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CULTURAL COMPETENCY/Building Competency


It is imperative that providers, clinicians, and clinic staff understand and embrace the importance of building personal and organizational cultural and linguistic competency.

In April 2003, the National Abortion Federation invited experts on cultural and linguistic competence to train reproductive health care providers and activists about how to develop a culturally competent workplace and to provide strategies for addressing the concerns and specific needs of women of color, low-income women, and immigrant women. Read Developing Cultural Competence in Reproductive Health Care: Understanding Every Woman (PDF file, 2.2 MB).

Three key recommendations were identified by seminar participants to assist providers and clinic staff in building cultural competency:

  • Incorporate the challenge of cultural competence into the philosophy, staffing and budget of your organization. More
  • Expand your affiliations with local and national service, education, and advocacy organizations concerned with the needs of women from diverse backgrounds. More
  • Improve your ability to communicate with clients and provide a welcoming environment for all women, including non-English speaking women. More

Incorporate the challenge of cultural competence into the philosophy, staffing and budget of your organization.

The first step is to incorporate the value of cultural competence into the basic philosophy of your organization and systematically evaluate which aspects of your organization would benefit from developing cultural competence.

What you can do:

  • Identify the different communities served by your organization. Once you have determined the different groups among your clientele, research the unique barriers faced by women in each of these communities.
  • Talk to other nonprofit organizations in the area or poll your clients about how you might better serve them.
  • Assess your staff and the structure of your organization. Does your staff come from the communities they serve?
  • When you are hiring, write job descriptions that include language to reflect your commitment to cultural and linguistic competence.
  • Recruit job candidates from communities of color by placing advertisements for open positions in venues besides the local newspaper.
  • Once you make a hiring decision, incorporate cultural competence into your protocols for training and evaluating new staff. During the orientation for new employees, share information about underserved women in your community.
  • Create an annual employee feedback survey that includes questions about the cultural and linguistic competence of the organization, both at the level of client services and among the staff.
  • Changing the hiring and staffing patterns of your organization should include formal training in cultural competence. Some NAF member clinics devote at least one day a year to training, and every staff member is required to attend.

Developing cultural competence requires an investment of both time and financial resources. Although the amount of money required to create outreach programs and train staff is not necessarily a significant sum, it does need to be incorporated into your organization budget, for instance as a line item for staff training or for the development of translated materials. This is the only way to ensure that your philosophical commitment to cultural and linguistic competence becomes a reality. Regardless of where you start, the simple act of stating the problem will make it possible to identify solutions that will benefit the women you serve.

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Expand your affiliations with local and national service, education, and advocacy organizations concerned with the needs of women from diverse backgrounds.

As part of reaching out to different groups in your community, seek out opportunities to establish new affiliations with organizations serving women of color, low-income, and immigrant women. These affiliations might begin as informational meetings between members of your staff and representatives of these groups, or they might be as formal as co-sponsoring conferences and events. This will allow your organization to build meaningful relationships with the communities you serve, which will provide you with more insights about culturally influenced health behaviors and how best to meet the needs of these constituencies and your clients.

What you can do:

  • Find out how women can travel to your organization using public transportation by locating the nearest bus line.
  • Increase the visibility of your organization by co-sponsoring events in your community. Sign on with charity walks for breast cancer research or the American Heart Association. Contact the local medical school and find out if students have organized mobile clinics that your organization can contribute to with volunteers or supplies.
  • Celebrate Black History Month or International Women's Day at your organization with poster displays or special events.
  • Network and develop relationships with religious pro-choice organizations.
  • Engage in educational outreach to underserved communities. For example, you could give presentations about reproductive health and sexuality to teens in local high schools and community colleges.

In addition to learning from and working with the people in your community, you might also be in touch with other reproductive health organizations that have made efforts to develop culturally competent care. One example of this kind of networking is the SisterSong Women of Color Reproductive Rights Collective, which began in 1997 when the Latina Roundtable on Health and Reproductive Rights convened meetings for sixteen organizations representing four women of color communities - African American, Asian and Pacific Islander, Latina, and Native American.

NAF was a co-sponsor for the first annual SisterSong conference in Atlanta, GA in November 2003, where hundreds of women of color activists and allies gathered to discuss the concerns and address the reproductive health care needs of women in diverse communities. The primary function of the collective is to lend mutual support in initiating and enhancing local programs to foster increased awareness of reproductive health care for women of color. Visit the SisterSong website.

The women who come to you for services do so out of a particular need, but they cannot be reduced to that need. The more that you are able to learn about who they are and how they live, you will be in a better position to provide appropriate care.

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Improve your ability to communicate with clients and provide a welcoming environment for all women, including non-English speaking women.

Regardless of the measures your organization takes to develop a deep understanding of different groups in your community, this endeavor will be wasted if you are not able to communicate with your clients. Linguistic competence in the realm of client materials is essential to your ability to provide quality care. Immigrant women, women who do not speak English, and women with limited education need client materials in different languages using basic vocabulary.

What you can do:

  • Create pictographs to convey information without the necessity of words.
  • Work on translating the most important materials first, like pre-appointment guides and counseling information. This will provide a basic level of communication about what your client can expect.
  • To assess your linguistic and cultural competence, add questions to a post-operative form in which you ask your clients directly about their experiences with your services and staff.
  • Hire multi-lingual staff, and work with interpreters on an as-needed basis. Interpreters can be found via local translation services listed in your phonebook. Several clinics have also successfully used graduate students at universities.
  • Even if staff members are not fluent in a particular language, the ability to say a few welcoming words in the client's language builds trust and puts the client at ease.

Along with transforming written and verbal communications between staff and clients, take time to evaluate the physical aspects of your organization. Do the posters in your waiting area include images of women of different ages and ethnicities? Are the posters filled with words or do they contain pictures as well?

The goal is not to completely transform into a culturally and linguistically competent organization in one day, but to make incremental changes on a variety of levels to make sure that all women who enter your door will find some reflection of themselves inside.

The preceding was excerpted from the NAF publication Developing Cultural Competence in Reproductive Health Care: Understanding Every Woman (PDF file, 2.2 M) © 2004.

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