This article was published in our local paper today.  It struck me as a tool
for supporting more women from varied backgrounds to breastfeed.  It applies
also to teaching breastfeeding sensitivity.  Judy Ritchie


http://www.newsday.com/news/printedition/health/ny-hsmod294193963mar29,0,487
8531.story?coll=ny-health-print

When modesty poses an obstacle
BY STEPHANIE SHAPIRO
THE BALTIMORE SUN
March 29, 2005

Caryn Andrews was searching for a dissertation topic when a member of her
synagogue happened to pose a question: "Do you think religious Jews would be
less likely to go for a mammogram?"

Andrews, then a doctoral candidate at the University of Maryland School of
Nursing, pondered the question with her rabbi, Susan Grossman, at Beth
Shalom in Columbia, Md. 
 
"She suggested that I couldn't look at religion; I had to look at modesty,"
Andrews says.

It was a crucial distinction in a faith in which healing oneself and others
is a requirement, but can often be difficult because of some forms of
modesty practiced in the Jewish community. A dissertation topic was born.

The concept of modesty and its role in Jewish culture led Andrews, an
oncology nurse practitioner at Northwest Hospital Center in Randallstown,
Md., to conduct a research project that examines whether modesty among
Jewish women might discourage breast cancer screenings.

Andrews hopes her findings and further studies will have an impact on the
administration of health care in any community where rules of modesty may
pose obstacles to preventive care and treatment.

Andrews began with a hypothesis: that invasive health care practices often
clashed with a culture dictated in part by tzeniut, the Hebrew notion of
modesty in dress, conversation and habit. That clash could potentially be
harmful to Jewish women's health.

She knew, for example, that relatively few Israeli women participated in
breast screening programs, most likely because the procedure is thought to
violate Orthodox rules of modesty by requiring a woman to disrobe and have
physical contact with a technician. In Israel's Haredi community, the media
even avoid using the term "breast cancer."

Andrews also found studies of Muslim and Asian communities demonstrating
that modesty is an issue in their use of health care she says. She also
found evidence of the same in the Amish population.

"We know that women are not getting care," she says.

Measuring modesty

Andrews further hypothesized "that cultures that have strict rules of
modesty may also underutilize health care." But before she could prove her
theory, Andrews had to define a concept with religious, cultural and
psychological attributes that didn't lend itself to quantitative
measurement. "No one had defined modesty," she says. "That's where the
research began."

Phone calls, e-mails and postcards sent by the local Hadassah chapter led
her to women from a wide spectrum of Judaism who expressed different degrees
of modesty.

With a research grant from the Women's Health Research Group, Andrews
designed and administered a questionnaire that asked Jewish women in
Baltimore whether they agreed with statements about modesty. They were
asked, for example, if they were comfortable wearing sleeveless clothes.

In interviews with 40 women, Andrews also gleaned the many dimensions of how
modesty played a role in their lives, from the clothing they wore to the
books they read.

The result, Andrews says, was development of a "modesty scale that provides
evidence that modesty can be measured." Now that such a tool exists, "you
can address it in health care," says Andrews, who received her doctorate in
nursing last year.

Finding sensitive solutions

The measurement tool will lay the groundwork for further research on whether
standards of modesty hinder health care and if so, what can be done to
provide care while assuring those standards aren't violated.

"It may mean something as simple as putting up a curtain, or not leaving
someone uncovered while waiting," Andrews says.

She has heard from other health care researchers interested in modesty's
role. For example, researchers working with the Muslim community in
Dearborn, Mich., want to use the modesty scale, she says.

Andrews also hopes her modesty scale may be modified to understand whether
Orthodox Jewish and Muslim men avoid colonoscopies and other tests for
reasons of modesty.

Some health care facilities have found their own solutions. At one Maine
hospital an in-house seamstress creates hospital gowns that cover the body.
The gowns are intended to encourage Muslim women from Somalia to follow
through on appointments.

Within the outpatient area where she works, Andrews has heightened
sensitivity to modesty on behalf of patients, visitors and staff. "Paying
attention: That's all it is," Andrews says. 

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