Social and Cultural Practices affecting health and disease in family. Give answer from Park's Textbook of Preventive and Social Medicine

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Social and Cultural Practices Affecting Health and Disease in the Family

(Park's Textbook of Preventive and Social Medicine)

Park's discusses social and cultural factors under the broader framework of determinants of health, specifically in the context of family health and infant/child mortality. These are classified under "(3) Cultural and Social Factors" and are presented as follows:

(a) Breast-feeding

Infant health is directly related to breast-feeding because of the nutritional content and natural immunizing agents in breast milk. Early weaning and bottle-feeding under poor hygienic conditions significantly increases infant mortality. Fully breast-fed infants have better survival rates even in similar socio-economic environments.

(b) Religion and Caste

Differences in health outcomes between communities are attributed to socio-cultural patterns of living, involving age-old habits, customs, and traditions that affect cleanliness, eating, clothing, child care, and almost every detail of daily living. Religion and caste determine dietary practices, hygiene norms, and access to healthcare.

(c) Early Marriages

The child of a teenage mother carries the highest risk for neonatal and post-neonatal mortality. Early marriage - a common social practice in parts of India - leads to early childbearing, resulting in higher maternal and infant mortality. Women with schooling (as noted under maternal education) tend to marry later and delay child-bearing.

(d) Sex of the Child (Gender Discrimination)

In most parts of India, female infants receive far less attention than males, especially where there are already several female children. Statistics show:

Female infant mortality is higher than male infant mortality overall.
However, neonatal death rate is higher for males than female infants.
Post-neonatal death rate is higher for females, reflecting deliberate neglect and discrimination.

The birth of a female child being unwelcome in many families directly translates into increased female post-neonatal mortality.

(e) Quality of Mothering

The art of child care must be learnt. Even in conditions of extreme poverty, children could reasonably survive if they have an efficient, attentive mother. The "quality of mothering" - shaped by cultural norms, knowledge, and societal support - is a key factor in reducing infant mortality.

(f) Maternal Education

Illiteracy is the greatest barrier to any improvement in health conditions. Mother's education level, even within the same socio-economic class, is a key determinant of children's health. The Kerala experience demonstrates that maternal education plays a major role in the decline of infant and child mortality.

Women with schooling tend to:

Marry later
Delay child-bearing
Practice family planning more reliably
Have fewer children with wider birth spacing
Make better use of healthcare services

(g) Quality of Health Care and Trained Birth Attendants

A significant determinant of infant mortality in India is inadequate prenatal care and infrequent attendance at delivery. The percentage of deliveries attended by untrained persons or relatives is very high in rural India. Only an estimated 47% of deliveries are attended by trained birth attendants, reflecting how social norms and geographic barriers prevent access to skilled care.

(h) Broken Families

Infant mortality tends to be higher where the mother or father has died or separated. Family structure and stability directly influence child health outcomes. Single-parent households often face economic stress, reduced caregiving capacity, and social stigma.

Broader Social and Cultural Determinants (from the Social Determinants Framework in Park's)

Park's also lists the following socio-cultural factors under the broader determinants of health (Table 9):

Social class - higher social class correlates with better health outcomes
Ethnic and cultural group - cultural identity shapes health behaviours
Family disruption, education, housing - all affect health access and outcomes
Customs, habits and behaviour - e.g., smoking, lack of exercise, over-eating, drug addiction
Access to health services - often shaped by cultural attitudes toward modern medicine
Lifestyles - culturally determined food choices, physical activity, hygiene practices

Child Death Rate (Ages 1-4) as a Cultural Indicator

The child death rate (1-4 years) is considered a more refined indicator of the social situation in a country than infant mortality rate. It reflects adverse environmental health hazards including economic, educational, and cultural characteristics of the family. In developing countries, the second year of life is the highest-risk period, when infectious diseases (measles, whooping cough, diphtheria, diarrhoea, ARI) interact fatally with malnutrition - outcomes largely shaped by family-level cultural practices around feeding, hygiene, and treatment-seeking.

Summary Table

Social/Cultural Factor	Health Impact
Breast-feeding practices	Infant survival, immunity
Religion and caste customs	Hygiene, diet, child care
Early marriage	High neonatal/maternal mortality
Sex discrimination (female neglect)	Excess female post-neonatal mortality
Quality of mothering	Child survival despite poverty
Maternal illiteracy	Poor child health, high IMR
Untrained birth attendants	High perinatal mortality
Broken/disrupted families	Increased infant mortality
Food taboos, customs, habits	Malnutrition, disease susceptibility
Lifestyle practices	Chronic disease risk

Source: Park's Textbook of Preventive and Social Medicine, Chapter on Family Health / Cultural and Social Factors (Section on Infant Mortality and Determinants of Health)

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