Pacific Islanders family approach to birth conflicts with American medical health services

family pacific

A study in Arkansas in the United Stages has found a big cultural mismatch between the family orientated culture of the Marshallese, a sub-group of Pacific Islanders, for whom birth is a family celebration, and the individualistic culture of American maternal health services, for which birth is a medical event involving only the mother and a second person to provide practical support.

The study reflects a global tension between birth as a family event and as a medical event, brought into sharp focus across a cultural divide.

The study involved 20 service providers. Many of their comments about the Marshallese family approach were negative:

“They are sleeping all or the floors…..I wouldn’t walk around barefoot here.”

“Is this an opportunity for them to have a mini-vacation and go to the hospital and have an air-conditioned place to stay?”

One respondent expressed the opinion that only a “primary” support person is legitimate:

“I have even seen extended family members, who it wasn’t crucial to have there for the birth, ask for a note saying they were there. I’m sure they need it for work because they wanted to be there for their family. But, you know, ‘I’m not sure that I can excuse you for these whole three days.’ Especially since they are not the father of the baby. If I witness them being the primary support person I will write them a note.”

Earlier research has found a perception on the part of Marshallese service users of prejudice. This results in less or later use of services, which could be a contributing factor to the poorer health outcomes seen in the Marshallese community – higher rates of pre-term births, low birth-weight babies and infant mortality.

The researchers recommend cultural competency / cultural humility training for maternal health providers. The researchers followed up the study by creating a training session, co-presented by a registered nurse and a Marshallese community member.


Ayers BL, Hawley NL, Purvis RS, Moore SJ & McElfish PA (2017), Providers’ perspectives of barriers experienced in maternal health care among Marshallese women, Women and Birth

Photo: DVIDSHUB. Creative Commons.