Abstract: Providing prenatal care to the Hmong can be a challenge for the Advanced Practice Nurse. Although some Hmong have become acclimated to Western medicine, others may not understand Western preventative medicine, health promotion or prenatal care. Traditional cultural beliefs and socioeconomic status may contribute to the barriers a practitioner faces when providing prenatal care to a Hmong client. Practitioners must assess each client and identify barriers. Integrating cultural beliefs and Western medicine practices can then foster prenatal care.
Key Words: Hmong, Prenatal Care and the Hmong, Barriers to Prenatal Care
Since the end of the Vietnam War, over 1,000,000 Hmong refugees have relocated to the United States. Many refugees settled on the West Coast or in the Midwest (garrett, Shadick, Schilling, Spencer, Del Rosario, Moua, &v Vang, 1998; Jumbunathan & Stewart, 1995). A large number of Hmong continue to practice traditional customs. These Hmong not only want to help maintain their culture, but the advanced technology and medical practice of America may be overwhelming and unacceptable to some. However, others have assimilated Western ideas and practices (Barrett et al., 1998; Bjorkman, 1985; Mattson, 1995; Smith, 1997b; Walters, Rap & Petracchi, 1992). There are even variations of practices and beliefs among family members. Hmong elders often maintain traditional Hmong beliefs, but their children may acculturate Western practices. The practitioner must acknowledge these variations of cultural practices when providing prenatal care.
The Hmong client does not always understand preventative medicine, health promotion or prenatal care (Walters, Rap & Petracchi, 1992). Some Hmong have expressed a desire to receive health care similar to American care. However, despite these desires, many Hmong remain under-served by the Western medicine system and do not receive adequate prenatal care. This quandary exists not only because of conflicting beliefs between two cultures, but also because the practitioner and the Hmong client lack knowledge about each other (Fallen 1985; Gervais, 1996). Advanced practice nurses can learn about the cultures they serve and tailor prenatal care according to the needs of the client.
NEEDS OF HMONG CLIENTS
Practitioners must be clear on what the needs of their clients are. In the early 1980's, there was some concern that the Hmong had high levels of infant mortality. However, research indicated there was a higher incidence of low birth weights among whites compared to Hmong. Hmong also had a lower incidence of gestational diabetes, eclampsia, hypertension, cesarean sections, dystocia, failure to progress and cephalopelvic disproportion (Fallen 1985, 1992; Helsel, Petitti & Kunstadter, 1992). The possibility exists that even though the Hmong were under served by Western medicine their own self-- care prenatal practices resulted in healthy babies. Nevertheless, Hmong have a right to obtain adequate Western prenatal care.
The prenatal needs of Hmong have been compared to those of low socioeconomic status (Barrett et al., 1998; Helsel et al., 1992; Smith, 1997a). Hmong routinely have large families, lower income and less education. Socioeconomic status may have a direct impact on the utilization of prenatal care. Overcrowding and lack of income increases the risk for poor nutrition and illness. The Hmong with low socioeconomic status may also lack the conveniences of transportation and childcare (Mattson, 1995; Smith, 1997a; Sword, 1999).
BARRIERS TO PRENATAL CARE
There are a number of barriers when providing prenatal care to the Hmong. These barriers are not all due to cultural beliefs. Some are related to socio-- economic status, and some are related to lack of knowledge. Prior to coming to America, Hmong did not receive structured prenatal care. For many Hmong in the United States, routine prenatal care was not established until the second or third trimester. …