# Measuring Cultural Alignment Beyond the Average: A Framework for Evaluating Maternal-Health LLM Interactions in Indian Contexts

arXiv: https://arxiv.org/abs/2610.11586 · HTML: https://mlsanity.com/paper/2610.11586/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 10 of its 26 references that are in the map.
- First posted on arXiv 8 Oct 2026.

## Builds on (most cited first, 10 of 10)

- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [WorldValuesBench: A Large-Scale Benchmark Dataset for Multi-Cultural Value Awareness of Language Models](https://mlsanity.com/paper/2404.16308/) (2024)
- [Cactus: Towards Psychological Counseling Conversations using Cognitive Behavioral Theory](https://mlsanity.com/paper/2407.03103/) (2024)
- [CulturePark: Boosting Cross-cultural Understanding in Large Language Models](https://mlsanity.com/paper/2405.15145/) (2024)
- [Cultural Conditioning or Placebo? On the Effectiveness of Socio-Demographic Prompting](https://mlsanity.com/paper/2406.11661/) (2024)
- [DiaSynth: Synthetic Dialogue Generation Framework for Low Resource Dialogue Applications](https://mlsanity.com/paper/2409.19020/) (2024)
- [Synthetic Patient-Physician Dialogue Generation from Clinical Notes Using LLM](https://mlsanity.com/paper/2408.06285/) (2024)
- [Synthetic Data Generation with LLM for Improved Depression Prediction](https://mlsanity.com/paper/2411.17672/) (2024)
- [Cultural Fidelity in Large-Language Models: An Evaluation of Online Language Resources as a Driver of Model Performance in Value Representation](https://mlsanity.com/paper/2410.10489/) (2024)
- [UPDESH: Synthesizing Grounded Instruction Tuning Data for 13 Indic Languages](https://mlsanity.com/paper/2509.21294/) (2025)

## Abstract (arXiv)

Existing evaluation methods for healthcare LLMs primarily assess factual correctness,safety, and fluency, while providing limited insight into whether generated interactions reflect culturally situated healthcare reasoning. This limitation is particularly important in maternal health, where care decisions are shaped by social and relational norms. We introduce MH-INDIC, a culturally grounded evaluation framework for maternal-health interactions in urban and semi-urban North Indian contexts that operationalises cultural behaviour through ten dimensions of maternal-health reasoning. Using a 26-item survey administered to 102 pregnant and postpartum women from urban and semi-urban North India, we evaluate ten LLMs. We distinguish population level cultural alignment from profile-level behavioural variation. Although several models approximate the human population-level distribution, all evaluated systems exhibit substantially lower variation across demographic and household profiles than the human cohort, revealing a gap between aggregate alignment and profile-conditioned sensitivity. As a downstream application of MH-INDIC, we use the strongest-aligned proprietary and open-source models to generate culturally conditioned maternal-health dialogues under zero-shot, self-conditioned, and human-grounded prompting. Human-grounded conditioning produces stronger profile alignment and dialogue quality ratings, suggesting that measured cultural profiles can improve the cultural grounding of generated interactions