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Introduction

Bhutanese immigrants are the first poor Hindus to arrive in the United States as refugees in large numbers, and health care providers are often not familiar with Bhutanese beliefs and attitudes toward contraception. The objectives of this qualitative study were to explore and identify Bhutanese contraceptive beliefs and practices to facilitate provision of culturally sensitive contraceptive services.

Background

All contraceptive methods, except abortion and emergency contraception, are considered acceptable to Hindi people. Sex outside marriage is prohibited in this culture, and sexual health is often considered a taboo topic. Women are generally not educated about contraceptive options until after the birth of their first child; however, contraception and family planning services were widely used and accepted in Bhutanese refugee camps.

Methods

Individual interviews were conducted with 14 Bhutanese women in the Nepali language. The interviews were audio recorded then later translated and transcribed verbatim. The interviews were evaluated for common themes and quotes.

Results

The interviews revealed contraception is a private matter for Bhutanese women. They are comfortable talking about pregnancy and other health issues rather than contraception. However, contraception is known about and accepted in Bhutanese culture. There are no religious prohibitions regarding contraception. The medroxyprogesterone acetate injection was the most common method of contraception. None of the Bhutanese women were using long-term contraception such as intrauterine devices. Women were hesitant to use contraception because of the concerns about menstrual side effects and fears about infertility. Contraception appeared to be used only after the ideal family size and composition were met and only if women were married. Single women did not use any contraception. Most of the women agreed that they discussed contraception with married women, as a source of information. Most women were exposed to an explanation of contraceptive methods at the hospital after the birth of their first child.

Discussion

These findings inform midwives and other health care providers about Bhutanese women's beliefs so that they can provide culturally congruent contraceptive counseling.