Cultural dimensions in obstetrics gynecology and neonatology.

Both family planning and obstetrics are becoming less restrictive and women have more choice in their care and treatment than they do in any other area of medicine. Whereas women are given greater freedom they are not necessarily given sufficient information particularly within their given individual and cultural contexts to appropriately exercise that freedom. Cases in point are contraceptive sterilization and marijuana use during pregnancy. These instances illustrate contrasting problems: the first is assessing the psychosocial consequences of a surgical intervention; and the second is assessing the need for intervention in regard to a widespread personal practice. Despite the volume of research on longterm physical and psychosocial consequences of tubal ligation few strong conclusions can be drawn about the impact of this procedure. To study the psychosocial and physical consequences of tubal sterilization a controlled prospective study was initiated in September 1980. The study group included 317 women scheduled for tubal sterilization. Group 1 included 244 women who have completed childbearing but have no plans for tubal ligation or vasectomy for their partners for at least 12 months and are relying on temporary contraceptive methods. Control group 2 consisted of 167 wives of vasectomy patients. Group 1 was employed primarily to control for the effect of the sterilization decision on psychosocial outcomes. There were significant intergroup differences in preoperative ambivalence. Women who had undergone tubal ligations were significantly more certain and comfortable with their decision to terminate childbearing than were the wives of men who have undergone vasectomy. The only variables which could explain these differences in ambivalence concern differential spousal roles in the decision making process. Analysis of the preopertive data indicate the importance of counseling both partners and selection of sterilization by the partner who wants to end childbearing most. By carefully studying women who smoke marijuana while pregnant and subsequently working with pediatricians who will follow up their children anthropologists can help determine the effects of inutero exposure to the substance.