t i c e s i n t e r m s c o n s i s t e n t w i t h a w e s t e r n h e a l t h c a r e c o n c e p t , t h e i r p o p u l a r e x p l a n a t o r y m o d e l s r e m a i n e d d i f f e r e n t f r o m t h e 125 p r o f e s s i o n a l e x p l a n a t o r y m o d e l . I n t h i s s t u d y , t h e women t a l k e d o f u t i l i z i n g f o u r w e s t e r n h e a l t h c a r e r e s o u r c e s : t h e p h y s i c i a n , t h e com m u n i t y h e a l t h n u r s e , t h e p o s t - p a r t u m h o s p i t a l n u r s e , and t h e h o s p i t a l i t s e l f . The women's r e l a t i o n s h i p s w i t h h e a l t h c a r e r e s o u r c e s d u r i n g c h i l d b e a r i n g w e re f r a u g h t w i t h c o n t r a d i c t i o n s . A l t h o u g h a l l t h e women s t a t e d t h a t t h e i r p h y s i c i a n s were t h e i r p r i m a r y s o u r c e o f i n f o r m a t i o n , t h e i r a c t u a l p r a c t i c e s were b a s e d on i n f o r m a t i o n o b t a i n e d f r o m f a m i l y members. Women who were l e s s a c c u l t u r a t e d i n t o C a n a d i a n s o c i e t y and p r a c t i c e s , r e c e i v e d i n f o r m a t i o n p a s s i v e l y f r o m t h e i r p h y s i c i a n s and t r u s t e d t h e d o c t o r s ' d e c i s i o n s . Women who had b e l i e f s and p r a c t i c e s more C a n a d i a n i n c h a r a c t e r a l s o t r u s t e d t h e i r d o c t o r s b u t , i n a d d i t i o n , s o u g h t o u t t h e i r own i n f o r m a t i o n . Two women had a t t e n d e d p r e n a t a l c l a s s e s a t t h e l o c a l h e a l t h u n i t on t h e a d v i c e o f t h e i r d o c t o r s . T h e s e women b o t h l i v e d i n n u c l e a r f a m i l i e s i n Canada and d i d n o t h a v e i n - l a w s t o d i s p e n s e i n f o r m a t i o n . A l t h o u g h t h r e e o f t h e o t h e r p a r t i c i p a n t s s h a r e d t h e same d o c t o r , t h e y s t a t e d t h a t t h e y had n o t been t o l d o f t h e c l a s s e s . They s a i d t h e y w o u l d have a t t e n d e d i f t h e y h a d known o f t h e c l a s s e s . Women who d i d a t t e n d t h e c l a s s e s p e r c e i v e d t h a t t h e com m u n i t y h e a l t h n u r s e s had b o t h t h e k n o w l e d g e and t h e i n t e r p e r s o n a l s k i l l s t o p r o v i d e c a r e f o r t h i s g r o u p . A l l o f t h e women d e s c r i b e d t h e f e e l i n g o f b e i n g 126 d i s c r i m i n a t e d a g a i n s t by t h e p o s t - p a r t u m n u r s i n g s t a f f . Women i n t h e s t u d y who had b e l i e f s and p r a c t i c e s more s i m i l a r t o C a n a d i a n c u l t u r e u s e d t h e t e r m " d i s c r i m i n a t i o n " t o d e s c r i b e t h e phenomenon t h e y were e x p e r i e n c i n g and t h e y c o u l d g i v e many c o r e r e a s o n s f o r t h e e x i s t e n c e o f d i s c r i m i n a t i o n . T h e s e women c o u l d a l s o a c t t o d e f l e c t d i s c r i m i n a t i o n f r o m t h e m s e l v e s o r d e c r e a s e i t . A l l o f t h e women f e l t t h a t t h i s phenomenon n e g a t i v e l y a f f e c t e d t h e n u r s i n g c a r e t h e y r e c e i v e d and saw t h i s a s a p r o b l e m f o r t h e f i r s t - t i m e m o t h e r l e a r n i n g b a by c a r e . D e s p i t e t h i s f e l t d i s c r i m i n a t i o n , h o w e v e r , t h e women m a i n t a i n e d t h e i r t r u s t i n t h e n u r s e s ' k n o w l e d g e as h e a l t h c a r e p r o f e s s i o n a l s and f o l l o w e d t h e n u r s i n g a d v i c e g i v e n . F i n a l l y , a l l o f t h e women p r e f e r r e d h a v i n g d e l i v e r e d t h e i r b a b i e s i n a C a n a d i a n h o s p i t a l . T h e i r e x p l a n a t i o n s f o r t h e i r p r e f e r e n c e a r o s e f r o m t h e i r k n o w l e d g e o f t h e d a n g e r s a t t a c h e d t o d e l i v e r y i n I n d i a and t h e i r a p p r e c i a t i o n o f t h e p o s t - p a r t u m r e s t i n g p e r i o d i n h o s p i t a l . C o n c l u s i o n s The f o l l o w i n g c o n c l u s i o n s were drawn f r o m t h i s s t u d y : 1. D i s s i m i l a r i t i e s i n t h e e x p l a n a t o r y m o d e l s o f t h e I n d o - C a n a d i a n i m m i g r a n t womens' c h i l d b e a r i n g e x p e r i e n c e s a r e a t t r i b u t a b l e t o t h e p r o c e s s o f a c c u l t u r a t i o n . 2. The I n d o - C a n a d i a n i m m i g r a n t womens' p e r c e p t i o n s o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s a r e l o c a t e d w i t h i n a b r o a d e r 127 c o n t e x t o f m e a n i n g s a s s o c i a t e d w i t h t h e r e p r o d u c t i v e c y c l e . 3. The I n d o - C a n a d i a n i m m i g r a n t womens' r e l a t i o n s h i p s w i t h t h e i r f a m i l i e s , and w i t h h e a l t h c a r e p r o f e s s i o n a l s , a r e s i g n i f i c a n t a s p e c t s o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s and a r e i n f l u e n c e d by a u t h o r i t y , r e s p e c t , l a c k o f k n o w l e d g e , and s h y n e s s . 4. The h e a l t h c a r e r e s o u r c e s u t i l i z e d by t h e I n d o - C a n a d i a n i m m i g r a n t women d u r i n g t h e i r c h i l d b e a r i n g e x p e r i e n c e s were t h e p h y s i c i a n , t h e c o m m u n i t y h e a l t h n u r s e , t h e h o s p i t a l n u r s e , and t h e h o s p i t a l i t s e l f . The women p e r c e i v e d t h e s e r e s o u r c e s a s t h e a u t h o r i t y i n a r e a s r e l a t e d t o w e s t e r n t e c h n o l o g i c a l m e d i c i n e b u t n o t i n ateas s u c h a s d i e t i n p r e g n a n c y . H e a l t h c a r e p r o f e s s i o n a l s were n o t u t i l i z e d a s r e s o u r c e s f o r p s y c h o - s o c i a l s u p p o r t . 5. W i t h i n t h e i r c h i l d b e a r i n g e x p e r i e n c e s , t h e I n d o - C a n a d i a n i m m i g r a n t women p e r c e i v e d d i s c r i m i n a t i o n d i r e c t e d a t them by t h e p o s t - p a r t u m h o s p i t a l n u r s e s . I m p l i c a t i o n s f o r N u r s i n g P r a c t i c e The c o n c l u s i o n s o f t h i s s t u d y s u g g e s t a number o f i m p l i c a t i o n s f o r n u r s i n g p r a c t i c e : 1. The k n o w l e d g e o f a c c u l t u r a t i o n s h o u l d g u i d e t h e n u r s e s ' p r a c t i c e t h r o u g h o u t by c o n t r i b u t i n g t o n u r s i n g ' s k n o w l e d g e b a s e . W i t h i n h e r p r a c t i c e , t h e n u r s e i s g u i d e d i n h e r a s s e s s m e n t . The nee d i s s e e n t o a s s e s s f o r d i f f e r e n c e s and n o t assume t h a t t h e I n d o - C a n a d i a n p o p u l a t i o n i s a 128 homogenous g r o u p . I n d i v i d u a l c a r e must be p l a n n e d and i m p l e m e n t e d w i t h t h e u n d e r s t a n d i n g t h a t e a c h woman i s a u n i q u e i n d i v i d u a l . W i t h i n t h e a s s e s s m e n t p h a s e o f t h e n u r s i n g p r o c e s s i m p o r t a n t d a t a t o c o l l e c t w o u l d be r e l a t e d t o a c c u l t u r a t i o n . E x a m p l e s o f s p e c i f i c i n f o r m a t i o n t h e n u r s e w o u l d want t o c o l l e c t a r e : h i g h e s t l e v e l o f e d u c a t i o n a t t a i n e d ; l i v i n g i n a n u c l e a r v e r s u s e x t e n d e d f a m i l y ; c o m i n g f r o m a c i t y o r v i l l a g e i n t h e P u n j a b a n d , o c c u p a t i o n i n C a n a d a . T h i s i n f o r m a t i o n w o u l d s e r v e a s a g u i d e i n d e l i v e r i n g n u r s i n g c a r e b u t t h e n u r s e must be aware o f t h e p o t e n t i a l f o r d e v e l o p i n g s t e r e o t y p e s f r o m t h e d a t a t h a t w o u l d r e s u l t i n u n i f o r m c a r e t o a l l women w i t h t h e same c h a r a c t e r i s t i c s . The a s s e s s m e n t p h a s e must i n c l u d e i n f o r m a t i o n r e l a t e d t o t h e i n d i v i d u a l woman's b e l i e f s and v a l u e s s u r r o u n d i n g c h i l d b e a r i n g and t h e s e v i e w s must be t a k e n i n t o c o n s i d e r a t i o n i n t h e p l a n n i n g and i m p l e m e n t a t i o n o f c a r e . 2. The k n o w l e d g e t h a t t h e I n d o - C a n a d i a n women i m m i g r a n t s ' p e r c e p t i o n s o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s a r e l o c a t e d w i t h i n a b r o a d e r c o n t e x t o f m e a n i n g s a s s o c i a t e d w i t h t h e r e p r o d u c t i v e c y c l e , g i v e s t h e n u r s e g u i d a n c e t o a s s e s s what t h e l a r g e r c o n t e x t c o n s i s t s o f f o r t h i s c u l t u r a l g r o u p and what t h e m e a n i n g s a r e f o r t h e s p e c i f i c i n d i v i d u a l . C a r e s h o u l d be p l a n n e d w i t h i n t h e c o n t e x t o f t h e b r o a d e r m e a n i n g s b o t h f o r t h e g r o u p and t h e i n d i v i d u a l . 3. The i m p o r t a n c e o f t h e f a m i l y and h e a l t h c a r e p r o f e s s i o n a l s a t t h i s t i m e , and t h e i n f l u e n c i n g f a c t o r s o f 129 a u t h o r i t y , r e s p e c t , l a c k o f k n o w l e d g e and s h y n e s s have i m p l i c a t i o n s f o r t h e n u r s e t o p r o v i d e f a m i l y f o c u s e d n u r s i n g c a r e w i t h e m p h a s i s on t h e women and t h e f e m a l e e l d e r s . The f a m i l y must be a s s e s s e d f o r t h e a p p r o p r i a t e n e s s o f i n c l u d i n g f e m a l e e l d e r s a n d , where a p p r o p r i a t e , t h i s s h o u l d be p l a n n e d . An e x a m p l e o f t h i s w o u l d be f e m a l e e l d e r s and t h e women a t t e n d i n g p r e n a t a l c l a s s e s t o g e t h e r . The women must be a s s e s s e d as t o w h e t h e r t h e y a c t u a l l y l i s t e n t o t h e i r e l d e r s o r d o c t o r s i n m a t t e r s s u c h as d i e t and a c t i v i t y i n p r e g n a n c y a s t h i s has i m p l i c a t i o n s f o r a p p r o p r i a t e i n t e r v e n t i o n s . The women's p r i o r c h i l d b e a r i n g e x p e r i e n c e s s h o u l d be a s s e s s e d a n d , i f e m p h a s i s i s s t i l l p l a c e d on p r o d u c i n g a s o n , c a r e s h o u l d be p l a n n e d t o p r o v i d e s u p p o r t . S u p p o r t s h o u l d be m a i n t a i n e d i n t h e p o s t - p a r t u m p e r i o d w h i l e t h e woman i s a d j u s t i n g t o t h e b i r t h o f a d a u g h t e r and t h e p r o b a b i l i t y o f a n o t h e r p r e g n a n c y i n t h e n e a r f u t u r e . The n u r s e i s g i v e n d i r e c t i o n t o a s s e s s t h e women f o r t h e i r b a s e l i n e k n o w l e d g e o f r e p r o d u c t i o n and p l a n t o f i l l i n any i n f o r m a t i o n g a p s i n a c u l t u r a l l y a c c e p t a b l e manner. I t i s i m p o r t a n t t o a s s e s s t h e women ( a n d f e m a l e e l d e r s ) f o r t h e i r k n o w l e d g e and u n d e r s t a n d i n g o f h e a l t h c a r e p r o f e s s i o n a l s ' r o l e s and f u n c t i o n s s o t h a t t h e y become a w a r e , f o r e x a m p l e , o f p r e n a t a l c l a s s e s . D i r e c t i o n i s g i v e n f o r t h e n u r s e t o r e s p e c t t h e women's b e l i e f s and v a l u e s when p r o v i d i n g c a r e . The n u r s e must be aware t h a t i n t h i s c u l t u r a l g r o u p s h y n e s s p e r s i s t s d e s p i t e 130 the process of a c c u l t u r a t i o n . I f the woman's shyness i s overlooked by the nurse, she may m i s i n t e r p r e t the woman's behaviour and l o s e her rapport to t h i s c l i e n t . P r i v a c y and c o n f i d e n t i a l i t y w i t h i n t h i s p a r t i c u l a r group should be g i v e n a high p r i o r i t y when pl a n n i n g and implementing c a r e . 4. D i r e c t i o n i s g i v e n f o r h e a l t h care p r o f e s s i o n a l s to set up s p e c i a l progammes using nurses from d i f f e r e n t c u l t u r a l backgrounds. Health care p r o f e s s i o n a l s with s i m i l a r backgrounds to t h e i r c l i e n t s would be i n an e x c e l l e n t p o s i t i o n to provide the women with the p s y c h o - s o c i a l and p r a c t i c a l support t h a t i s now m i s s i n g from most of t h e i r r e l a t i o n s h i p s with h e a l t h care p r o f e s s i o n a l s . 5. In order to reduce p e r c e i v e d d i s c r i m i n a t i o n , the nursing p r o f e s s i o n must act on many l e v e l s . Nursing a d m i n i s t r a t o r s must be made aware of the p e r c e i v e d d i s c r i m i n a t i o n by c l i e n t s . Nursing p o l i c y must make e x p l i c i t that d i s c r i m i n a t i o n towards any i n d i v i d u a l , or groups of i n d i v i d u a l s , i s unacceptable. To t h i s end, i n - s e r v i c e e ducation progammes should be set up to help nurses develop self-knowledge. Through an awareness of s e l f the nurse w i l l come to know her own b e l i e f s and v a l u e s , and i n so doing, may f e e l more comfortable n e g o t i a t i n g with i n d i v i d u a l s h o l d i n g d i f f e r e n t b e l i e f s and v a l u e s . I m p l i c a t i o n s f o r Nursing Research The c o n c l u s i o n s of t h i s study suggest a number of 131 i m p l i c a t i o n s f o r n u r s i n g r e s e a r c h : 1. The p a r t i c i p a n t s v a r i e d i n t h e i r a b i l i t y t o s p e a k E n g l i s h . The r e s e a r c h e r r e l a t e d t h e s e v a r i a t i o n s t o t h e p r o c e s s o f a c c u l t u r a t i o n . T h i s r e l a t i o n s h i p h a s i m p l i c a t i o n s f o r r e p e a t i n g t h i s s t u d y w i t h a P u n j a b i s p e a k i n g r e s e a r c h e r . More r e s e a r c h must be done t o d e t e r m i n e i f a c c u l t u r a t i o n i n f a c t a c c o u n t s f o r t h e women's d i f f e r e n c e s i n t h e i r c h i l d b e a r i n g e x p e r i e n c e s , t h e nee d i s s e e n t h e r e f o r e f o r a c o m p a r a t i v e a n a l y s i s b e t w e e n two g r o u p s o f women, w i t h one g r o u p b e i n g f u r t h e r a l o n g i n t h e p r o c e s s o f a c c u l t u r a t i o n t h a n t h e o t h e r g r o u p . The two g r o u p s w o u l d t h e n be s t u d i e d t o s e e s i m i l a r i t i e s o r d i s s i m i l a r i t i e s o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s . 2. The f a c t o r s r e l a t e d t o t h e c h i l d b e a r i n g e x p e r i e n c e was n o t t h e f o c u s o f t h i s s t u d y . The need i s s e e n f o r a more i n d e p t h e x a m i n a t i o n o f a l l t h e f a c t o r s i n t h e s t u d y w h i c h seem t o a f f e c t t h e c h i l d b e a r i n g e x p e r i e n c e . 3. S e v e r a l q u e s t i o n s a r i s e f r o m t h e s u b j e c t s ' r e l a t i o n s h i p s w i t h t h e i r f a m i l i e s and w i t h h e a l t h c a r e p r o f e s s i o n a l s ; as t h e women c o n s u l t t h e h e a l t h c a r e p r o f e s s i o n a l s more o f t e n , do t h e y c o n s u l t t h e i r e l d e r s l e s s ? I f t h e y c o n s u l t them l e s s d o e s t h i s c a u s e f r i c t i o n ? What i s t h e women's k n o w l e d g e o f t h e i r own r e p r o d u c t i v e c y c l e ? What i n f o r m a t i o n a b o u t r e p r o d u c t i o n do t h e y a c t u a l l y i m p a r t t o t h e i r c h i l d r e n and how do t h e y p r o v i d e i t ? As t h e women d i d n o t t a l k a b o u t s h y n e s s i n r e l a t i o n t o h e a l t h c a r e p r o f e s s i o n a l s , i t w o u l d be i m p o r t a n t t o i n v e s t i g a t e t h i s a r e a 132 f u r t h e r . 4. I t i s i m p o r t a n t t o u n d e r s t a n d i n g r e a t e r d e p t h t h e r e l a t i o n s h i p b e t w e e n h e a l t h c a r e p r o f e s s i o n a l s and I n d o - C a n a d i a n i m m i g r a n t women. S t u d i e s s h o u l d be u n d e r t a k e n t o d e t e r m i n e why h e a l t h c a r e p r o f e s s i o n a l s a r e u s u a l l y n o t s e e n as s o u r c e s o f p s y c h o - s o c i a l s u p p o r t . I t i s i m p o r t a n t t o a s c e r t a i n i f and how n u r s e s c a n a l t e r t h e i r n u r s i n g c a r e i n o r d e r t o p r o v i d e t h e s u p p o r t d i r e c t l y o r t o f o s t e r i t s p r o v i s i o n by f a m i l y members. 5. T h i s s t u d y was c a r r i e d o u t i n one h o s p i t a l ; f u r t h e r s t u d i e s must be done i n s e v e r a l h o s p i t a l p o s t - p a r t u m w a r d s t o d e t e r m i n e i f d i s c r i m i n a t i o n e x i s t s e l s e w h e r e . I t w o u l d be i m p o r t a n t t o d e t e r m i n e i f d i s c r i m i n a t i o n i s p e r c e i v e d by t h e women a t any o t h e r t i m e i n t h e i r c h i l d b e a r i n g e x p e r i e n c e s . I f d i s c r i m i n a t o r y p r a c t i c e s by n u r s e s i s more, v i s i b l e i n t h e p o s t - p a r t u m t i m e i n h o s p i t a l , more r e s e a r c h i s n e c e s s a r y t o d e t e r m i n e why i t o c c u r s t h e n . I m p l i c a t i o n s f o r N u r s i n g E d u c a t i o n I n o r d e r t o f o s t e r s e l f - a w a r e n e s s and a c c e p t a n c e o f d i f f e r e n t b e l i e f and v a l u e s y s t e m s , n u r s i n g c u r r i c u l a must i n c l u d e a b r o a d k n o w l e d g e o f t h e s o c i a l s c i e n c e s . By i n t e g r a t i n g s o c i a l s c i e n c e c o n c e p t s i n t o t h e c u r r i c u l u m t h e n u r s e i s p r o v i d e d w i t h t h e i n f o r m a t i o n n e c e s s a r y t o move h e r n u r s i n g c a r e b e y o n d t h a t o f a t e c h n i c a l l y s k i l l e d i n d i v i d u a l t o a p r o f e s s i o n a l p r a c t i t i o n e r . 133 N u r s i n g c u r r i c u l a s h o u l d be d e v e l o p e d t h a t h e l p s t u d e n t s u n d e r s t a n d t h e e x p l a n a t o r y m o d e l o f I n d o - C a n a d i a n women i m m i g r a n t s d u r i n g t h e c h i l d b e a r i n g e x p e r i e n c e . The s t u d e n t s s h o u l d be e n c o u r a g e d t o e x p l o r e t h e i r own e x p l a n a t o r y m o d e l s and g i v e n t h e o p p o r t u n i t y t o compare and c o n t r a s t m o d e l s s o t h a t t h e y a r e aware o f t h e d i f f e r e n c e s and s i m i l a r i t i e s . I t i s i m p o r t a n t t h a t t h e c u r r i c u l a b u i l d i n o p p o r t u n i t i e s f o r s t u d e n t s t o c a r e f o r p e o p l e f r o m c u l t u r e s d i f f e r e n t f r o m t h e i r own d u r i n g t h e c h i l d b e a r i n g e x p e r i e n c e s o t h a t t h e y may i n t e g r a t e t h e i r k n o w l e d g e and l e a r n t o n e g o t i a t e b e t w e e n t h e i r own and t h e i r c l i e n t s ' e x p l a n a t o r y m o d e l s . D i r e c t i o n i s a l s o p r o v i d e d f o r t h e d e s i g n and i m p l e m e n t a t i o n o f o n g o i n g s t a f f d e v e l o p m e n t programmes i n t h e a r e a o f t r a n s - c u l t u r a l n u r s i n g . Summary o f C h a p t e r The f i n d i n g s o f t h i s s t u d y h a v e i m p l i c a t i o n s f o r n u r s i n g p r a c t i c e , r e s e a r c h and e d u c a t i o n . A l t h o u g h p r o v i d i n g a b e g i n n i n g , f u r t h e r s t u d y i n t o t h e I n d o - C a n a d i a n i m m i g r a n t s ' p e r c e p t i o n s o f t h e i r c h i l d b e a r i n g e x p e r i e n c e s i s n e e d e d i n o r d e r t o p l a n more e f f e c t i v e , r e l e v a n t c a r e . T h i s d i s t i n c t c u l t u r a l g r o u p e x p l a i n s t h e i r c h i l d b e a r i n g e x p e r i e n c e s i n a manner t h a t i s d i f f e r e n t f r o m t h e p r o f e s s i o n a l s ' e x p l a n a t o r y m o d e l . As h e a l t h c a r e p r o f e s s i o n a l s we must u n d e r s t a n d and t a k e t h e I n d o - C a n a d i a n women's e x p l a n a t o r y m o d e l i n t o a c c o u n t when p r o v i d i n g n u r s i n g c a r e . As one s t u d y p a r t i c i p a n t s a i d : My G o d s , we be human b e i n g s t o o r i g h t . We be t h e same r i g h t m o s t l y . I t n o t be f a i r r i g h t t h a t t h e y t h i n k we no g o o d s j u s t a s we be d i f f e r e n t i n some l i t t l e t h i n g s l i k e . Womens r e a l l y h ave b a b i e s t h e same e v e r y w h e r e r i g h t s and we need t h e same c a r e f o r o u r t e n d e r e m o t i o n s t h e n r i g h t ? You u n d e r s t a n d ? 135 REFERENCE L I S T A b o u d , F. & S k e r r y , S. ( 1 9 8 4 ) . The d e v e l o p m e n t o f e t h n i c a t t i t u d e s . J o u r n a l o f C r o s s - C u l t u r a l P s y c h o l o g y , 15 ( 1 ) , 3-35. Ames, M. & I n g l i s , J . ( 1 9 7 6 ) . T r a d i t i o n and c h a n g e i n B r i t i s h C o l u m b i a ' s S i k h f a m i l y l i f e i n K. I s h w a r a n , ( E d . ) , The C a n a d i a n f a m i l y . T o r o n t o : H o l t , R i n e h a r t , and W i n s t o n o f C a n a d a . A n d e r s o n , J . ( 1 9 8 1 ) . The e x p l o r a t i o n o f two d i s t i n c t i v e r e s e a r c h p a r a d i g m s and t h e i m p l i c a t i o n s f o r r e s e a r c h t r a i n i n g . A d d r e s s t o c o n f e r e n c e R e s e a r c h — A b a s e  f o r t h e f u t u r e ? S c o t l a n d : U n i v e r s i t y o f E d i n b u r g h . A r m s, S. ( 1 9 7 7 ) . I m m a c u l a t e d e c e p t i o n . B o s t o n : B a ntam B o o k s . A y r e s , B. ( 1 9 6 7 ) . P r e g n a n c y m a g i c : A s t u d y o f f o o d t a b o o s and s e x a v o i d a n c e s . I n C. F o r d , ( E d . ) , C r o s s - c u l t u r a l a p p r o a c h e s . New H a v e n , C o n n e c t i c u t : Human R e l a t i o n s h i p A r e a F i l e s . B e r r y , B. ( 1 9 8 0 ) . A c c u l t u r a t i o n a s v a r i e t i e s o f a d a p t i o n . I n A. P a d i l l o , ( E d . ) , A c c u l t u r a t i o n : T h e o r y , m o d e l s and  some new f i n d i n g s . B o u l d e r : W e s t v i e w P r e s s , pp. 9-25. B e r r y , B. & T i s c h l e r , H. ( 1 9 7 8 ) . Race and e t h n i c r e l a t i o n s . B o s t o n : H o u g h t o n , M i f f l i n Co. B o g d a n , R. & T a y l o r , S. J . ( 1 9 7 5 ) . I n t r o d u c t i o n t o  q u a l i t a t i v e r e s e a r c h m e t h o d s . T o r o n t o : J o h n W i l e y & S o n s . B r a d l e y , C. ( 1 9 7 8 ) . P e r i n a t a l h e a l t h c a r e f o r t h e c i t y . V a n c o u v e r p e r i n a t a l h e a l t h p r o j e c t . V a n c o u v e r : V a n c o u v e r H e a l t h D e p a r t m e n t . B r i t i s h C o l u m b i a G o v e r n m e n t . ( 1 9 8 1 ) . L i v e b i r t h s by w e i g h t  g r o u p s . V i c t o r i a : P r o v i n c e o f B.C. B r i t i s h C o l u m b i a G o v e r n m e n t . ( 1 9 8 2 ) . L i v e b i r t h s by w e i g h t  g r o u p s . V i c t o r i a : P r o v i n c e o f B.C. B r o w n , M. S. ( 1 9 7 6 ) . A c r o s s - c u l t u r a l l o o k a t p r e g n a n c y , l a b o u r and d e l i v e r y . J o u r n a l o f O b s t e t r i c and  G y n e c o l o g i c a l N u r s i n g , S e p t e m b e r , 35-38. Cameron, J . ( 1 9 7 9 ) . Y e a r l o n g c l a s s e s f o r c o u p l e s b e c o m i n g p a r e n t s . M a t e r n a l C h i l d N u r s i n g , November/December, 358-362. 136 C a r t e r - J e s s o p , L. ( 1 9 8 1 ) . P r o m o t i n g m a t e r n a l a t t a c h m e n t t h r o u g h p r e n a t a l i n t e r v e n t i o n . M a t e r n a l C h i l d  N u r s i n g , M a r c h / A p r i l , 1 0 7 - 1 1 2 . C h a n c e , N. A. ( 1 9 6 5 ) . A c c u l t u r a t i o n , s e l f - i d e n t i f i c a t i o n , and p e r s o n a l i t y a d j u s t m e n t . A m e r i c a n A n t h r o p o l o g i s t , 6 7 , 3 7 2 - 393. C h r i s m a n , N. J . ( 1 9 7 7 ) . The h e a l t h s e e k i n g p r o c e s s : An a p p r o a c h t o t h e n a t u r a l h i s t o r y o f i l l n e s s . C u l t u r e ,  M e d i c i n e and P s y c h i a t r y , 1, 3 51-357. C i c o u r e l , A.V. ( 1 9 6 4 ) . M e t h o d and m e a s u r e m e n t i n s o c i o l o g y . New Y o r k : F r e e P r e s s . C l a r k , A. L. & A f f o n s o , D. D. ( 1 9 7 9 ) . C h i l d b e a r i n g : A  n u r s i n g p e r s p e c t i v e . P h i l a d e l p h i a : F.A. D a v i s . D a v i e s , M. & Y o s h i d a , M. ( 1 9 8 1 ) . A m o d e l f o r c u l t u r a l a s s e s s m e n t o f t h e new i m m i g r a n t . C a n a d i a n N u r s e , 3^  ( 1 ) , 2 2 - 2 3 . D i n i t z , S., D y n e s , R. & C l a r k , A. ( 1 9 5 4 ) . P r e f e r e n c e s f o r m a l e o r f e m a l e c h i l d r e n : T r a d i t i o n a l o r a f f e c t i o n a l ? M a r r i a g e and F a m i l y L i v i n g . 16 , 1 2 8-130. E i s e n s t a d t , S. ( 1 9 7 0 ) . The p r o c e s s o f a b s o r b i n g new i m m i g r a n t s i n I s r a e l . I n C. A d l e r , S. E i s e n s t a d t , & R. Y o s e f , ( E d s . ) , I n t e g r a t i o n and d e v e l o p m e n t i n  I s r a e l . J e r u s a l e m : I s r a e l U n i v e r s i t y P r e s s . E i t z e n , S. ( 1 9 7 3 ) . Two M i n o r i t i e s : The Jews o f P o l a n d and t h e C h i n e s e o f t h e P h i l i p p i n e s . I n D. G e l f a n d , & R. L e e , ( E d s . ) , E t h n i c c o n f l i c t and p o w e r : A  c r o s s - n a t i o n a l p e r s p e c t i v e . T o r o n t o : J o h n W i l e y and S o n s . F a b r e g a , H. ( 1 9 7 5 ) . The n e e d f o r an e t h n o m e d i c a l s c i e n c e . S c i e n c e , 19, S e p t e m b e r , 9 6 9 - 9 7 5 . F i l s t e a d , W.J. ( 1 9 7 0 ) . I n t r o d u c t i o n . I n W.J. F i l s t e a d ( E d . ) , Q u a l i t a t i v e m e t h o d o l o g y : F i r s t h a n d i n v o l v e m e n t w i t h  t h e s o c i a l w o r l d . C h i c a g o : Markham, 1-11. F r i e d m a n , G. ( 1 9 7 3 ) . Jews as t h e p r o d u c t o f h i s t o r y . I n D. G e l f a n d , & R. L e e , ( E d s . ) E t h n i c c o n f l i c t and  p o w e r : A c r o s s - n a t i o n a l p e r s p e c t i v e . T o r o n t o : J o h n W i l e y and S o n s . G i d e o n , H. ( 1 9 6 2 ) . A baby i s b o r n i n t h e P u n j a b , A m e r i c a n  A n t h r o p o l o g i s t . 6 4 , 1220-1234. G i d e o n , H., G o r d o n , J . & Wyon, J . ( 1 9 6 5 ) . C h i l d b i r t h i n 137 r u r a l P u n j a b , I n d i a . A m e r i c a n J o u r n a l o f O b s t e t r i c s  and G y n e c o l o g y 93 ( 5 ) , 7 3 4 - 7 4 1 . G i o r g i , A. ( 1 9 7 5 a ) . An a p p l i c a t i o n o f p h e n o m e n o l o g i c a l method i n p s y c h o l o g y . I n A. G i o r g i , C. F i s c h e r , & E. M u r r a y ( E d s . ) , Duquesne s t u d i e s i n p h e n o m e n o l o g i c a l p s y c h o l o g y . Volume I I , P i t t s b u r g h : D u s q u e s n e U n i v e r s i t y P r e s s , pp. 8 2 - 1 0 3 . G i o r g i , A. ( 1 9 7 5 b ) . C o n v e r g e n c e and d i v e r g e n c e o f q u a l i t a t i v e and q u a n t i t a t i v e m e t h o d s i n p s y c h o l o g y . I n A. G i o r g i , C. F i s c h e r , & E. M u r r a y ( E d s . ) , Duquesne s t u d i e s i n p h e n o m e n o l o g i c a l p s y c h o l o g y .  Volume I I , P i t t s b u r g h : Duquesne U n i v e r s i t y P r e s s , pp. 7 2 - 7 9 . H a n d l i n , 0. ( 1 9 4 1 ) . B o s t o n ' s I m m i g r a n t s : A s t u d y o f  a c c u l t u r a t i o n . C a m b r i d g e : H a r v a r d U n i v e r s i t y P r e s s . H annan, M. ( 1 9 7 9 ) . The d y n a m i c s o f e t h n i c b o u n d a r i e s i n modern s t a t e s . I n J . M a y e r , & M. Hannan, ( E d s . ) , N a t i o n a l d e v e l o p m e n t and t h e w o r l d s y s t e m . C h i c a g o : C h i c a g o U n i v e r s i t y P r e s s . H e i s s , J . ( 1 9 6 9 ) . F a c t o r s r e l a t e d t o i m m i g r a t i o n a s s i m i l a t i o n : P r e - m i g r a t i o n t r a i t s . S o c i a l F o r c e s . 4, 4 2 2 - 4 2 8 . H e n d e r s o n , V. ( 1 9 6 7 ) . The n a t u r e o f n u r s i n g . New Y o r k : The M a c m i l l a n Company. J o h n s o n , S., Snow, L. & Mayhew, H. ( 1 9 7 8 ) . L i m i t e d p a t i e n t k n o w l e d g e as a r e p r o d u c t i v e r i s k f a c t o r . The J o u r n a l  o f F a m i l y P r a c t i c e , £ ( 4 ) , 8 5 5 - 8 6 2 . K e n d a l l , P. ( 1 9 8 1 ) . V a n c o u v e r , V a n c o u v e r H e a l t h D e p a r t m e n t , U n p u b l i s h e d l e t t e r . K i t z i n g e r , S. ( 1 9 7 7 ) . I m m i g r a n t women i n c h i l d b i r t h — a n a n t h r o p o l o g i s t ' s v i e w . N u r s i n g M i r r o r , 19. K i t z i n g e r , S. ( 1 9 7 8 ) . The e x p e r i e n c e o f c h i l d b i r t h . New Y o r k : P e n g u i n B o o k s . K l e i n m a n , A. (.1977). L e s s o n s f r o m a c l i n i c a l a p p r o a c h t o m e d i c a l a n t h r o p o l o g i c r e s e a r c h . M e d i c a l A n t h r o p o l o g y  N e w s l e t t e r , 8_ ( 4 ) , 1 1 - 1 5 . K l e i n m a n , A. ( 1 9 7 8 ) . C o n c e p t s and a m o d e l f o r c o m p a r i s o n o f m e d i c a l s y s t e m s as c u l t u r a l s y s t e m s . S o c i a l S c i e n c e  and M e d i c i n e , 1 2 , 8 5 - 9 3 . K l e i n m a n , A. ( 1 9 8 0 ) . P a t i e n t s and h e a l e r s i n t h e c o n t e x t o f 138 c u l t u r e . B e r k l e y : U n i v e r s i t y o f C a l i f o r n i a P r e s s . K l e i n m a n , A., E i s e n b e r g , L., & Good, B. ( 1 9 7 8 ) . C u l t u r e , i l l n e s s and c a r e . A n n a l s o f I n t e r n a l M e d i c i n e , 8 8 , 251-258. K n a a c k , P. P h e n o m e n o l o g i c a l r e s e a r c h . ( 1 9 8 4 ) . The W e s t e r n  J o u r n a l o f N u r s i n g R e s e a r c h , 6^  ( 1 ) , 107-114. K o r t e , D. & S c a e r , R. ( 1 9 8 4 ) . C h i l d b i r t h . New Y o r k : Bantam B o o k s . L i p o w s k i , Z. J . ( 1 9 6 9 ) . P s y c h o s o c i a l a s p e c t s o f d i s e a s e . A n n a l s o f I n t e r n a l M e d i c i n e , 71 ( 6 ) , 1 1 9 7-1206. Luckmann, J . & S o r e n s o n , K. ( 1 9 7 4 ) . M e d i c a l - s u r g i c a l  n u r s i n g — a p s y c h o p h y s i o l o g i c a p p r o a c h . T o r o n t o : W.B. S a u n d e r s Co., 3-86. L y t l e , N. ( E d . ) , ( 1 9 7 7 ) . N u r s i n g o f women i n t h e age o f  l i b e r a t i o n . Dubuque, I o w a : Wm. C. Brawn Co. P u b l i s h e r s . M a c C l a i n , C. ( 1 9 8 2 ) . Toward a c o m p a r a t i v e f r a m e w o r k f o r t h e s t u d y o f c h i l d b i r t h : A r e v i e w o f t h e l i t e r a t u r e . I n M. K a y , ( E d . ) , The a n t h r o p o l o g y o f human b i r t h . P h i l a d e l p h i a : F.A. D a v i s Co. M c K i n l a y ( 1 9 7 2 ) . The s i c k r o l e — i l l n e s s and p r e g n a n c y . S o c i a l S c i e n c e and M e d i c i n e . 6, 561-5 7 2 . M a l i n o w s k i , B. ( 1 9 4 8 ) . M a g i c , s c i e n c e and r e l i g i o n a n d o t h e r  e s s a y s . B o s t o n : B e a c o n P r e s s . M e r c e r , R., H a c k l e y , K. & B o s t r o m , A. ( 1 9 8 3 ) . R e l a t i o n s h i p o f p s y c h o s o c i a l and p e r i n a t a l v a r i a b l e s t o p e r c e p t i o n o f c h i l d b i r t h . N u r s i n g R e s e a r c h , 32, ( 4 ) , 202-207. M u e c k e , M. ( 1 9 7 6 ) . H e a l t h c a r e s y s t e m s as s o c i a l i z i n g a g e n t s : C h i l d b e a r i n g t h e N o r t h T h a i and w e s t e r n w ays. S o c i a l S c i e n c e a n d M e d i c i n e , 10 , 3 7 7 - 3 8 3 . Newman, L. ( 1 9 7 2 ) . The a n t h r o p o l o g y o f b i r t h . S o c i o l o g i c a l  Symposium. 8, 51 - 6 3 . N e w t o n , N. ( 1 9 7 9 ) . B r e a s t f e e d i n g . I n J . W i l l i a m s , ( E d . ) , P s y c h o l o g y o f women. New Y o r k : W.W. N o r t o n & Co. N i c h t e r , M. ( 1 9 8 1 ) . I d i o m s o f d i s t r e s s : A l t e r n a t i v e s i n t h e e x p r e s s i o n o f p s y c h o s o c i a l d i s t r e s s . A c a s e s t u d y f r o m S o u t h I n d i a . C u l t u r e , M e d i c i n e a n d P s y c h i a t r y , 5 ( 4 ) , 379-408. 139 N i e h o f f , A. & M e i s t e r , N. ( 1 9 7 2 ) . The c u l t u r a l c h a r a c t e r i s t i c s o f b r e a s t f e e d i n g . E n v i r o n m e n t C h i l d  H e a l t h , 3, 16-20. N i g h t i n g a l e , F. ( 1 9 6 9 ) . N o t e s on n u r s i n g . T o r o n t o : G e n e r a l P u b l i s h i n g Company L i m i t e d . O a k l e y , A. ( 1 9 7 7 ) . C r o s s - c u l t u r a l p r a c t i c e s . I n T. C h a r d , & M. R i c h a r d s , ( E d s . ) , B e n e f i t s and h a z a r d s o f t h e new  o b s t e t r i c s . P h i l a d e l p h i a : J . B . L i p p i n c o t t . O i l e r , C. ( 1 9 8 2 ) . The p h e n o m e n o l o g i c a l a p p r o a c h i n n u r s i n g r e s e a r c h . N u r s i n g R e s e a r c h , 3 1 , 1 7 8 - 1 8 1 . Omery, A. ( 1 9 8 3 ) . P h e n o m e n o l o g y : A m e t h o d f o r n u r s i n g r e s e a r c h . A d v a n c e s i n N u r s i n g S c i e n c e , 5_ ( 2 ) , 4 9 - 6 4 . P a r k e r , R. & Neumann, A. ( 1 9 7 9 ) . S e l f - c a r e i n r u r a l a r e a s o f I n d i a and N e p a l . C u l t u r e , M e d i c i n e a n d P s y c h i a t r y , 3j_ 3-27. P o r t e s , A. ( 1 9 8 4 ) . The r i s e o f e t h n i c i t y : D e t e r m i n a n t s o f e t h n i c p e r c e p t i o n s among Cuban e x i l e s i n M i a m i . A m e r i c a n S o c i o l o g i c a l R e v i e w , 49 ( 6 ) , 3 83-397. R a d c l i f f - B r o w n , A. ( 1 9 5 2 ) . S t r u c t u r e a n d f u n c t i o n i n  p r i m i t i v e s o c i e t y . L o n d o n : Cohen and W e s t , L t d . R a g i n , C. ( 1 9 7 9 ) . E t h n i c p o l i t i c a l m o b i l i z a t i o n : The W e l s h c a s e . A m e r i c a n S o c i o l o g i c a l R e v i e w , 4 2 , 4 3 8 - 4 5 0 . R e d f i e l d , R., L i n t o n , R. & H e r s k o v i t s , M. J . ( 1 9 3 6 ) . Memorandum on t h e s t u d y o f a c c u l t u r a t i o n . A m e r i c a n  A n t h r o p o l o g y , 38, 149-152. R e e d e r , S. J . , M a s t r o i a n n i , L. & M a r t i n , L. ( 1 9 8 0 ) . M a t e r n i t y n u r s i n g . T o r o n t o : J . B . L i p p i n c o t t . R i s t , R. C. ( 1 9 7 9 ) . On t h e means o f k n o w i n g : Q u a l i t a t i v e r e s e a r c h i n e d u c a t i o n . New Y o r k U n i v e r s i t y  E d u c a t i o n Q u a r t e r l y , 1 7 - 2 1 . R u b i n , R. ( 1 9 6 7 ) . A t t a i n m e n t o f t h e m o t h e r r o l e . P a r t I : P r o c e s s e s . N u r s i n g R e s e a r c h , 2 3 7 - 2 4 5 . S a l v e n d y , J . ( 1 9 8 3 ) . The m e n t a l h e a l t h o f i m m i g r a n t s : A r e a s s e s s m e n t o f c o n c e p t s . C a n a d i a n M e n t a l H e a l t h , M a r c h , 9-12. Shaw, N. ( 1 9 7 4 ) . F o r c e d l a b o u r : M a t e r n i t y c a r e i n t h e U n i t e d  S t a t e s . New Y o r k : Pergamon P r e s s . 140 S i d d i q u e , C. ( 1 9 7 7 ) . S t r u c t u r a l s e p a r a t i o n and f a m i l y c h a n g e : An e x p l o r a t o r y s t u d y o f t h e i m m i g r a n t I n d i a n and P a k i s t a n i Community o f S a s k a t o o n , C a n a d a . I n t e r n a t i o n a l R e v i e w o f Mo d e r n S o c i o l o g y , 7, 13-34. S i m p s o n , G e o r g e E. & Y i n g e r , J . M. ( 1 9 7 2 ) . R a c i a l and  c u l t u r a l m i n o r i t i e s : An a n a l y s i s o f p r e j u d i c e and  d i s c r i m i n a t i o n . New Y o r k : H a r p e r & Row. Snow, L., J o h n s o n , S., & Mayhew, H. ( 1 9 7 8 ) . The b e h a v i o u r a l i m p l i c a t i o n s o f some o l d w i v e s t a l e s . O b s t e t r i c s &  G y n e c o l o g y , 5 1 , 7 2 7 - 7 2 9 . S o c i a l S c i e n c e R e s e a r c h C o u n c i l Summer S e m i n a r . ( 1 9 5 4 ) . A c c u l t u r a t i o n : An e x p l o r a t o r y f o r m u l a t i o n . A m e r i c a n A n t h r o p o l o g y , 5 6 , 973 - 1 0 0 2 . S t a t i s t i c s C a n a d a . ( 1 9 7 1 ) . C e n s u s o f C a n a d a . O t t a w a : G o v e r n m e n t o f C a n a d a . S t a t i s t i c s C a n a d a . ( 1 9 7 6 ) . C e n s u s o f C a n a d a . O t t a w a : G o v e r n m e n t o f C a n a d a . S t a t i s t i c s C a n a d a . (1981) . C e n s u s o f C a n a d a . O t t a w a : G o v e r n m e n t o f C a n a d a . S u n d e e n , S. J . , S t u a r t , G. ( 1 9 8 1 ) . N u r s e - c l i e n t W., R a n k i n , E. i n t e r a c t i o n D. & C o h e n , S. A. ( 2 n d e d . ) , S t . L o u i s : Mosby. T r i p p - R e i m e r , T., B r i n k , P. & S a u n d e r s , J . ( 1 9 8 4 ) . C u l t u r a l a s s e s s m e n t : C o n t e n t and p r o c e s s . N u r s i n g O u t l o o k ,  3 2 , 7 8 - 8 2 . V a n c o u v e r I s l a n d H e a l t h D e p a r t m e n t . ( 1 9 8 1 ) . D e s c r i p t i o n o f  p r e n a t a l p r o j e c t . V a n c o u v e r I s l a n d : P r o v i n c i a l H e a l t h D e p a r t m e n t . , U n p u b l i s h e d r e p o r t . V a n d e r E n d e , G. ( 1 9 8 0 ) . Community o u t r e a c h p r o j e c t . W i l l i a m s L a k e : P r o v i n c i a l H e a l t h D e p a r t m e n t . Wagner, H. R. I n A. S c h u t z . ( 1 9 7 0 ) . On p h e n o m e n o l o g y and s o c i a l r e l a t i o n s . S e l e c t e d w r i t i n g s . C h i c a g o : U n i v e r s i t y o f C h i c a g o P r e s s . W a k i l , S., S i d d i q u e , C M . & W a k i l , F. ( 1 9 8 1 ) . B e t w e e n two c u l t u r e s : A s t u d y o f s o c i a l i z a t i o n o f c h i l d r e n o f i m m i g r a n t s . J o u r n a l o f M a r r i a g e and t h e F a m i l y , 1 0, 9 2 9 - 9 4 0 . 141 W a r n e r , W. & S r o l e , L. ( 1 9 4 5 ) . The s o c i a l s y t e m s o f A m e r i c a n  e t h n i c g r o u p s . New H a v e n : Y a l e U n i v e r s i t y P r e s s . W i l l i a m s o n , N. ( 1 9 7 9 ) . Sex p r e f e r e n c e s , s e x c o n t r o l and t h e s t a t u s o f women. I n J . W i l l i a m s ( E d . ) , P s y c h o l o g y o f  Women. T o r o n t o : G e o r g e J . McLeod L i m i t e d . Y u , L. ( 1 9 8 4 ) . A c c u l t u r a t i o n and s t r e s s w i t h i n C h i n e s e A m e r i c a n f a m i l i e s . J o u r n a l o f C o m p a r a t i v e F a m i l y  S t u d i e s . 15 ( 1 , ) 7 7 - 9 4 . 142 APPENDICES 143 A p p e n d i x A I n f o r m a t i o n and C o n s e n t t o C o n t a c t Form My name i s H a l i n a S t r u s e r . I am a r e g i s t e r e d n u r s e i n v o l v e d i n g r a d u a t e work a t t h e S c h o o l o f N u r s i n g , U n i v e r s i t y o f B r i t i s h C o l u m b i a . I am i n t e r e s t e d i n t h e e x p e r i e n c e o f p r e g n a n c y , l a b o u r a n d d e l i v e r y f o r E a s t I n d i a n women i n C a n a d a . The p u r p o s e o f my s t u d y i s t o l e a r n how y o u v i e w y o u r p r e g n a n c y , l a b o u r and d e l i v e r y and what i s i m p o r t a n t t o y o u a t t h i s t i m e . I am i n v i t i n g y o u t o p a r t i c i p a t e i n t h i s s t u d y a n d , i f y o u a g r e e , I w o u l d l i k e t o i n t e r v i e w y o u i n y o u r home t o s h a r e y o u r v i e w s w i t h me. E a c h i n t e r v i e w w i l l l a s t a p p r o x i m a t e l y one h o u r . I w i l l a s k t o i n t e r v i e w y o u more t h a n o n c e , t o a l l o w b o t h o f us t o d i s c u s s y o u r v i e w s i n g r e a t e r d e t a i l , b u t y o u w i l l d e c i d e i f more t h a n one i n t e r v i e w i s t o t a k e p l a c e . The o n l y p e o p l e I w i l l d i s c u s s t h e i n t e r v i e w s w i t h w i l l be my t e a c h e r s a t t h e u n i v e r s i t y . Y o u r name w i l l n o t be i d e n t i f i e d i n any c o n v e r s a t i o n o r w r i t t e n r e p o r t s . Y o u r d e c i s i o n t o p a r t i c i p a t e o r n o t i n t h i s s t u d y , WILL NOT AFFECT ANY CARE YOU RECEIVE FROM THE PUBLIC HEALTH UNIT. I f y o u d e c i d e t o p a r t i c i p a t e i n t h i s s t u d y , YOU MAY WITHDRAW AT ANY TIME WITHOUT ANY CONSEQUENCES TO YOUR FUTURE CARE. I n f o r m a t i o n g a t h e r e d i n t h i s s t u d y w i l l h e l p me l e a r n more a b o u t p r e g n a n c y , l a b o u r and d e l i v e r y f o r E a s t I n d i a n women i n C a n a d a . T h i s k n o w l e d g e w i l l be g i v e n t o o t h e r 144 h e a l t h c a r e w o r k e r s c a r i n g f o r E a s t I n d i a n f a m i l i e s . I f y o u have any q u e s t i o n s a b o u t t h i s s t u d y , i f y o u w o u l d l i k e a ny more i n f o r m a t i o n , o r i f y o u a g r e e t o p a r t i c i p a t e , p l e a s e a l l o w y o u r c o m m u n i t y h e a l t h n u r s e t o g i v e me y o u r name and phone number and I w i l l c o n t a c t y o u by ph o n e . Y o u r s t r u l y , H a l i n a S t r u s e r I a g r e e t o a l l o w t h e co m m u n i t y h e a l t h n u r s e t o g i v e my name and phone number t o H a l i n a S t r u s e r . D a t e : S i g n a t u r e : I a c k n o w l e d g e r e c e i p t o f a c o p y o f t h i s i n f o r m a t i o n and c o n s e n t t o c o n t a c t f o r m . 145 A p p e n d i x B C o n s e n t Form I have t a l k e d w i t h H a l i n a S t r u s e r a b o u t h e r r e s e a r c h s t u d y and I a g r e e t o p a r t i c i p a t e i n i t . I u n d e r s t a n d t h a t H a l i n a S t r u s e r w i l l d i s c u s s t h e i n t e r v i e w s o n l y w i t h h e r t e a c h e r s a t t h e u n i v e r s i t y a n d t h a t my name w i l l n o t be i d e n t i f i e d i n any c o n v e r s a t i o n o r w r i t t e n r e p o r t . I f u r t h e r u n d e r s t a n d t h a t my d e c i s i o n t o p a r t i c i p a t e o r n o t i n t h i s s t u d y , WILL NOT AFFECT ANY CARE I RECEIVE FROM THE PUBLIC  HEALTH UNIT and I MAY WITHDRAW f r o m t h i s s t u d y a t any t i m e WITHOUT ANY CONSEQUENCE TO MY FUTURE CARE. D a t e : S i g n a t u r e : I a c k n o w l e d g e r e c e i p t o f a c o p y o f t h i s c o n s e n t f o r m . S i g n a t u r e : A p p e n d i x C Sample Q u e s t i o n s f o r I n i t i a l I n t e r v i e w 146 1. P l e a s e d e s c r i b e y o u r p r e g n a n c y ( l a b o u r , d e l i v e r y ) . What s p e c i a l t h i n g s d i d y o u do a t t h i s t i m e ? What s p e c i a l t h i n g s were y o u n o t a l l o w e d t o do? ( e . g . What f o o d s d i d y o u e a t ? What d i d t h e s e f o o d s do f o r y o u ? ) 2. How was y o u r e x p e r i e n c e d i f f e r e n t f r o m what y o u may have e x p e r i e n c e d i n I n d i a ? How was i t t h e same? 3. Would y o u have p r e f e r r e d t o h a v e had y o u r b a b y i n I n d i a o r i n Canada? Why? 4. Who g a v e y o u i n f o r m a t i o n on p r e g n a n c y ( l a b o u r , d e l i v e r y ) ? 5. D i d t h i s i n f o r m a t i o n come f r o m members o f y o u r c o m m u n i t y ? From o u t s i d e y o u r c o m m u n i t y ? 6. Who was w i t h y o u d u r i n g l a b o u r and d e l i v e r y ? 7. Who w o u l d y o u l i k e t o h a v e b e e n w i t h y o u ? 8. A f t e r t h e b a b y was b o r n , c a n y o u t e l l me a b o u t y o u r h o s p i t a l s t a y ? ( e . g . h o s p i t a l r o u t i n e s , t i m e s p e n t w i t h b a b y ; t i m e w i t h f a m i l y ; p e r c e i v e d a t t i t u d e s o f h o s p i t a l s t a f f ; h o s p i t a l f o o d ) . How was t h i s d i f f e r e n t f r o m what y o u w o u l d have e x p e r i e n c e d i n I n d i a ? 9. What s u g g e s t i o n s w o u l d y o u h a v e f o r o t h e r E a s t I n d i a n i m m i g r a n t women h a v i n g t h e i r b a b i e s i n Canada? A p p e n d i x D 147 D e m o g r a p h i c I n f o r m a t i o n C o d e: Husband W i f e : D a t e o f B i r t h ( Y e a r ) P l a c e o f B i r t h Y e a r o f I m m i g r a t i o n t o Canada Y e a r o f l e a v i n g I n d i a Has s u b j e c t r e t u r n e d t o I n d i a n s i n c e e m i g r a t i o n ? I f y e s , when? F o r how l o n g ? I f s u b j e c t h a s l i v e d i n o t h e r c o u n t r i e s o r p r o v i n c e s p r i o r t o B.C., p l e a s e l i s t w i t h d a t e s and l e n g t h o f s t a y : Number o f y e a r s o f s c h o o l i n g i n I n d i a Number o f y e a r s and p l a c e o f any o t h e r s c h o o l i n g H i g h e s t l e v e l o f e d u c a t i o n a t t a i n e d i n I n d i a H i g h e s t l e v e l a t t a i n e d i n any o t h e r c o u n t r y O c c u p a t i o n a l P r e p a r a t i o n P r e s e n t O c c u p a t i o n H o u r s o f Work Number o f y e a r s o f m a r r i a g e M a r r i a g e a r r a n g e d ? Number o f c h i l d r e n _ B i r t h d a t e s and p l a c e s o f b i r t h Number o f p e o p l e l i v i n g i n h o u s e h o l d and r e l a t i o n s h i p t o s u b j e c t I n t e r v i e w number: 1 2 3 4 I n t e r v i e w d a t e s : Who was p r e s e n t a t e a c h i n t e r v i e w ? P l e a s e l i s t 

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