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. *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html