Cultural implications of Mormonism on birthing patterns and related belief systems

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Authors Stark, Sarah Lydia

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Link to Item http://hdl.handle.net/10150/557309 CULTURAL IMPLICATIONS OF MORMONISM ON BIRTHING

PATTERNS AND RELATED BELIEF SYSTEMS'

by

Sarah Lydia Stark

A Thesis Submitted to the Faculty of the

COLLEGE OF NURSING

In Partial Fulfillment of the Requirements For the Degree of

MASTER OF SCIENCE

In the Graduate College

THE UNIVERSITY OF ARIZONA

1 9 7 9 STATEMENT BY AUTHOR

This thesis has been submitted in partial fulfillment of re­ quirements for an advanced degree at The University of Arizona and is deposited in the University Library to be made available to borrowers under rules of the Library,

Brief quotations from this thesis are allowable without special permission, provided that accurate acknowledgment of source is made. Requests for permission for extended quotation from or reproduction of this manuscript in whole or in part may be granted by the head of the major department or the Dean of the Graduate College when in his judg­ ment the proposed use of the material is in the interests of scholar­ ship. In all other instances, however, permission must be obtained from the author.

SIGNED:

APPROVAL BY THESIS DIRECTOR

This thesis has been approved on the date shown below:

IlMAyvcfcL kJ^Y Ocuuv)% /

I wish to express my sincere gratitude to all those who have helped make this research study possible.

The members of my committee, Dr. Margarita Kay, Chairperson,

Dr. Alice Longman, and Dr. Agnes Aamodt for their advice, assistance, and.support during this experience.

The clients who so willingly participated with their time and information.

Special appreciation to my daughters, Sarah Elizabeth Williams and Tedene Lisa Williams for their support and loving understanding during the entire process of my education. TABLE OF CONTENTS

Page

LIST OF ILLUSTRATIONS...... vi

LIST OF TABLES ...... e .. o ...... vii

ABSTRACT ...... viii

CHAPTER

1. INTRODUCTION ...... 1

Conceptual Framework ...... 4 Significance of the Problem...... 5 Statement of the Problem ...... 7 Purpose of the S t u d y ...... 7

2. REVIEW OF LITERATURE ...... 8

Mormonism as a Culture ...... 8 History...... 10 Church Organization 14 The Priesthood ...... 19 Membership Composition and Requirements ...... 20 Special Ordinances ...... 21 Kinship ...... v...... 22 Development of Church Theology ...... 27 Effect on Fertility ...... 35 Effect on Attitude ...... 36 Past Birthing Techniques ...... 38

3. METHODOLOGY ...... 42

Design of the Study ...... 42 Sample ...... 43 Human Subjects Protection ...... 43 Data Collection Tool ...... 43 Data Analysis ...... 45

4. PRESENTATION AND ANALYSIS OF THE D A T A ...... 47

Characteristics of the Sample ...... 47

iv V

TABLE OF CONTENTS (CONTINUED)

Page

Importance of Marriage » ...... 48 Family Planning and Spacing of Children . » » • • - 53 Childbirth Practices ...... 58 Special Concerns...... 61 S u m m a r y ...... 63

5. DISCUSSION AND RECOMMENDATIONS FOR FURTHER STUDY . . . . 66

Discussion of the Findings ...... „ , „ . 66 Implications for Childbearing ‘ . >69 Recommendations for Further Study o 71

APPENDIX A: CONSENT FORM ...... 73

LIST OF REFERENCES 74 LIST OF ILLUSTRATIONS

Figure Page

lo Chronology of Some Early Historical Events « e • » e . . 15

2. Organizational Chart of Church Authorities ...... 16

3. Levels of the Priesthood in Hierarchical Order ...... 20

4. Characteristics of the Sample Informant’s Family Size . 49

5. Characteristics of the Sample Age of Informants .... 50

vi LIST OF TABLES

Table Page

1 . Reasons for Delaying Pregnancy or Spacing Children . . . 54

2. Acceptability of Birth Control Methods ...... 57

vii ABSTRACT

Cultural background plays an important role in how individuals interact with one another» The quality of health care delivery can be affected by the ability to recognize and utilize the knowledge of cul­ tural influences in providing care to various cultural groups. The focus of this study was to explore the feelings of Mormon women con­ cerning their health care in general and childbearing specifically to identify the existence of culturally based health care requirements.

The sample consisted of 20 Mormon women from Utah and Arizona aged 18 or over. The. subjects were interviewed, either individually or in small groups. The interviews were unstructured beyond a description of the study purpose and occasional open ended questions.

The responses were reviewed to establish the categories of im­ portance of marriage, family planning and spacing of children, child­ birth practices, and special concerns,

The findings indicate that these categories represent areas where special health care needs exist which must be considered by the health care deliverer in order to provide quality care for Mormon women. Recommendations for further study were based on utilizing and expanding these data. CHAPTER 1

INTRODUCTION

She who can paint or write a book that will influence millions deserves the admiration and the plaudits of mankind; but She who rears successfully a family of healthy, beautiful sons and daughters whose influence will be felt through generations to come. c . . deserves the highest honor that man can give, and the choicest blessings of God (Hawkes 1974, p. 49).

This quotation typifies the attitude of the Mormon Church on the role of women in their culture. It is substantially the same to­ day as it was in 1936 when David 0. McKay, past president of the Church of Jesus Christ of Latter Day Saints, made the above statement. Every woman in the church is expected to become a mother. This expectation is part of the woof and web of the Mormon culture.

Cultural influences on almost every phase of life are currently being studied by a large number of researchers for an equally wide vari­ ety of reasons. The really significant benefit of this development is the awakening awareness that culture does have an important effect on how each individual perceives any given experience. Thus, though a specific event may be experienced by people the world around,it will be uniquely colored by the numerous and complex influences of the particu­ lar culture of the individual or group involved. i This is particularly true of the acts of conceiving and giving birth. Although they are universally experienced and based upon

1 reasonably stable physiological principles, they are intensely personal experienceso Aamodt .(1978) feels that culturally based content in this area involves many aspects of the social life of the members of a com­ munity. Each person involved brings her own heritage into play.

According to Leininger (1978) there is a sub-field of nursing focusing on comparative study and analysis of cultures and sub-cultures which concentrates on health-illness and caring behaviors, values, and beliefs. The goal of this sub-field is to utilize information so gained to provide culture-specific care to clients. She feels that one of the primary professional responsibilities of nurses is to study and utilize this information in planning nursing care. Failure to recog­ nize these interrelating influences by health care givers can cause a great deal of pain and frustration to the participants in health care delivery.

Members of the Mormon culture have influences on their lives beyond those experienced by members of the dominant culture within which they live. These influences may result in some special health care needs. To identify these needs and assist health care workers in recognizing them and developing plans to meet them requires looking at the Mormon culture in more detail.

In many ways the members of the L.D.S. or Mormon Church have not been assimilated into their surroundings. The members perceive themselves as separate from their non-Mormon neighbors. History has shown that others also often see Mormons as different. The Mormon re­ ligion is not merely a Sunday exercise, it is a way of life practiced every minute of every day. It controls its membersf lives not only through fundamental principles controlling behavior, but also through a continuous stream of meetings and other church programs. Expecta­ tions for individual members, as well as for family groups, can be de­ lineated by direct communication from a living prophet. Beliefs and practices are constantly enforced and reinforced through close and con­ tinuous contacts and supervision. A lay ministry, divinely chosen, makes each member accountable to God first, then to self, and finally, but no less significantly, to every other member.

Mormon birthing patterns, then,r are influenced by two distinct doctrines which are specific to this group alone. One is the hierarchi­ cal order of the Priesthood in the church organization. The other is the doctrine of eternal progression and salvation (explained in detail later) which requires earthly bodies as a step in this progression.

Each soul given an earthly body is added to the eternal family of the earthly parents and will add to their glory in progression after death.

The result of these beliefs is that supporting statements of the church authorities must be complied with at risk of an individual’s eternal salvation and that families are valued not only for present satisfac­ tion but also for eternal glory. It further becomes obvious that such doctrines could result in problems for L,D.S, women not shared by non-

Mormon women.

This paper is an attempt to investigate and identify specific places where health care providers can better assist these women in meeting their special needs. It is assumed that any attempt to add to the body of nursing knowledge by increasing cultural awareness cannot

help but have a positive effect on the quality of nursing care„ Lein-

inger (1978) predicts that professional nurses throughout the world

will increasingly incorporate cultural knowledge into their care plan­

ning, teaching, and research.

Conceptual Framework

The premise of this study is that culture, religious beliefs,

and the value of having a family are important concepts for Mormon

women. In order to provide quality health care to a Mormon woman, es­

pecially in the childbearing area, it is important to become aware of

her perceptions concerning these experiences and their influences upon

her.

Leininger (1978) has stated that one of the first professional

responsibilities of a nurse is to study and utilize culture-specific

information in delivering nursing care. Aamodt (1978) points out that

health care workers must understand cultural forms and their interre­

lation with social environment in order to provide meaningful care in

trans-cultural settings.

Religion, referring to the presence of a belief in a supernat­

ural powerj is operationalized through religious beliefs. These beliefs

vary from one church to another, and to a lesser extent from one indi­ vidual within any church to another member of the same church. The

degree to which individual behavior is shaped and influenced also varies. Some churches extend their belief system to include all areas of their members life styles. Others only exert significant influence

over selected behaviors such as going to a special religious service.

Religious influence is often a strong factor in behavior. In the case

of Mormons it is an even greater than usual influence since it is per­

ceived as a way of life, influencing behavior in all areas of life and

even after death. The religious doctrines in this church are so strong

that they have developed a separate culture for its members dividing

them from the broader cultural patterns of their non-Mormon neighbors.

The family is the center of Mormon life. It is doctrinally im­

portant as well as personally valued by Mormons. The behavior patterns

established by this fact can have a definite impact on the health care

needs and values of Mormon women.

Another concept to be considered is that of value behavior dis­

crepancy (Christensen 1976). This concept deals with the degree of

isomorphicity between belief structure and actual behavior. This cul­

ture has strong rules and beliefs about family and childbearing which may lead to some discrepancy between actual behavior, such as utiliza­

tion of birth control, and the cultural mores concerning this behavior.

Only by studying and analyzing these behavior patterns will nurses be able to offer health care which reflects the culture of the

receiver rather than the culture of the deliverer.

Significance of the Problem

Failure to receive health care which meets individual needs

can result in emotional as well as physical distress. Unless the care giver is familiar with the rules governing a given culture and can

provide care which allows the recipient to observe the rules as well

as meet her special problems, quality care cannot be delivered.

I have been aware of many situations where no one was available

to understand or provide appropriate care for Mormon women. One such

situation occurred when a Mormon woman with a serious problem with her

pregnancy required extended hospitalization. Nurses became angry at

her because she did not express what they considered adequate concern

about her children at home. They had her evaluated as an unfit mother.

They did not realize that the church members were providing very ade­

quately for the children and the patient knew this was part of her cul­

ture so she was not worried about their safety. A lack of understanding

concerning the teachings of this religion and the role of a woman with­

in it has led to failure to meet client expectations and needs. Un­

aware nursing attitudes concerning specific events such as infertility

or the loss of a pregnancy, have resulted in unmet client needs when nursing judgments have been based on uninformed feelings of the nurse

or failure to provide available religious support. Emotional or phys­

ical support has been delayed or overlooked completely. Role fulfill­ ment, such as by successful childbearing, has been dismissed as

irrelevant through failure to understand the importance of certain

things to Mormon women. Many nurses, however, do not perceive this

group as having any special or different.health care needs apart from

the rest of their clients. Statement of the Problem

In order to investigate this problem it was considered necessary to ask the following questions:

le Is there a Mormon culture?

2c What are the roles of women in this culture concerning child­

bearing and health care?

3c Are there special health care needs exhibited by members of

this group because of these roles?

4, How can health care givers better meet these needs?

To answer these questions requires investigating the Mormon way of life by looking at the women and how they perceive their roles and needs.

This will assist in delineating the existence of and categories of special needs. *

Purpose of the Study

In order to provide more complete and appropriate care, nurses must continually study and assess the cultures of their clients. To determine whether there actually are some significant cultural needs which are not being currently met for Mormon women by health care work­ ers, it is necessary to investigate the beliefs and feelings of these women» This study will try to elicit and analyze some of these con­ cepts to provide some guidelines for areas of further study and for possible areas of special needs. It is hoped that suggestions for meeting these needs will also be forthcoming. CHAPTER 2

REVIEW OF LITERATURE

To provide a better understanding of the possible areas of concern to Mormon women9 it was necessary to review some background lit­ erature. One topic was whether there really is a f,MormonM culture sep­ arate from the dominant culture of the locality where Mormons live.

The second need was for some historical frame of reference. The third purpose was to describe the church organization. The fourth area was to study kinship patterns, and the final concern was to look at the theological beliefs and the effect of this background, past and present, on birthing practices.. This chapter will present the material in each of these areas.

Mormonism as a Culture

Religious groups are frequently considered only a part of their larger national identity. Actually there are many definitions of "cul­ ture." To the average person the term often indicates the differences occurring when one is reared in 1another countryv such as Mexico or

Africa. We rarely perceive our own set of living rules as ’culture.x

We limit the term to some other ’different’ group. The definition I have chosen to use was originally proposed by Goodenough and has been utilized by many ethnoscientists. It states that culture is the knowl­ edge or beliefs needed to behave in an acceptable manner within the

8 9 group (Spradley and McCurdy 1972). This knowledge is both learned and shared rather than instinctive and individual.- Each member of a specif­ ic culture may interpret the knowledge a little bit differently, but the basic principles remain the same, - Consequently one of the basic premises of this study is that a separate culture exists within the

Mormon group,

The cultural student must investigate this knowledge from the outlook of the participant rather than as an outsider recording events.

The perceptions of the culture members about their thoughts, feelings, and actions must be discovered. This is appropriate for the Mormon culture because there are significant differences in the way this re­ ligion is interpreted by its members in comparison with the way other sects interpret their religion.

The following "chapter will expand on some of the beliefs which are crucial to Mormonism and have a great deal of influence on atti­ tudes about childbearing, women's roles, and health care. The practice of polygamy had an effect not only on the structure of family life but also on the role of women in this culture. 'The importance of the fam­ ily unit is stressed as a requirement for eternal progression as well as a responsibility to waiting souls. The role of women as 'priestess,7 see page 26, yet subject to the power of the priesthood of the male is significant. The use of the priesthood in directing the family living and in healing will be discussed. The doctrinal background explaining the three degrees of heavenly glory and the behavior required for at­ taining them is a particularly important concept in childbearing and 10

formulating marriage rules. The special dietary and clothing

requirements represent some of the ways in which these beliefs in­

fluence member's individual life style. All of these concepts must be viewed in relationship to what the Mormons believe to be God's first commandment, to multiply and replenish the earth.

The role of the church as a social center as well as a reli­ gious center will be demonstrated through an explanation of the church structure and meeting systems. This structure emphasized the impor­ tance of family in its auxiliaries and in some of its rituals. An ex­ ample of the latter would be the importance of genealogical study and the special rites for the dead. Thus this culture is bound together not only by doctrinal beliefs but also by a physical structure which requires total participation to be a fully accepted member.

O'Dea (1972) has identified Mormons as a separate ethnic group

He suggests that there are three components in an ethnic identity, a cultural content involving specific behavior, a common history, and a sense of identity separate from other groups. He states that the

Mormons meet these three criteria. The information in this study ap­ pears to strengthen and uphold his conclusion.

History

This section is intended to provide some insight into the com­ mon history of the early establishment of the Mormon Church.

In 1820, an Angel appeared to young Joseph Smith in a small grove of trees near Palmyra, New York. During this and future visits, 11 the groundwork was laid, through knowledge delivered to Smith by the

Angel and other heavenly visitors, for the translation of the Book of

Mormon, one of the three additional scriptural books used in addition to the Bible by this church. The Book of Mormon purports to be the history of an Israelite migration to American and of Christ's visit to the people on the American Continent, (The Bible is considered to be the history of the Jewish people and Christ's visit to the people of

Judea,) This book was translated from gold plates found in the hill

Commorah, also located near Palmyra, by Joseph Smith with the help of

God and a translating device called the Urim and Thummim, Based upon the principle of present and continuing revelation from God, other scriptures were revealed to Joseph at later times and are known as the

Doctrine and Covenants and The Pearl of Great Price.

The establishment of a church was not the intent of the boy,

Joseph, as he went to that grove in New York. He was acting in keeping with his sensitive nature during a time of great religious upheaval and fervor. His intention was to seek guidance from the Lord concerning which of the many churches available he should join. Years of study and work passed before a small group of family and friends in New York recognized him as a leader, accepted his prophetic powers, and a church was born. This church developed into more than the Sunday-go-to-meeting type religion. Because of the pervasive nature of its doctrines and teachings, it has become a way of life to guide its members in every phase of their physical as well as spiritual life. 12

From its actual organization in 1830, the members have displayed remarkable solidarity in their attempts to follow its teachings even to their own monetary and physical detriment. The early years show an embattled course of migrations from New York, the place the Church was founded, through Kirtland, Ohio, to Missouri, where many church leaders and members were massacred, to Nauvoo,Illinois, near Carthage, Illinois, where Joseph Smith was murdered. Writings of the times tell of the con­ tinuous move to the "Far West" (Tullidge, 1877). They were not refer­ ring to the final trek to Utah, as yet unknown and impossible even to comprehend, but to the moves to Missouri and eventually to Illinois.

Some of the rapid growth of the Church, even in the face of such harsh circumstances, was due to the strong missionary effort which has always been an integral part of Mormonism. From the early days men devoted substantial periods of time to the church, leaving their fam­ ilies and traveling about this country as well as in foreign countries, such as England and the Scandinavian countries, seeking to convert new

Saints, as members are called among themselves. Many of these converts left their homes and countries to join the Saints in America.

After the death of Joseph Smith, Brigham Young was chosen to lead the Mormon people. His first task was to guide them out of danger from the mobs in Illinois to a place where they could settle and be free of the continuous threat of harm from their neighbors. Speculation as to the cause of the continuous harassment varies from the analogy to that visited in Biblical times upon God’s chosen People, to the fact that they were just "different." 13

The emergence of the doctrine of polygamy did little to endear these already unusual people to their neighbors, Contrary to much pub­ lic opinion, the idea of plural marriage was not an exciting idea,to the membership. They were shocked and resistive (Goodson 1976). The revelation concerning the need to enter into plural marriage was re- ceieved about 1831, written in 1843, but was not publicly announced until 1852 (Bushman 1976)« Initially, its purpose was solely religious and based upon the threat of heavenly punishment„ Later, it seems likely that practicality became a guiding motivation, particularly as women were more numerous than men in a time and place where survival depended on togetherness.

A report of a mob attack in Haun1s Mill, Missouri indicates some.of the views of the times. A group of Saints traveling west from

Kirtland were stopped and threatened. When they asked why, the response was, "You are one of those d d Mormons. That’s offense enough. . . •

It is the order of the Governor that you should all be exterminated, and by G_d you will be" (Tullidge 1877, p. 117).

The end result of all this animosity was the long, arduous trip to the Salt Lake Valley. The journey of 1,500 miles was begun with the crossing of the Mississippi River early in 1846. Members journeyed from other states to join the group of beleaguered and ill- prepared families who would bear great hardship to reach a place they could at last call their own.

There seems little doubt that the experiences of birth, death, and privation had an effect on the development of the strong, demanding 14

role expected of and demonstrated by Mormon women from that day to the

present.

I have compiled a list of some of the significant occurrences

in the early history of this culture in an attempt to help the reader

visualize the time sequence of what I consider to be the formative

period of the initial beginnings of current beliefs and practices. It

is not complete in any way and is not meant to represent all the sig­

nificant events of this time period (see Figure 1).

Church Organization

The home organization for the L.D.S, Church is in Salt Lake

City9 Utah. The president and his top advisors are all located there.

Offices of the General Authorities, as the top officials are called,

are supposed to be open to all members of the church for consultation, but in fact it is frequently difficult to actually gain access to the

highest authorities. Generally one uses the local officials before ap­

proaching a General Authority but this is not always necessary.

As can be seen by the Organizational Chart (Figure 2), there

are many positions to be filled in this Lay Ministry. In addition to

those listed on the chart there are many clerks, teachers, secretaries

and other assistants who must be involved to make this organization run

smoothly. All leaders except those of the Relief Society and the Young

Womens Mutual Improvement Society are worthy male priesthood holders.

Each job holder is chosen by the authority in the position above the proposed job who then 'calls' the prospective worker to the new position.

A 'call' is considered to be the will of God and is not to be turned 15

1829 Joseph Smith's first vision

1827 Plates delivered and translation begins

1830 Church organized in Fayette, Seneca County, New York

1831 Centers established in Kirtland Ohio and Jackson County, Mo. Polygamy revealed but not made public

1837 Driven out of Kirtland, Ohio

1838 Driven out of Missouri

1840 Nauvoo, Illinois chartered

1843 Polygamy and Celestial marriage recorded as basic tenet of church

1844 Joseph Smith murdered; Brigham Young becomes new leader

1847 Arrival in Utah

1852 Public announcement of practice of polygamy

1862 Morrill Act passed prohibiting plural marriage

1877 Brigham Young dies

1879 Supreme Court upholds legality of anti-polygamy laws

1882 Edmunds Act passed in Congress establishing heavy penalties for plural marriage

1887 Federal Edmunds-Tucker Act disfranchises polygamists and all women

1890 Church publishes Manifesto prohibiting polygamy on pain of ex- communication

1896 Utah given statehood; women granted right to vote, one of the first senators is a woman

Figure 1. Chronology of Some Early Historical Events. — Compiled from a variety of sources. Level Position

General Church President Authorities First Second Counselor Counselor Council of the Twelve Presidency of the Quorum of Seventy

Presiding Bishop

First Second Counselor Counselor Regional Representative District Stake President First High Second Counselor Council Counselor | Seventy Sunday Relief Young Men's Young Women's School Super­ Primary Society Mutual Mutual intendent President President President President Z\ /x /X /X /X first and 2 coun­ 2 coun­ 2 coun­ 2 coun­ second coun­ selors selors selors selors selors

Local Ward Bishop First Second Counselor Counselor

Sunday Relief School Super­ Primary Society Young Men's Young Women' intendent President President President President /X /% /\ /X z \ first and 2 coun­ 2 coun­ 2 coun­ 2 coun­ second coun­ selors selors selors selors selors

Figure 2. Organizational Chart of Church Authorities 17

down loosely. However9 if one has a legitimate excuse9 such as

illness9 many young children, or five other jobs, one may refuse a

’calling1 without detrimental consequences. The positions held by women are exclusively for women's organizations and still require the

immediate supervision of a priesthood holder. This is accomplished by delegation of responsibility for the women's organizations to vari­ ous of the general authorities.

As a general rule the leader of each unit in the organization

is 'called by the leaders of the immediately preceding unit, i.e., the

Stake leadership 'calls' the Ward Bishop. From the time this individ­ ual accepts his 'call' he will be basically involved in choosing the workers in his own unit, subject to approval of the leadership in the

Stake or his own unit, depending on the position being filled.

Since there are many positions to be filled in each unit, it is clear that any worthy, capable adult in the church can hold some position and frequently will hold several jobs.

Since there are planning meetings, membership meetings, Ward level meetings, and Stake level meetings plus the regular meetings for church, Sunday School and Sacrament meetings and the priesthood or Re­ lief Society meetings, etc., the membership spends a substantial part of their days in church and related activities,

The Ward is the basic unit of the church. Alder (1978) has likened the ward to a village or community. He points out that ward leaders work hard to create an atmosphere where the. 'Saints' can gather in unity to live and socialize. The size of an individual ward varies depending on geographical elements as well as available leaders. It usually consists of from 200 to 700 members, There are currently well over a thousand wards. Each ward maintains each of the auxiliary orga­ nizations in the chart (Figure 2) although their development level will depend on the quality of leadership and member interest available.

When a ward exceeds manageable size either in numbers of members or geographic distribution it is split into several new wards. Wards are organized into Stakes, Each Stake has about 10 wards when it has reached its capacity. When it exceeds that number due to splits of existing wards a new Stake is formed.

The church is also a social center for its members. Dances, suppers, and talent nights are frequent occasions both at the ward and at the stake level. A member without a family may find himself a lonely observer. Families are quick to absorb unattached members who wish to be included but some of the pleasure of the event may be diluted by the lack of one's own family to share it with.

One of the results of the intensity and frequency of church ac­ tivity is that there is a premium placed upon being able to live near the center of church activity. This results in a concentration of mem­ bers in Utah and surrounding states. It also results in spot concen­ trations in various other states with less extensive Mormon population.

It is easier and more comfortable to live near other Mormons who under­ stand the life style and participate in the same activities. The Priesthood

The priesthood is a special power conferred upon all worthy male members of the church0 A man is considered worthy when he follows

church teachings and attends all appropriate church meetings. It is

this power that assists them in maintaining a continuous contact with

God and aids in making appropriate decisions in all areas of living.

This power enables man to do the will of God. It is the leadership principle and it is the absence of this power that requires a woman to

remain in a subservient position to man. She may partake of the bless­

ings of direct communication with God only through her father, husband, or male family member. In the absence of male family, a woman.may be assisted in spiritual matters by other male church leaders.

The priesthood has two branches, the Aaronic and the Melchizedek priesthoods. Each branch has different levels which must be attained before advancement to the next level (Figure 3). The branches also have a hierarchical order in that one must successfully obtain the lev­ els of the Aaronic priesthood before moving on to the Melchizedek branch. Certain levels of the priesthood are required before appoint­ ment to some church authority positions.

The priesthood is originally conferred upon a worthy male either at age 12 or, if a convert to the church, as soon after conver­ sion as the individual is considered worthy. Progression through the levels thereafter is determined by reaching a degree of learning and spirituality although it frequently seems that these degrees are 20

Aaronic Melchizedek

Deacon Elder Teacher Seveny Priest High Priest

Figure 3. Levels of the Priesthood in Hierarchical Order

reached at about the same age for many men. Some men never reach the higher levels.

The power of the priesthood has a large influence on the roles assumed by the male and female. The man becomes head of the church and of the home while the woman functions as helpmate in the home, bearing, teaching, and caring for the children and supporting the husband in his many callings and tasks.

Membership Composition and Requirements

Admission into the Mormon church requires baptism by emersion followed by another ceremony of prayer with at least two members of the priesthood blessing the individual and committing him to the service of

God. Baptism never occurs before the age of eight, but can occur at any later age. One can be ’born in the church’ or born to parents who are already Mormon, or one can be a convert. Converts usually hear about the church from the missionaries. Young men and women between the age of 18 and 22 often devote two years of their life to traveling around the world teaching the gospel as missionaries, Older people, and sometimes even couples, can serve as missionaries under certain

( circumstanceso When an individual is considering conversion to the

Mormon Church the missionaries have a series of lectures and classes which they give to the person teaching them about the doctrinal be­

liefs as well as the special rules, such as the ’word of wisdom, * the

rule requiring abstinence from coffee, tea, tobacco, and other stim­ ulants. Adherence to the ’word of wisdom’ and other rules is a crit­

ical factor in how 'well a convert will be accepted by church members after baptism.

The church has a strict moral code requiring all members to behave with great propriety and responsibility in their lives. This code results in strict dress rules. Men are expected to keep their hair short and neat and to dress conservatively. Women have only re­ cently been allowed to wear long pants on Brigham Young University (the church run university) campus. They are expected to wear dresses to any special event. It is very common for the young women on the campus of this Mormon university to wear dresses all the time. The dresses should have sleeves and be of a conservative length.

Members refer to each other as ’brother’ and ’sister.’ Fre­ quently this title is accompanied by the last name but between good friends the first name is used. Children refer to adult church members as ’brother’ or ’sister’ in conjunction with the last name.

Special Ordinances

There are several special church ordinances which have signif­ icance for health care givers. The first relates to the Mormon view of 22 healing. Members are taught early the power of Sod through the priest­ hood as a healing technique. Mormons have a special ordinance of blessing the ill or those about to undergo surgery or childbirth through the ?laying on of hands.9 Two Priesthood holders usually per­ form the ceremony, but in an emergency, one is sufficient. The proce­ dure is basically a prayer for the successful outcome and the strength of the participant with a blessing from God that the right and good thing will occur. Even Mormons who may not be particularly active in the church usually set great store in this ordinance.

The second issue is the garment. When a member goes to the

Temple, a special building set aside for specific ceremonies, for the first time, he is involved in a ceremony which results in the wearing of a garment for the rest of his life. This garment is somewhat like long underwear and is felt to provide its wearer with special protec­ tion and comfort. How constantly it must be worn seems to be open to some individual interpretation, but some members may be uncomfortable without it. It also effects the member's dress since outer clothing must cover this garment completely. It is considered a very private thing and not to he discussed with "Gentiles" or non-Mormons.

Kinship

The most important social structure in the Mormon culture is the nuclear family. Although a change occurred for some families dur­ ing the time the doctrine of polygamy or plural marriage was being practiced, the importance of the family as an entity did not waver. 23

Even during the time when polygamy was actively supported and encouraged

by the church it was not the only family structure utilized. Before

entering into plural marriage, a man must be interviewed by the church

authorities to establish that he was worthy, and as a practical matter,

that he could support another wife. This practice had to be repeated

for each new wife at the time she was added to his family. He was also

supposed to have the approval of his other wife or wives, although the

literature indicates that this step was sometimes omitted. Many ap­ plicants were unable to meet either the financial or religious require­ ments (Goodson 1976). The stories of large harems were greatly exag­

gerated. Although a few top church officials actually had large numbers of wives, i.e., Joseph Smith, 27; Brigham Young, 27; Heber C.

Kimball, 45; John D. Lee, 19 (Goodson 1976); the general membership did not follow their lead. A study by Stanley Ivins of 2,000 practicing polygamists showed that 66 percent of the men had taken one additional wife and only six percent had taken five or more wives (Goodson 1976).

One estimate indicates that only about 10 percent of the members ac­ tually practiced polygamy (.Goodson 1976).

Although the Morrill Act, passed in 1862 by the United States

Congress, was intended to halt the practice of polygamy by the Mormons, it was not until the church issued the manifesto in 1890 and began ex­ communicating all who ignored or disobeyed it that the practice really came to a stop. This return to the nuclear family at pain of imprison­ ment and/or religious disfellowshiping resulted in some serious problems for the families of second or later wives who were often then left to 24 their own devices for survival. Occasionally stories still surface about the current practice of polygamy by members of the Mormon church, but the practice remains out of favor and will result in excommunica­ tion if proven.

Marriage and family are significant in the religious advance­ ment of a Mormon, The Mormons believe that there are three degrees of heavenly glory: the celestial, the telestial and the terrestrial de­ grees. It is the wish of every Mormon to reach the celestial degree, which is the highest degree of glory, and which results in a state of godhood for each individual who attains it.

Among the requirements to attain this level of glory, are mar­ riage and the production of children. Marriage is also significant in that it must be specially performed in a building called a Temple, rather than in an ordinary Mormon church, or in a public building as a civil marriage. This marriage involves special ordinances and is considered to last for time and all eternity rather than the customary

"Till death do us part" of the more familiar services. Children born within this special type of marriage are said to have been born funder the covenant.9 It is believed that death will not permanently separate such a family, but that they will all be reunited at a later time in the celestial kingdom. This belief has resulted in a strong family unit, which includes extended members also. The extended members in­ clude aunts, uncles, first cousins, grandparents and frequently great aunts, uncles or cousins of second degree. Some families include

Indian children brought from the reservations to obtain an education. 25

These children frequently remain with their foster families from the time they begin their education until they are to be self supporting.

Sometimes they return to the reservation for the summers, Unmarried aunts and uncles present something of a problem. Their marital status is frequently a concern to themselves and their other family members»

Only recently have they begun to establish their own homes. Often they lived with married relatives or at least devoted much energy to their married relatives* families.

Ruth Brasher (1969) found statistically significant higher rates of extended family interaction among Mormons than among other re­ ligious groups studied including telephone calls, visits face to face and correspondence. She found more family reunions and organizations and overnight visits.

O ’Dea (1972) reports that the family, both nuclear and extended are very important. He states that reunions of extended families with as many as a 1,000 persons attending are not uncommon. He feels the strong ties both by blood.and by marriage penetrate and support the church structure.

The church has another important teaching that further strength­ ens family ties. There are special rites which need to be performed for those who died without the opportunity of either receiving the gos­ pel or participating in some of the required ordinances, such as celes­ tial marriage. By these rites, family members still living can assist those who have departed on their celestial progression. This mandate is responsible for the strong interest in geneological work demonstrated 26 by members of the Mormon faith* The individual’s celestial progression may depend on having diligently sought for members of the family tree and provided these services» The performance of rites for the dead al­ lows the departed individual to take advantage of the blessings of those ordinances if he so desires. Acceptance is not mandatory but may be considered necessary for eternal progression. Examples of these rites include baptism and celestial marriage and the "sealing” of family mem­ bers together so they will not remain separated throughout eterniy.

"Sealing" is a religious ceremony performed in a Temple. It guarantees that members of a family will remain a family unit even after death so long as all family members fulfill their religious obligations.

The family units are officially patriarchal. The male, as hold­ er of the priesthood9 is the spiritual and literal head of the house.

The Mormon concept of women’s role is different from that epitomized by

St. Paul where male supremacy is often based on celestial celibacy..

Because marriage is so highly valued 9 woman was proclaimed as priestess in her own right9 but the duties were different. She was the helpmate of man9 a priest) and was responsible for the bearing and raising of the children (Tullidge 1877).

The role of equality for women was evident early in the teach­ ings of the church) and) in the fact that Utah women voted in municipal elections in 1870 while Utah was still a territory. This early history is now causing some conflict for Mormon women who must currently deal with the present anti-ERA stand of the church. The education women have been encouraged to seek in order to better perform their child rearing 27

tasks has prepared them for more equality in decision making, thus

increasing the conflict between reality and idealism.

Development of Church Theology

In order to determine possible areas of special concern to Mor­ mon women, it is necessary to review the theological teachings of this church and to relate these doctrines, past and present, to birthing practices.

Mormons take very seriously what they consider to be God Vs first commandment, to be fruitful, multiply, and replenish the earth. Mormon­ ism claims to have glorified woman and returned her to her true position of honor, that of a High priestess and prophetess. Her divine mission is the regeneration of the race and 'helpmeet* to the patriarchal priest­ hood (Tullidge 1877). Thus her position is totally dependent on her success in keeping the first commandment. Present life and life after death are dependent on the ability to marry and procreate. Warenski

(1978) points out that the number of children a woman produces becomes a means of determining righteousness since marriage and motherhood are required for eternal progression. She goes even further in defining the importance of marriage and childbearing. "Nowhere in patriarchal his­ tory or in present-day practice is there an innovation comparable to the

Mormon eternal marriage law, and in regard to the status of women that law separates Mormonism from all other religious organizations. . . The single woman is. a casualty" (Warenski 1978, p. 225). Recent comment on the subject of single women and eternal progression can be found in a 28

recent publication entitled Woman which contains a compilation of

articles by church authorities on the role of women in the church today.

Spencer W. Kimball9 current church president, comments that only if a

woman is single through no fault of her own, i.e., has not set her stan­

dards beyond possible fulfillment or decided against marriage will she

be given other opportunities to meet her obligations in this area (Kim­

ball 1979).

The subject of possible top utilization of the procreative pro­

cesses has been a topic of discussion by many of the church authorities.

Orson Pratt is said to have computed the number of spirits waiting in

Heaven for suitable earthly temples to be somewhat over 100 billion

(Bush 1976). Later Rudger Clawson stated in The Relief Society Magazine

that, i

Woman is so constituted that, ordinarily, she is capable of bearing, during the years of her greatest strength and phys­ ical vigor, from eight to ten children, and in exceptional cases, a larger number than that. The law of her nature so ordered it and God’s command, while it did not specify the ex­ act number of children allotted to woman, simply implied that she should exercise the sacred power of Procreation to its utmost limit (Watt and others 1854, Volume 3, p. 364) .

Brigham Young stated, "If my wife had born me all the children she would

ever bear, the celestial law would teach me to take young women that would have children" (Watt et al. 1854, Volume 4, p. 56) . Thus was polygamy

given another spiritual justification. David 0. McKay, recent past pres­

ident of the church and prophet of the people, stated in 1953, "The first

commandment to Adam and Eve was to multiply. This commandment has never been revoked" (Roundy 1970, p. 3). 29

One of the reasons for the emphasis on childbearing is the

Mormon belief that eternal progression requires time on this earth. It is felt that many souls are waiting in heaven for a chance to have an earthly body and thus continue in their eternal progression. The reason for the increased concern now is that we are now in what is called "the latter days" and that relatively little time remains to provide this op­ portunity.

Even more recently the importance of having as many children as possible was stressed with the production of Saturday? s Warriors. This play3 produced in most of the stakes and wards of the church, emphasized the fact that the latter days were at hand and it was the responsibility of every Latter Day Saint family to provide earthly temples (bodies) for as many of the waiting spirits as possible. The following question and answer on the subject of childbearing are the result of an interview with Spencer Kimball by two Associated Press writers in June 1979.

Q. Some Mormon parents say they feel pressure from the church to have more children than they can afford. Is it impor­ tant that a Mormon family have a lot of children or just as many as they feel they can handle?

A. Well, you realize that there are a lot of people who would guess wrong, very much wrong, about how many they could take care of . . . (Briscoe and Wertz 1979) .

From this material, it is fairly easy to conclude that abortion would be unacceptable since it would deny life to these waiting entities

From 1840 on the subject of abortion has been discussed in no uncertain terms. The spiritual consequences of any level of participation in the practice of abortion has been clearly defined. George Q. Cannon in 1884 stated. 30

They will be damned with the deepest damnation; because it is shedding innocent blood9 for which there is no forgive­ ness. . o . They are outside the pale of salvation. They are in a position that nothing can be done for them. They cut themselves off by such acts from all hopes of salva­ tion (in Bush 1976, p. 15).

The issue of contraception did not receive such clear and con­

stant damnation, however. There were sporadic comments, to be sure, which stressed the importance of having as many children as possible and

perhaps for the times, naturally imposed methods were sufficient. Men were sent on missions around the world to teach the gospel to new con­ verts and thus were not available. Polygamy also provided some control

in that the husband had other duties, conjugal and otherwise, which pro­

vided absence. Infants were breastfed for long intervals. Breastfeed­

ing was considered a time of reprieve from new pregnancy. While

breastfeeding is not an exact technique, it seemed to work for some.

Data from that era, less than completely reliable, but at least of some value, indicated that the average monogamous Mormon mother bore about

eight children (Bush 1976). There were some pronouncements on the sub­

ject. Brigham Young discussed negatively attempts to destroy or dry up

the fountains of life (Bush 1976). He also claimed that the reason for

polygamy1s revelation was so that the waiting spirits would have a

chance to be born (Bush 1976). Because the bringing of these spirits was an honor there were a few acceptable reasons for not bearing chil­

dren. These included drunken or idle habits, hereditary disease, or vicious habits (Bush 1976). The limitations were strictly ethical and

eugenic. They did not include poverty, Boyd Packer stated in 1966: 31

"This commandment 9 ie e0 9 multiply and replenish the earth, should be

lived no matter what the husband is doing; working, getting an educa­ tion, or collecting the material things of life" (in Roundy 1970, p« 9).

Bush (1976) points out that by the close of the nineteenth century the church had developed a comprehensive, if not systematic or exhaustive,

set of beliefs and teachings about fertility control. Early in the

1900’s the church became aware of a slightly falling birthrate. The reaction was quick and unmistakable. Bachelorhood and deliberate child­ lessness were attacked, while mothers of large families received special recognition (Bush 1976). The birthrate rose by ten percent within 10 years and again the subject slipped into a less obvious position. While it was not completely ignored, it was not as frequent a subject for dedicated harangue.

During the time between the late 1920’s and the development and easy availability of ’the pill,’ official statements seemed somewhat soft­ er. . In 1932, one authority referred to the fact that the ideal home must consider the health of the mother and the intelligence and health of the children (Bush 1976). Bush (1976) reports the view of John Widtsoe that the economic excuse for using birth control was seldom convincing. Widtsoe stated that if birth control was necessary it should be accomplished in nature’s way, which did not injure either man or woman (Bush 1976). The most gentle statement made on the subject was by Hugh B. Brown, church apostle, who stated: "The Latter Day Saints believe in large families whenever it is possible to provide for the necessities of life, for the 32 health and education of their children and when the physical and mental health of the mother permits’1 (in Bush 1976, p. 36) «

With the introduction of ’the pill’ for general use the situ­ ation changed. By 1965, the birth rate among Mormons had followed the national one in an unprecedented slide. The First Presidency still re­ iterated their earlier softer view in 1969.

The First Presidency is being asked from time to time as to what the attitude of the Church is regarding birth control. . . . We seriously regret that there should exist a sentiment or feeling among any members of the Church to curtail the birth of their children. We have been commanded to multiply and replenish the earth that we may have our posterity. Where husband and wife enjoy health and vigor and are free from im­ purities that would be entailed upon their posterity, it is contrary to the teachings of the Church artificially to cur­ tail or prevent the birth of children. We believe those who practice birth control will reap disappointment by and by. However, we feel that men must be considerate of their wives, who bear the greater responsibility, not only of bearing chil­ dren, but of caring for them through childhood. To this end the mother’s health and strength should be conserved and the husband’s consideration for his wife is his first duty, and self-control a dominant factor in all their relationships (in Bush 1976, p. 27).

McKay may have been less harsh in this statement because he believed and had stated in the past.

It is the policy of the Church to discourage the prevention of conception by any means unless the health of the mother demands it. It is also the policy of the Church to regard marital relations of husband and wife as their personal problem and responsibility to be solved and to be estab­ lished between them as a sacred relationship (in Bush 1976, p. 28).

This view was not necessarily shared by other church officials, some of whom continued to maintain the old hard line on childbearing. Joseph

Fielding Smith continued to reiterate his earlier stand on the evils of 33 limiting families and Mark E. Peterson used his Church News editorials to educate the membership on their responsibilities in this area. These views refused to even consider the overpopulation issue which was be­ ginning to be a national concern. One church news editorial stated,

11 o . o Are we to believe . . . that He is so blind and thoughtless that

He will overpopulate this earth? (in Bush 1976, p. 101).

Recently, with the installation of Spencer W. Kimball as the new

Church President and Prophet, the old line has been reestablished. In a speech at Spring Conference in 1977, he laid the blame for the drought conditions directly at the feet of the unfaithful membership, who en­ gaged in the forbidden practices of abortion, birth control, and other evils. In delivering this opinion, he is merely reiterating his pre­ vious stand on the issue, that nearly one-third of all young women be­ tween 18 and 24, are breaking the law of God in not bearing children

(Kimball 1963).

Although the edict of the church prohibiting birth control is clear, it is based more on the strong emphasis toward marriage, parent­ hood and family than on the evils of the behavior itself. There is a direct link between one’s procreative success and one’s status in the hereafter. Thus it is clear that birth control as a process is not the fundamental issue. It is an impediment which results in a failure to meet one’s spiritual obligations.

The position of the church on the ERA has had great impact on

Mormon women recently. Although Warenski (1978) points out that women who believe in and support a patriarchal priesthood could not, by 34 definition^ really support the ERA, many * closet* supporters can be found among the sisterhood. These women are very disturbed over the hardline position of the church in opposition to the ERA. Attempts to communicate with the top church officials have failed for at least one group of concerned Utah women after eight letters have passed between these women and Kimballf s secretary without any reply from Kimball him­ self. They doubt that he ever saw their letters. But they do not doubt his position. The following exerpt from the previously mentioned inter­ view with Kimball and the news writers leaves little doubt as to the official church position.

Q. What about the church's position on some ^issues which you have said are moral issues, like the ERA?

A. Well, if we consider it moral, we'll take a stand on it. But not if we consider it only political.

Q. What about a person in the church who favors the ERA?

A. We have many people already who have been pointed out as favoring the ERA. But we have done nothing with them. . . . 1 don't think one person has been excommunicated or disfellowshipped because she favored ERA (Briscoe and Wertz 1979).

These words have been interpreted by many Mormon women as containing a very thinly veiled warning. This uneasyness was not relieved by a re­ cent handout in at least one Utah ward priesthood meeting which stated that when a decision was released by the church authorities it was not to be questioned since the thinking had already been done. Such state­ ments clarify the position of women in the church. They are to produce but not to question the leadership of the priesthood. 35

Effect on Fertility

There is nothing unclear about the pronouncements of the church on the duty to have children. There is also nothing niggardly in the way this duty has been fulfilled. The fecundity of Mormons has been extensively studied by statistical number9 by attitudes, and by looking at variance between attitudes and behaviors, Mormons have been compared with other religious groups, They have been compared against themselves by locality, either in Zion or outside, or in metropolitan or non­ metropolitan areas. They have been compared cross-culturally within and without the United States. They have been compared by job, income, and education against each other and against outside groups, The results indicate several interesting facts.

Spicer and Gustavus (1974) cite tables which clearly indicate that the Mormon birthrate is significantly higher than that of the rest of the country. Their graphs also indicate that the rate fluctuates in about the same curves as those of the rest of the country. The authors theorize that Mormon couples may use their non-Mormon neighbors as a reference group and feel that they are obeying their command to multiply and be fruitful by having just a few more children than their neighbors.

Comparing various religious backgrounds, Poplin (1965) found the LoD.S. birthrate higher than that of Catholics or Lutherans. Com­ pared by metropolitan and non-metropolitan areas, they were still higher in every category. He got the same results when he compared the popula­ tion by income. He then made the assumptions that the positive emphasis on the values of family life, marriage and parenting was significant in 36 the higher fertility rate of the Mormons. He found that the higher the degree of acceptance of church teachings, the more a large family was valued as an important goal. He also hypothesized that an earlier mar­ riage a:ge is likely in members seeking these values, resulting in a longer fertility span. He concludes that the L.D.S„ Church has a value system which potentially influences the reproductive behavior of their members.

A recent study looked at pregnancy control attitudes and prac­ tices of large families (6 or more children) in rural Utah (Bell 1978).

These mothers indicated that they knew about birth control methods but thought that their use was an individual matter. Most of the women had used some form of control to space children. Many of the women felt that health was a valid reason for limiting family size, but overpopula­ tion and economics were not valid. They felt selfishness was the main motivation used by people who mechanically limited family size.

Effect on Attitude

One side effect within the Mormon culture has been the disparity which has surfaced in studies comparing attitudes and beliefs about

Church teachings and actual practices among the members. Harold T.

Christensen (1976) has done an in-depth study of this variance. He uses the phrase ’Value behavior discrepancy” to illustrate the problem. He looked at questions dealing with attitudes on pre-marital sex, and ap­ propriate dating behavior. He compared largely Mormon groups with groups of Europeans, Asians, and other selected United States areas.

His results indicated little discrepancy between belief and practice 37 with the Europeans, Asians and sections of the United States other than the Midwest and the Intermountain (Mormon) areas * In the Midwest, he found that attitudes were more permissive than actual experience demon­ strated. In the Intermountain area, however, there was more experience than would have been expected from the permissiveness of the attitudes.

He interpreted some of these results to indicate that this discrepancy between value and behavior forced rationalization resulting in negative responses to future experiences and related this to the high divorce rate among this group after a forced marriage due to premarital preg­ nancy.

In a study of a different type, Phyllis Roundy, in a 1970 mas­ ter’s thesis, looked at 1963 women graduates of Brigham Young University to evaluate how their present status as mothers reflected Church teach­ ings. She raised questions about actual and desired family size, use of contraception, working status of wife, and other possible influences on family size. Out of 360 answers on the subject of the use of con­ traception, she found 233 were using some form of birth control, of these, 117 were using the pill. She found that the majority of the wom­ en felt that six children constituted a large family and that for a sample of 372 there were currently 696 children. The reported desired number of children indicated by the participants was 1,727. The great­ est number of mothers were not working. Reasons given for postponement of children, in order of frequency of answers were, education, wife’s physical condition, finances, and social reasons, Mrs. Roundy concludes that for these women the Lord’s commandment to multiply has been broken 38 by the use of contraceptives5 and for reasons not valid according to church teachingsp Most of the families studied were financially able to support more children than they had (Roundy 1970).

These studies indicate the tremendous amount of pressure placed on L.D.Sp women to conform and to produce. The birthrate, while higher than the national average, is still not as high as strict adherence to the Church teachings would make it. Stress is thus placed upon any woman who decides not to capitulate to the expectation. The stress is no less for those women who are unable to bear children either from in­ fertility or from spinsterhood. At the core of this culture are mar­ riage and family.

Past Birthing Techniques

In the early days of the church, midwives were the basic care givers. They not only provided assistance with birthing, usually re­ ferred to as "putting to bed" (Noall 1974, p. 24), but also generally tended the sick and injured. In some localities, records of the mid­ wives were used to determine officially the number of births. Noall re­ ports that there were at least 108 active midwives (Noall 1942).

The early midwives did not have specific education into the med­ ical mysteries of delivering children. They had something many of them considered even more important. They were called by the Church Elders to perform these services and were given a special blessing at that time by one of the church authorities assuring them of the assistance of the

Lord in carrying out their duties. In view of primitive conditions and 39 lack of formal training, the success record is indeed astonishing. The reported number of failures is very small (Noall 1942).

There were several reasons for the lack of formal education for the midwives. Not the least of these was the difficulty in finding places where midwives could be trained. This was not the only reason, however, since when Brigham Young decided to have doctors trained, pros­ pects were sent East to the best schools. Many of those so trained were women who returned to Utah and set up schools for midwives and nurses.

The more likely reason for the delay in this training was that Brigham

Young did not approve of the ordinary medical care of the times. He ex­ horted that none should seek assistance of "Gentile" doctors, i.e., non-

Mormon doctors. One church leader is reported as saying that it was better that the Mormon loved ones dies unspotted, than to be saved if it required assistance from a Gentile (Noall 1942). The Mormon medical care was of the Thomsonian School. The course of training included spending a few months in Boston with Dr. Samual Thomson learning about herbal medicines and the principles of cleansing and heating the system

(Noall 1974). The Thomsonian view was that the cure for almost anything was available in nature.

Many of these midwives kept journals, in which they recorded the births and illnesses of the members complete with treatment and final outcome of the condition. The journals also include many of the recipes for potions and poultices used to heal various problems. One of the most complete and interesting journals available is that of Patty Ses­ sions, frequently called "Mother Sessions." She was one of the mainstays 40

of the women who were making the long trek West. She was 51 years old

at the time the trip began. Her notation for the 10th of February9

1846, tells of putting two women to bed, one with a daughter and the other with a son. Then she made herself a cap and went to a church meeting. Her journal tells of the stops and starts of the journey and the anguish of the hard winter and the families separated by travel and death. She also tells of the arrival at the Great Salt Lake and how the beauty of the place and the joy of their safe arrival made her grateful to God (Noall 1974).

Church records for the first year in the Salt Lake Valley re­ ported that *Mother Sessions1 had delivered 248 children since their ar­ rival in the Valley (Noall 1974). During her career, Patty Sessions is reported to have delivered 3,977 babies (Arrington 1976).

Eventually, attitudes changed and better medical schools opened in the East. Several Mormon women, some with children of their own, were called by the church and sent East to obtain the formal education required to improve care in Utah.

There was never a change in the attitude that the assistance of the Lord was required in successful medical care, however. Even women who had received the best medical training available always called in the Elders to annoint and bless the ill or delivering women as the mid­ wives had done when they were the only care givers. They themselves consistently called upon the strength and guidance of the Lord to assist their ministrations (Noall 1942). 41

There has been a recent return to the practice of utilizing midwives in childbearing. Beeman (1979) reports that midwives are legally practicing in some basically Mormon communities in Arizona.

She further reports a trend toward more family control in the birthing experience.

From all of this information it is possible to conclude that

Mormon women may have some special needs concerning the type of health care they receive which could be determined by studying their feelings about themselves and their health care needs. CHAPTER 3

METHODOLOGY

This study was designed to look at the Mormon culture in an attempt to identify areas where Mormon women might need specific types of health care because of their different beliefs and feelings. A de­ scriptive design was used since there were little data available which would actually support an hypothesis. Although I had some ’hunches* 1 I could neither support nor refute them with available data. The first step, therefore, was to look at the culture itself in an attempt to iso­ late ritual behavior and its effect on health care delivery.

Design of the Study

Participant observation of my own culture was combined with an interview technique. Because it is difficult to be objective when util­ izing participant observation, interviews were conducted to verify, identify, and solidify certain points. The interviews were conducted either in small groups or on a one to one basis. The interview technique utilized open-ended questions and as little imposed structure as possible in an attempt to prevent interviewer bias from influencing the responses of the informants. Questions were used only to stimulate discussion or return it to the broad topics. Notes were taken at the time of the in­ terview and were enlarged upon immediately after the interview was com­ pleted.

42 Sample

The criteria for admission to this study required participants to be:

1. 18 years of age or over,

2. members of the Mormon Church,

3. female,

. 4. English speaking with no other impediments to communication, and

5. be available for an interview in Utah or Arizona.

The sample was a convenience one obtained in part through an announce­ ment at a Relief Society meeting (the church women’s organization) ex­ plaining the study briefly and asking for volunteers. Family and friends were also invited to participate. Ttie first 20 women with whom satis­ factory arrangements could be made became the sample.

Human Subjects Protection

The study was cleared through The University of Arizona's Human

Subjects Committee and through the Human Subjects regulations of the

College of Nursing. The consent form is presented in Appendix A. A witness signature was used in most cases since the information was given orally to the group interviewees. It was also used to protect the iden­ tity of some of the subjects who did not wish to have their names re­ corded anywhere.

Data Collection Tool

The interview was the tool used in this study. Because of the need to avoid interviewer bias and in an attempt to prevent having the 44 informants assume interviewer knowledge on any particular subject, very general and open-ended questions were utilized. Examples of these ques­ tions include the following:

1. Tell me about your perceptions of your role as a women, a

wife, a mother, and a member of the Mormon church.

2. What influences your feelings about family size, spacing

of children, birth control?

3. What factors influence your choices in health care?

4. What kinds of behaviors were helpful during the birthing ex­

perience?

These questions were used only to stimulate conversation or re­ turn the discussion to the broad topics of women’s health issues and women’s roles. The women were all very talkative and after a brief de­ scription of the topics, rarely needed encouragement. The topics were described as being their feelings as women in and outside of the church, and on such issues as family size, marriage, pregnancy and the birthing experience, and health-illness needs.

Although the interview was scheduled to last one hour, many lasted considerably longer, particularly the group interviews. One group interview in Utah lasted four hours and then terminated only be­ cause the women had to go home to prepare supper for their families.

All were eager to share feelings and experiences.

Interviews were conducted in Utah and Arizona. There were two group interviews in Utah, one with eight participants and one with four 45

participants, Arizona had one group interview with four participants

and four individual interviews.

Data Analysis

Data Analysis for an ethnography consists of presenting the material accumulated from the study in a manner which will allow the reader to form an accurate picture of the study culture from descrip­

tions which range from generalizations to specific situations. Spradley

(1979) has identified six levels of data presentation which allow an author to organize and present data in the most appropriate methods for the readership. These levels consist of:

1. Statements which are based on broad and universal concepts which apply generally to all societies, i.e., women all over the world have special methods for birthing children.

2. Statements which compare two or more societies but which may not apply to any other cultures. Mormon women generally use hospi­ tals for the birthing process while African women often have home births.

3. General statements about a specific culture group, i.e., geographic location or universally shared traits, i.e.. Mormon women be­ lieve having children is an important duty.

4. General statements about an individual, identifiable cul­ tural unit, i.e.. Mormon women in Salt Lake City birth their children in hospitals.

5. Statements by informers identifying cultural use of terms and concepts, i.e., I prefer to have my child born in a hospital. 46

6. Statements by an observer describing specific behavior or

situations, i.e., after contacting the doctor to inform him her contrac­

tions were now five minutes apart and 45 seconds long, Sharon rides with

her husband to the hospital.

The utilization of these techniques must be balanced in accor­

dance with the nature of the material presented and the nature of the audience. In a scholarly work it is appropriate to concentrate heavily

on levels three and four with minor excursions into the other levels, particularly two and five to clarify relationships and provide addition­

al information.

Presentation of data analysis will be presented in accord with

the Spradley model. CHAPTER 4

PRESENTATION AND ANALYSIS OF THE DATA

Because of the nature of the data to be presented5 I have tried to organize the information into categories relating to life events -

The categories decided upon developed from trying to sort the informa­ tion into similar areas for comparison. I have chosen the following categories: 1. Importance of marriage; 2. family planning and spacing of children, 3. childbirth practices, and 4. special concerns. This chapter will begin with a presentation of the characteristics of the sample and will then proceed through the above categories.

Characteristics of the Sample

The sample included 20 women from ages 18 to 75. All were mem­ bers of the Mormon church. Eighteen had been members since birth and two were converts, one of about five years and the other of about two years. To some extent all participants were active in church activities.

All of the women spoke English and had not other communication barriers.

The women came from two different states. Twelve women resided within a 60 mile radius of Salt Lake City, Utah. The other eight women lived within a 130 mile radius of Tucson, Arizona. All came from com­ munities with a strong Mormon population.

Seventeen of the women had reared or were rearing at least one child. Three were rearing foster children in addition to their own

47 48 offspring and two had reared adopted children. Four of the women had never borne a child. Two had never married and had never borne or reared children. Two had histories of repeated unsuccessful pregnancies and two had been unable to conceive during their marriages. Two were now divorced. Figure 4 shows the number of children in each of the par­ ticipants families. Note that the greatest number of women reared 4 children. Large families were not in the majority.

The sample contained some women from each age bracket which I arbitrarily established as 10 year periods, with the exception of the first period which contains 12 years. Figure 5 shows the number of women in each age bracket. Although no attempt was made to select for a balanced age distribution, each decade is represented. The majority of the informants were under 50 with the mean age being 44.

Importance of Marriage

All of the women expressed an awareness of the importance of marriage and parenthood in their individual as well as in their spiri­ tual life. Four of the women had been married after the age of 25 and they discussed the pressure from other church members when they did not follow the general pattern of early marriage. The unmarried members expressed some ambivalent feelings about the fact that so much of life in the church surrounds the family that there was really no place for them in the social structure. Not only did they find themselves unable to participate without a spouse but they also had to deal with the con­ stant harrassment of members who continually questioned them on their Figure4 Number of Families with Each Number of Children 1 2 4- 3- 5- - - Characteristics theSampleInformant'sofSize Family * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 3 5 6 5 4 3 2 NumberofChildren EachReared by Women * * * * * * * * * * * * * * * * * * * * * * * * * * * • * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * VO iue . hrceitc o the CharacteristicsSample ofInformants ofAge Figure 5.

Number of Women in Each Age Decade 1 2 4 5 3 18-29 03 70-7940-49 60-69 50-59 30-39 Age in Decades Mean age = 44age Mean= inDecadesAge n i O 51 single status. One woman reported being singled out in a church meeting as being derelict in her spiritual duties because she was not yet married and started on a family. One unmarried woman said that she travelled a lot so she tried to find a family she could go to activities with in each of the places she spent considerable time. She said she did a lot of "taking care of other people’s children" until she .became more com­ fortable being without a partner at church functions. The two divorced women in the sample stated that they shared the problem of church activi­ ties. One said the pressure was so strong to find another husband that she had virtually stopped going to social activities which did not in­ volve her children. All of the participants agreed that the social life in the church is primarily based upon the family group and only occasion­ ally were there activities provided which focused on the individual.

Even such groups as the Relief Society focus on being a better mother, housekeeper, nurturer, spiritual and otherwise.

Recently the church has become aware of the increasing numbers of divorced or single people. They have instituted a special group for these people in an attempt to assist them with socialization and to pro­ vide a more rewarding experience in the church which does not depend on being married. The success of these groups has been mixed but the idea has met with much support.

Almost all of the women felt that their worth was frequently measured by how many children they had and how much work they did in the church. Those who also worked outside the home felt they had to justify their behavior and produce twice as much in church and at home to ?make /

52 up? for their other existence» A few of the women expressed some anger about being made to feel so guilty for doing something other than the prescribed role. One woman described the church expectations as requir­ ing her to be ?Super Woman.? Most of the women, however, did not feel such strong restrictions. They stated that the church gave them a spe­ cial status and a special responsibility, which they were glad to have.

They felt their role in the church had many rewards in prestige and praise. All of the women who felt this way had families. One woman said she loved having children around the house because they were the only way she felt as if she had value. If she couldnv t be raising chil­ dren she did not know what she would do. She hoped her children would quickly have big families so she could help raise her grandchildren.

This feeling was not expressed by all the women. Four of them said they would be very grateful when their children were grown so they could do some of the things they enjoyed; writing, painting, working, etc., with­ out feeling that they were neglecting their family responsibilities.

All of the women were aware that progression to the highest de­ gree of heavenly glory required marriage for time and all eternity. The unmarried women said they felt this as a strong burden and were always hoping someone would come along. One of the unmarried women was in her seventies, and she said she hoped God could make up for her lack somehow.

Several of the other women stated that the pressure to marry had re­ sulted in settling for marriage instead of college or some other desired activity. 53

This strong emphasis on marriage and family may have something to do with the serious problem the church has with teenage pregnancy.

This situation represents a double crisis since marriage is the only acceptable cure for the situation and the Temple marriage for time and all eternity is usually not available in this situation because of the nature of the marriage. The couple must have a civil service and wait until later for the Temple marriage. This results in embarrassment to the families and participants.

The importance of marriage was delineated by one informant who said that.she felt that without marriage one was only ’second rate.’

Contribution to the group as well as one’s own spiritual progression was more effective within the marital framework. Most of the women corrobor­ ated this feeling9 pointing out that it was because the priesthood was necessary in order to be a fully contributing member and it was only availalbe to women through the patriarchy.

Family Planning and Spacing of Children

On the subject of family planning or spacing of children, all the participants agreed that the church expected them to have as many children as possible. There was disagreement on the determination of timing, actual number, and reasonable excuses for spacing or not having additional children. There was also a difference in how the women felt about this responsibility. Some of the differences seemed to depend on age. Table 1 shows the breakdown of how the informants responded on the subject of reasons to postpone childbearing. The young women under 30, one of the women in the 30-40 bracket, and one in the 60-70 bracket all Table 1* Reasons for Delaying Pregnancy or Spacing Children

Informant's Sample No Acceptable Job Physical Mental Age Decade Size Reason to Delay* Education* Security* Health* Health*

18-29 4 25 0 0 75 0

30-39 5 0 40 20 100 80

40—49 4 0 75 25 100 75

50-59 3 0 66 33 100 66

60-69 2 0 50 0 100 50

70-79 2 0 100 50 100 100

^Number in each block represents percentage in each age decade who agree that pregnancy can be delayed for the designated reason.

Ui 55

felt there was no acceptable reason for delaying pregnancy or controlling

family size other than severe health problems. When some of the older

women questioned them about education, job security, or quality of life,

the young women responded that since it was God's commandment, he would

find a way. One of the grandmothers then stated she felt she must be

"God's way" since she would either have to help support her children's

families or else watch them give up their education or suffer other

deprivation. This particular woman felt this was an unacceptable re­

sponsibility but three of the other women over 60 said they did not

agree. They were willing and eager to serve in this capacity. However,

all but one of the women over 50 and three of the women under 50 felt

there were other legitimate reasons for delaying family. The possible

reasons included, education, having a job, being able to afford to have

a baby, and stress level in the home. The only reason that was accept­

able to all of these women was education.

What constituted 'severe' health problems was also discussed.

The women under 30 felt that the problem must be life threatening. Only

one of the women under 30 felt that a pregnancy could be terminated if

it was life threatening. All of the other women in this category stated

that they were referring to preexisting conditions and preventing preg­ nancy. One of the women had carried a pregnancy to term while being

treated for a brain condition and had refused to terminate the pregnancy at medical advice. All but two of the women over 30 felt that there were other 'medical' considerations that were acceptable reasons for de­

laying pregnancy. They talked of the physical drain of pregnancy and 56 lactation and the possible physical effects on future children of not permitting recovery time between pregnancies. They also felt mental health was an issue. They all agreed that some women simply could not stand the strain of many children too close together. Three of the women felt this was a defect in the woman.

The subject of abortion was discussed. Only three of the women felt that an abortion was ever an alternative. None of these women felt it could be used for birth control purposes. One felt it could only be used if the mother’s life was in danger and the other two felt it could be used if the mother’s life or mental, status was in danger.

The other 17 women were adamant that abortion is never an alternative.

Adoption was an acceptable alternative under some circumstances. It was generally considered acceptable for unmarried mothers if there was some really good reason why they could not marry the father of the child.

The informants discussed methods of spacing children or termin­ ating childbearing. Two women felt that permanent sterilization could be used after desired family size had been reached. One other woman felt it could only be utilized if there was a nonreparable condition which would make further pregnancy life threatening. All of the women would accept a hysterectomy if medically necessary but not if its main purpose was to terminate childbearing. Table 2 shows the percentages of informants who would consider various methods of birth control ac­ ceptable. Five of the women felt mechanical and pharmaceutical birth control was acceptable and should be utilized when needed. Four of the participants felt only natural methods such as rhythm, lactation. 57

Table 2. Acceptability of Birth Control Methods

Informant's Sample Natural Either Natural Unde­ Age Decade Size Only* or Artificial* cided* None *

18-29 - 4 50 25 0 25

30-39 5 20 60 20 0

40-49 4 0 100 0 0

50-59 3 0 66 33 0

60-69 2 50 50 0 0

70-79 2 0 100 0 0

^Number in each block represents the percentage in each age group who consider the method acceptable. withdrawal, and abstinence were acceptable. Some methods unacceptable by Biblical standards may be acceptable as natural methods since any method, natural or otherwise, requires additional justification. If the justification is present the question becomes whether the contraceptive method utilizes external intervention. If not, it is considered natural.

One woman said no method could be used by a married woman since concep­ tion should never be interferred with or stopped. Two women were unsure about what methods would be acceptable but they had never used anything themselves. Eight women said it didn’t matter what type of contracep­ tion was used, the issue was that it was to be used only as long as ab­ solutely necessary. All of the women agreed that there was a religious responsibility to have children. Most of the women had seen Saturday’s

Warriors and only three had been upset by the message it portrayed. The rest of the women who had seen it felt it had been very inspirational and explanatory.

Childbirth Practices

All of the informants utilized the physician as the head of the obstetrical care delivery team. Two of the women stated that if they were having children now they would consider a midwife instead. All of the participants had delivered in the hospital but one had also had a home delivery with a physician in attendance. The woman who had had the home delivery stated that she had felt ’safer’ in the hospital but it must be pointed out that the home delivery had been about 30 years ago.

When it came to choosing the doctor, the majority of the women said they would feel more comfortable with a doctor who was a member of 59

the church» They said they felt better with a doctor where "you could

be sure God was helping him." They felt this would be the case because a Mormon doctor would have the priesthood to guide him. As an example9

one woman refused to consult a second physician because her doctor was her Bishop and she was sure God was assisting him so no further help was needed. The other women said it was not critical that the doctor be

Mormon since you could have the Elders come in to give you a blessing and

that would keep you safe. Two of the women stated they had had women doctors and had been very pleased. Several of the other women stated

they would have preferred to have women but had been unable to find ac­ ceptable ones.

Prenatal care was considered essential. All of the women felt

that such care should begin as soon as pregnancy was suspected. They

felt it was their responsibility to ensure that they had followed all

the medical rules of care so they could produce a ’goodv baby. During

the prenatal period it is acceptable for the mother to reduce her church activities in order to insure adequate rest. She may even take a nap in the afternoon. She is permitted to cut down a little on the amount of household chore work and may ask for and receive assistance from spouse or other Relief Society sisters. In the event that illness should accompany the pregnancy she can count on the sisters to provide assist­ ance with household work and child care. She is expected to follow the doctor’s instructions to the letter. Prenatal instruction is not dis­ couraged by the church. Although the medical model is the accepted meth­ od for care some leaway is available. In mral areas of Utah and Arizona 60 midwives are being utilized with increasing frequency. The woman is also free to choose a specific type of prenatal and labor instruction, i.e., Bradley, Lamaze, etc., if she wishes. I There are no special rules in force during labor and delivery.

The presence of the husband in the labor room or the delivery room is a personal decision. The only exception is the understanding shared by all of my informants that they were to behave as responsible strong women and not yell or give into unseemly displays of discomfort during the labor and delivery process. Several of the women indicated that they had been unsuccessful in this behavior and felt that they had let their pioneer heritage down.

After the infant is born the mother remains in the hospital the amount of time prescribed by her particular medical model. When she returns home she will often have her mother, sister, or some female relative to help for a week or two. If there is no one who can come to assist her during this time, the Relief Society sisters will step in to give whatever assistance is needed. These services will be provided un­ til the new mother is once again able to cope on her own. She is re­ sponsible for doing whatever is necessary to recover in the shortest possible time. These services will be provided in any time of illness or extended hospital stay, either pre or post parturn and will be con­ tinued as long as genuinely needed. Because having and rearing children is her major responsibility, the new mother will be permitted to continue her light load at church. 61

Breastfeeding is encouraged„ Lactation is considered an

important time for the mother and infant and she is expected to center her major time and interests on the infant.

Infant care usually reflects the approved medical teachings of

the era. Male infants are usually circumsized but this is not re­ quired by the religion. All of the informants had had their male chil­ dren circumsized.

Infants are not baptized in the Mormon Church. Each infant is given a father's blessing (a prayer for well-being, strength, and a good life) and a name on the first Sunday of the first month following birth unless illness prevents. Baptism does not occur until the age of eight. There is no need to baptize an infant that is about to expire.

Special Concerns

Some of the information from my informants did not fit in any of the previous categories but represented matters of special concern^ for a majority of the informants. Two of the items deal with ritual behavior specific to the members of this culture, the blessing for the sick, and the wearing of the garment. The third item concerns the at­ titudes of health care givers and how these attitudes effect the re­ sponses of health care givers to members of this culture. Because of the special significance of these items they have been included in this section.

The blessing is a special prayer that is administered to anyone who is about to undergo surgery, some special procedure, or is ill. It must be administered by men holding at least the level of Elder in the 62

Melchizedek prietshood. During this procedure a specially blessed oil

is used to anoint the individual. Several of my informants who had

been hospitalized in ’gentile’ hospitals away from family and friends

stated that they had been very upset because the staff did not know how

to contact the church in that location so they had been unable to re­

ceive this blessing. They stated that it brings them considerable

peace of mind and they were definitely uneasy about not being able to

receive it. This blessing is equally, important to less active members,

who may be more hesitant in requesting it.

The second concern was that of the garment which is an item of

clothing much like long underwear. It is worn by any Mormon who has

been through the special ceremonies in the Temple. The women were not

in complete agreement as to what the church position on wearing these

garments in the hospital was, but the majority felt that they felt saf­

er with them on. Some said they had worn them in the hospital at all

times except for the actual delivery. Those who had delivered in a

gentile hospital said they had not worn them because it was too diffi­

cult and uncomfortable to try to explain them to ’gentile’ care givers.

For this reason they preferred hospitalization in a Mormon hospital but

realized this often was not possible. One of the women said it was her

understanding that she should never be without the garment and bathed with one foot still in it until she could put the clean one on the

other foot. Several of the women said that it was important not to

die without having it on. One woman said she hoped she would never have

to be in a gentile hospital if it meant she could not wear her garments. 63

The final issue to be dealt with in this section was brought up by one of the informants who had had repeated miscarriages around

the fourth to sixth months of pregnancy. She said that the nurses sym­ pathized with her but usually said things like, "you can try again," or

"you have one child at home, that’s enough." She said she appreciated them trying to make her feel better but they just didnTt understand.

She said her failure to produce living children was having a detrimental effect on her image of herself, on her status in the church, and her marriage. Platitudes were not really helpful. Two other women then added their feelings concerning similar situations. One said she had been hospitalized about 100 miles from her home for three months with the last pregnancy. She had four children at home all quite young.

She reported that the nurses kept telling her she should just abort this pregnancy, after all she had kids at home and she should be home tending them. She said she knew the children were in good hands with the Relief Society sisters and she felt her responsibility was to deliv­ er a healthy baby is possible. She said she was hurt that the nurses felt she was failing in her duty to her other children. She didn’t know how to explain to them.

Summary

Since this study was an ethnography, it was conducted by inter­ viewing the people who were the experts on the subject, the members of the Mormon culture. The information obtained was intended to lay a basis for possible hypothesis formation. Spradley (1979) points out 64

that information obtained by interview with informants is frequently

different than that obtained from questionnaires because information

is not as subject to a preinterpretation by the researcher and because

questionnaires are sometimes seen as threatening by informants, In

order to avoid researcher bias or direct answers into predetermined categories it is first necessary to learn how the informant sees her own culture. From this basis a more reliable hypothesis or study ques­

tion can be formed.

After analyzing the material obtained from, the 20 informants intervieweds several interesting observations can be made. The first observation is that all of the women were very willing and eager to talk about their needs and experiences. They were willing to share their feelings and beliefs about the areas discussed, specifically, mar­ riage, childbearing, and the role of women. These women seemed to feel that there were some areas of their health care which were affected by their culture and which health care givers needed to know about in order to provide good care to them. Examples of such areas were birth control, privacy, provision of religious rituals, and attitude of health care giver concerning their cultural demands.

It is important to note that although many of the physical ele­ ments of their health care are not significantly different from that of the dominant culture in the United States, these women have some very different views and beliefs about themselves and having families which influence how they perceive their needs. 65

Health care given with some of these influences in mind will be more likely to meet the needs of Mormon women. An understanding of the importance of childbearing and family will assist the care giver in planning the type of assistance needed and in eliciting problems from the client. An understanding of the closeness of the members of this culture may assist in obtaining aid or prevent a misunderstanding be­ tween care givers and their clients, Special areas of health care de­ livery can be investigated more thoroughly to identify needs and methods of meeting these needs e CHAPTER 5

DISCUSSION AND RECOMMENDATIONS FOR FURTHER STUDY

Included in this chapter are a discussion of the findings, implications for health care delivery, particularly in the area of childbearing, and recommendations for further study.

Discussion of the Findings

One of the most significant findings in this study was the eager­ ness with which the participants shared their feelings and concerns.

The sessions were not used for complaining, but centered on issues these women felt were important. This indicated that a need does exist to provide insight into particular client concerns to enable care givers to meet client needs more fully. One good way to provide this insight is through analyzing client input to isolate critical factors. By al­ lowing these women to express their views it is possible to begin to zero in on specific differences in needs.

Several areas of special need appear in this data. One area is the importance of childbearing within this culture. This has bearing not only upon the actual birthing process but also upon the problems of infertility, failure to produce a viable infant and contraception. All of the informants expressed the importance of successfully bearing chil­ dren. The fact that the Mormon birth rate exceeds that of the rest of the United States indicates that this value is practiced as well as

66 ' '■ - 1

67 preached. Marriage is important because this culture does not readily accept unwed mothers. Spinsterhood and infertility are seen as crises by all of the respondents.

Contraception is a major problem within this area. Its use is in direct violation of church teachings but some of the women feel its use is justified under certain conditions, such as ill health and high maternal stress. Methods of family size control which are acceptable may also be an issue. Twenty percent of the sample felt only natural methods would be acceptable. Sixty-five percent of the participants felt natural, pharmacological, or mechanical methods could be utilized for the acceptable reasons and length of time only.

Another important finding concerns how the sick-well role of the pregnant, newly delivered, or lactating mother is perceived. Mor­ mons have some specific rules concerning this role. While pregnancy is not identified as a sick role it does not require the same level of functioning expected of an individual in optimum health. There are al­ lowances made for extra rest and slightly less productivity at home as well as within the church organization. If some complication arises either pre- or post-delivery, a well organized system of members will mobilize to provide supportive care for the duration of the disability.

Continuation of these services is dependent upon the cooperation of the mother in an attempt to return to a healthy position as soon as possible.

The mother is seen as being directly responsible for following appro­ priate medical intervention for perinatal care to provide an acceptable outcome, i.e., healthy baby, healthy mother. 68

The next finding deals with choosing a mode of health care services• The medical model is acceptable to the majority of the re­ spondents although members of this culture are susceptible to some of the current outside influences such as holistic medicine and home birth.

There is a definite feeling among the majority of the informants that it is better for the outcome of the event if the care giver is a Mormon.

It is felt that a Mormon would provide an additional quality in their care which is not available from vgentilef doctors who do not have the benefit of the priesthood. This feeling may also be influenced by the ethnic identity of this culture. This identity results from the shared history and experiences of the group. It includes such things as the early church history of distrust for fgentile’ medical people and the special garment and ritual behaviors shared by the members of the cul­ ture.

The next finding deals with the religious ordinances of this culture. All of the members felt it was very important for them to have access to members of the priesthood so they could receive the special blessing relating to illness or labor and delivery. This blessing was seen as significant in the outcome and recovery process. The other or­ dinance which was particularly important to these women related to the garments worn by all members who have participated in special Temple ceremonies. Many of the women said they felt unprotected when they were unable to wear these garments but also felt uncomfortable wearing them around uninformed ’gentiles.? 69

The last finding is that there are some areas of the childbear­ ing experience which do not differ significantly from those of the dom­ inant culturee Among these areas are the willingness to accept medical intervention in all areas of the childbearing process. There are no special behaviors concerning the labor process other than the expecta­ tion that the participant will be strong and uncomplaining throughout the experience. This is not really at variance with the behavior ex­ pected by the health care givers of their clients. There are also no special procedures required by the newly delivered mother. No special church service is required after birth to readmit the mother into the society. There are no specific beliefs concerning infant care either for the newborn or for the older infant which concern health care de­ liverers. Newborns and infants are not baptized in this culture so no special procedure is needed if death is imminent. There are also no special death rites required before actual death occurs in the adult,

The only significant dietary restrictions are from stimulating beverages such as coffee and tea. All foods are permitted at the member’s dis­ cretion or taste. There are generally ho restrictions on methods of preparation.

Implications for Childbearing

Incorporation of specific health care practices required to fully and adequately care for clients of different cultural backgrounds is rapidly becoming an important professional obligation. There are some practices9 particularly important to nursing„ since more immediate 70 and lengthy client contact occurs between the nurse and client, but also of value to other health care deliverers, which appear from the findings in this study. The majority of the items deal with understanding of the client's feelings and emotional needs rather than with specific physical requirements.

The first area deals with the importance of production of chil­ dren. This is specially significant when dealing with a client who has experienced repeated unsuccessful pregnancies. Comments frequently giv­ en by nurses to comfort such clients center around the possibility of adoption and being grateful for children already in the family. This is not appropriate for a woman whose grief is directly related to the re­ ligious mandate that she provide bodies for waiting spirits. The issue is not merely raising children but bearing them. This philosophy is also important in understanding the needs of a Mormon mother grieving the death of a child born alive. Since her religion teaches that such death is only a passing on to new progressions, the grieving will gener­ ally center on the sorrow of loss to those who remain rather than the finality of death.

Another variance which may occur lies in long-term hospitaliza­ tion for a mother with young children at home. Although the Mormon mother will miss her family, her major concern may be with the current pregnancy as she is probably secure in knowing her family is well cared for by the Relief Society members. The nurse should ascertain the avail­ ability of such help before becoming angry with a client who does not 71 wish to hurry or terminate a pregnancy or who displays less concern for family welfare than the nurse expects.

Birth control may be another area where the health care deliv­ erer will need to carefully assess the client's wishes before assuming the therapy will be desired or accepted. Methods to be used, if any, will need to be tailored to the client’s beliefs and teaching may need to center on preparing the mother for another pregnancy with rest and nutrition rather than prevention of conception.

Health care givers should be aware of the importance of having priesthood members available. Each hospital unit should know how to - contact the local church group to provide services for members who may be away from their usual place of residence. Willingness to contact the church should be indicated to any member who is hospitalized. Privacy should be provided all clients during visits from the priesthood mem­ bers. Extra privacy should also be provided for the hospitalized mother so she may wear her garments without fear of embarrassment or intrusion.

Each Mormon woman should be recognized as having special needs as a result of her culture which may not be familiar to the health care giver. Assessment skills should be utilized to assist in delineating areas which need consideration.

Recommendations for Further Study

1. A study investigating actual care delivered to Mormon clients relating to the categories delineated be made. 72

2o A study investigating how Mormon women perceive hospital nursing intervention in the childbearing area as related to their per­ ceptions of ideal care be made,

3, A study to investigate additional areas in the lives of Mor­ mon women be made to delineate new categories of concern for health care deliverers,

4, A study be made to investigate whether Mormon men have health care needs which are not currently being satisfied,

5, A study be made to investigate child rearing responsibil­ ities. APPENDIX A

CONSENT FORM

You are being asked to voluntarily participate in a study titled "Mormon Patterns of Birthing and Their Implications for Health Care De­ livery." The purpose of this study is to examine feelings and actions of Mormon women related to women’s health care. I hope to be able to determine the existence of special needs, if any in fact exist, which are not currently being met for Mormon women by health care deliverers. To obtain this information I am conducting interviews with Mormon women age 18 or over.

The data will be collected in a single interview of about one hour. The interview may be as an individual or in a small group. It may be taped or notes may be taken at the time of the interview. The time and place will be mutually agreed upon in advance.

Your participation in the interview will be assumed to indicate your willing consent to participate in this study.

The information obtained is intended for publication, teaching, and a Master’s Thesis. Your identity will remain completely confiden­ tial, Your name and address will never be recorded and will not be used in connection with any portion of this material. All material will be number coded and grouped so there is no way to identify any individual.

There will be no costs, benefits, or payments to you as a re­ sult of your participation. There are no known risks to you. You may refuse to answer any question, ask any question relevant to the study, or completely withdraw at any time without incurring any ill will.

Thank you for your help. The success of this project depends on your participation and I believe you will find it interesting. I will provide you with a summary of the findings upon request. If you have any questions concerning this study do not hesitate to ask me at any time or to contact me at the address and number below.

Sarah Lydia Stark, 1232 S. Normount Ave., Tucson, AZ 85713 (602) 325-8455.

Signature of witness to distribution of information Date

73 LIST OF REFERENCES

Aamodt, Agnes M. "Culture," Culture, Childbearing Health Professionals ed. Ann L. Clark, (Philadelphia: F. A. Davis, 1978), pp. 3-19.

Alder, Douglas D. "The Mormon Ward: Congregation or Community?" Journal of Mormon History, Vol. 5, 1978, pp. 60-78.

Arrington, Chris Rigby. "Pioneer Midwives," Mormon Sisters, ed. Claudia L. Bushman (Mass.: Emmeline Press Limited, 1976), pp. 43-66.

Beeman, Ruth. Unpublished report of the Arizona Advisory Task Force on Maternity Care, 1979.

Bell, Kaydon. "Pregnancy Control Knowledge, Practices, and Attitudes of Multiparous Women in Rural Utah, (Masters Thesis, University of Utah, 1978).

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