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Appiah-Kubi R, Kim YH, Attanasio LB. African Immigrant Women's Experiences of Maternity Care in the United States. MCN Am J Matern Child Nurs 2024:00005721-990000000-00062. [PMID: 38976780 DOI: 10.1097/nmc.0000000000001043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
OBJECTIVE The purpose of this study was to explore maternity care experiences of African immigrant women during the perinatal period including factors affecting access to and use of care. METHODS We used Sandelowski's (2010) qualitative descriptive approach to examine how African immigrant women from various countries of origin and with diverse ethnic backgrounds experienced and navigated the maternity care system in the United States during pregnancy and childbirth. We conducted semi-structured interviews with 15 African immigrant women living in the Columbus, Ohio area. Participants were recruited using purposive and snowball sampling between February 2021 and May 2021. Interviews were recorded, transcribed, and analyzed using a reflexive thematic analysis approach. FINDINGS Four major themes defined the experiences of our study participants: access to information, patient-clinician relationships, experiences of discrimination, and costs of maternity care. CLINICAL IMPLICATIONS Findings highlight key barriers to providing quality and acceptable maternity care to African immigrant women at multiple levels. This group's unique barriers underlie the importance of incorporating their diverse experiences into maternity care models and clinical practice. Further research is needed to evaluate and improve maternity care for African immigrant women.
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Adebayo CT, Olukotun OV, Olukotun M, Kirungi J, Gondwe KW, Crooks NK, Singer RB, Adams S, Alfaifi FY, Dressel A, Fahmy L, Kako P, Snethen J, Valhmu LM. Experiences of gender-based violence among Somali refugee women: a socio-ecological model approach. CULTURE, HEALTH & SEXUALITY 2024; 26:654-670. [PMID: 37516928 PMCID: PMC10825063 DOI: 10.1080/13691058.2023.2236163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 07/10/2023] [Indexed: 07/31/2023]
Abstract
Gender-based violence (GBV) is an all-encompassing term that speaks to acts or threats that may lead to physical, sexual or emotional harm to an individual based on their gender. This paper provides a scoping review of research on gender-based violence among Somali refugee women in different parts of the world. Using the socio-ecological model as a framework, we reviewed 30 empirical studies focusing on some form of GBV among Somali refugee women. We identified societal, community and individual factors contributing to the experience of GBV. We also discuss how these factors influence women's willingness to access care, especially healthcare and social services. The review reveals that oftentimes, institutions that work closely with this population have a limited understanding of how closely culture affects the willingness and ability to seek help about GBV. Based on our analysis, we suggest ways in which social institutions and healthcare providers can provide culturally-safe support to Somali refugee women who have experienced some form of GBV.
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Affiliation(s)
| | | | - Mary Olukotun
- Faculty of Nursing, University of Alberta-Edmonton, Edmonton, AB, Canada
| | - Jackline Kirungi
- Department of African & African Diaspora Studies, University of Wisconsin, Milwaukee, WI, USA
| | | | - Natasha K. Crooks
- Human Development Nursing Science, University of Illinois, Chicago, IL, USA
| | - Randi B. Singer
- Human Development Nursing Science, University of Illinois, Chicago, IL, USA
| | - Shukri Adams
- Ras Al Khaimah School of Nursing, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
| | | | - Anne Dressel
- College of Nursing, University of Wisconsin, Milwaukee, WI, USA
| | - Laila Fahmy
- Department of Psychology, Towson University, Towson, MD, USA
| | - Peninah Kako
- College of Nursing, University of Jazan, Gizan, Saudi Arabia
| | - Julia Snethen
- College of Nursing, University of Jazan, Gizan, Saudi Arabia
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Adrian Parra C, Stuardo Ávila V, Contreras Hernández P, Quirland Lazo C, Bustos Ibarra C, Carrasco-Portiño M, Belmar Prieto J, Barrientos J, Lisboa Donoso C, Low Andrade K. Structural and intermediary determinants in sexual health care access in migrant populations: a scoping review. Public Health 2024; 227:54-62. [PMID: 38118243 DOI: 10.1016/j.puhe.2023.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/27/2023] [Accepted: 11/15/2023] [Indexed: 12/22/2023]
Abstract
OBJECTIVES Addressing migrant population's sexual health needs is essential, given the high vulnerability of this population, especially during migratory trajectories and when accessing health care in destination countries. The aim of this scoping review is to identify and describe the structural and intermediary determinants and their dimensions, which negatively influence sexual healthcare access in migrant population in the world in the last 20 years. STUDY DESIGN Scoping review. METHODS The search strategy was carried out in the databases PubMed/MEDLINE, Web of Science, EMBASE, and CINAHL. The inclusion criteria were primary studies published in English or Spanish from 2000 to 2022, describing determinants or barriers to access to sexual health for international migrants, refugees, and asylum seekers. The construction of the results was based on the social determinants of health framework. RESULTS A total of 44 studies were included. Thirteen categories that negatively affect access to sexual health in migrants were identified-structural determinants: language and communication barriers, religious and cultural values, VIH stigma and discrimination, irregular migration status, financial constraints, racism and discrimination, gender inequalities, and lack of knowledge and awareness about sexuality and sexual health; and intermediary determinants: financial health coverage, privacy and confidentiality, health system navigation; health system and facilities, and psychosocial factors. CONCLUSION The most relevant dimensions identified as barriers to access to health services were "culture and societal values" and "health system". Identifying the determinants that affect migrants' access to sexual health is relevant for the formulation of public policies with sociocultural relevance and an intersectional and human rights approach.
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Affiliation(s)
- C Adrian Parra
- PhD in Biomedical Research Methodology and Public Health, Department of Pediatrics, Obstetrics and Gynaecology and Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Spain
| | - V Stuardo Ávila
- Institute of Public Health, Universidad Andrés Bello, Santiago de Chile, Chile.
| | | | - C Quirland Lazo
- PhD in Biomedical Research Methodology and Public Health, Department of Pediatrics, Obstetrics and Gynaecology and Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Spain; Health Technology Assessment Unit, Arturo López Pérez Foundation, Chile
| | - C Bustos Ibarra
- Department of Social Work, Faculty of Social Sciences, Universidad de Concepción, Concepción, Chile
| | - M Carrasco-Portiño
- Department of Obstetrics and of Childcare, Faculty of Medicine, Universidad de Concepción, Concepción, Chile
| | - J Belmar Prieto
- School of Public Health, Faculty of Medicine, University of Chile, Santiago, Chile
| | - J Barrientos
- Faculty of Psychology, Universidad Alberto Hurtado, Chile
| | - C Lisboa Donoso
- School of Dentistry, Faculty of Health Sciences, Universidad Autonoma de Chile, Chile
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Azugbene EA, Cornelius LJ, Johnson-Agbakwu CE. African Immigrant Women's Maternal Health Experiences in Clarkston, Georgia: A Qualitative Study. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:603-616. [PMID: 38155870 PMCID: PMC10754423 DOI: 10.1089/whr.2023.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 12/30/2023]
Abstract
Introduction The maternal health experiences of African immigrant women, their utilization of health care services, and the effects on maternal health have received limited attention in research. This research explored the maternal health experiences of African immigrant women residing in Clarkston, Georgia, and their use of health services. Methods Fourteen African immigrant women responded to semistructured interviews. An adapted version of the Andersen health care utilization model explained the predisposing factors, enabling factors, and need factors, which influence the use of maternal health care for African immigrant women. Results Findings were presented according to the Andersen health care utilization model. Analysis of the interviews resulted in 11 themes. The themes were as follows: (1) Community social structure, (2) community health beliefs, (3) health organization concerning the use of women, infants, and children, (4) social support at the individual level, (5) limited English proficiency, (6) need for better health education, (7) perception of care, (8) health financing, (9) long wait times and lack of transportation, (10) fear of medication and obstetrical interventions, and (11) impact of Female Genital Mutilation/Cutting. Discussion Maternal health practices of African immigrant women are impacted by environmental and cultural factors. Public health interventions should be implemented to advance African immigrant women's health care utilization practices through required health education and tailored care, which will translate to positive maternal health experiences.
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Affiliation(s)
- Ehiremen Adesua Azugbene
- Maternal and Child Health Translational Research Team (MCHTRT), College of Public Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | | | - Crista E. Johnson-Agbakwu
- Division of Preventive and Behavioral Medicine, UMass Chan Medical School, UMass Memorial Health, Worcester, Massachusetts, USA
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Lokot M, Hartman E, Hashmi I. Participatory approaches and methods in gender equality and gender-based violence research with refugees and internally displaced populations: a scoping review. Confl Health 2023; 17:58. [PMID: 38066619 PMCID: PMC10704759 DOI: 10.1186/s13031-023-00554-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/22/2023] [Indexed: 01/05/2024] Open
Abstract
Using participatory approaches or methods are often positioned as a strategy to tackle power hierarchies in research. Despite momentum on decolonising aid, humanitarian actors have struggled to describe what 'participation' of refugees and internally displaced persons (IDPs) means in practice. Efforts to promote refugee and IDP participation can be tokenistic. However, it is not clear if and how these critiques apply to gender-based violence (GBV) and gender equality-topics that often innately include power analysis and seek to tackle inequalities. This scoping review sought to explore how refugee and IDP participation is conceptualised within research on GBV and gender equality. We found that participatory methods and approaches are not always clearly described. We suggest that future research should articulate more clearly what constitutes participation, consider incorporating feminist research methods which have been used outside humanitarian settings, take more intentional steps to engage refugees and IDPs, ensure compensation for their participation, and include more explicit reflection and strategies to address power imbalances.
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Affiliation(s)
- Michelle Lokot
- London School of Hygiene and Tropical Medicine, London, UK.
| | - Erin Hartman
- London School of Hygiene and Tropical Medicine, London, UK
| | - Iram Hashmi
- London School of Hygiene and Tropical Medicine, London, UK
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Ho CH, Denton AH, Blackstone SR, Saif N, MacIntyre K, Ozkaynak M, Valdez RS, Hauck FR. Access to Healthcare Among US Adult Refugees: A Systematic Qualitative Review. J Immigr Minor Health 2023; 25:1426-1462. [PMID: 37009980 DOI: 10.1007/s10903-023-01477-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/04/2023]
Abstract
Refugees encounter numerous healthcare access barriers in host countries, leading to lower utilization rates and poorer health outcomes. In the US, social inequities and fragmented health systems may exacerbate these disparities. Understanding these factors is necessary to ensure equitable care of refugee populations. A systematic literature review of qualitative studies on US adult refugee healthcare access from January 2000 to June 2021 was performed in accordance with PRISMA. Studies were analyzed deductively and then inductively to incorporate previous findings in other resettlement countries and emergence of US-specific themes. 64 articles representing 16+ countries of origin emerged from the final analysis, yielding nine interrelated themes related to health literacy, cost of services, cultural beliefs, and social supports, among others. The main challenges to refugees' healthcare access emerge from the interactions of care fragmentation with adverse social determinants. Given diverse barriers, integrated care models are recommended in treating refugee populations.
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Affiliation(s)
- Chi H Ho
- Department of Public Health Sciences, Frank Batten School of Leadership and Public Policy, University of Virginia, Charlottesville, VA, USA
| | - Andrea H Denton
- Claude Moore Health Sciences Library, University of Virginia, Charlottesville, VA, USA
| | - Sarah R Blackstone
- Office of Institutional Research, James Madison University, Harrisonburg, VA, USA
| | - Nadia Saif
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Baltimore, MD, USA
| | - Kara MacIntyre
- Office of Institutional Research, James Madison University, Harrisonburg, VA, USA
| | - Mustafa Ozkaynak
- College of Nursing, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Rupa S Valdez
- Department of Public Health Sciences, Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA, USA
| | - Fern R Hauck
- Department of Family Medicine, Department of Public Health Sciences, University of Virginia, PO Box 800729, Charlottesville, VA, 22908-0729, USA.
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Sawadogo PM, Sia D, Onadja Y, Beogo I, Sangli G, Sawadogo N, Gnambani A, Bassinga G, Robins S, Tchouaket Nguemeleu E. Barriers and facilitators of access to sexual and reproductive health services among migrant, internally displaced, asylum seeking and refugee women: A scoping review. PLoS One 2023; 18:e0291486. [PMID: 37708137 PMCID: PMC10501608 DOI: 10.1371/journal.pone.0291486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/31/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Migrant, internally displaced, asylum seeking and refugee women experience ongoing risks of having their reproductive healthcare rights violated. This ever-increasing population also has limited access to sexual and reproductive health services. We conducted a scoping review to identify the barriers and facilitating factors when accessing sexual and reproductive health services for this specific population. METHODS We searched the grey literature and queried eight bibliographic databases (Embase, Medline, Cinahl, Scopus, Science Direct, Web of Science, Hinari, and Cochrane Library) to extract articles published between January, 2000, and October, 2021. The extracted data were organized in a framework adapted from Peters et al. and then categorized as facilitators or barriers. We followed the Arksey and O'Malley framework and wrote the report according to the PRISMA-Scr recommendations. RESULTS The search identified 4,722 records of which forty-two (42) met eligibility criteria and were retained for analysis. Ten (10) groups of factors facilitating and/or limiting access to sexual and reproductive health care emerged from the synthesis of the retained articles. The main barriers were lack of knowledge about services, cultural unacceptability of services, financial inaccessibility, and language barriers between patients and healthcare providers. Facilitators included mobile applications for translation and telehealth consultations, patients having a wide availability of information sources, the availability health promotion representatives, and healthcare providers being trained in cultural sensitivity, communication and person-centered care. CONCLUSION Ensuring the sexual and reproductive rights of migrant, internally displaced, asylum-seeking and refugee women requires that policymakers and health authorities develop intervention strategies based on barriers and facilitators identified in this scoping review. Therefore, considering their mental health in future studies would enable a better understanding of the barriers and facilitators of access to sexual and reproductive health services.
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Affiliation(s)
- Pengdewendé Maurice Sawadogo
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, (ISSP/UJKZ), Ouagadougou, Burkina Faso
| | - Drissa Sia
- Département Sciences Infirmières, Université du Québec en Outaouais, Saint-Jerôme, Québec, Canada
| | - Yentéma Onadja
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, (ISSP/UJKZ), Ouagadougou, Burkina Faso
| | - Idrissa Beogo
- École des Sciences Infirmières, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Gabriel Sangli
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, (ISSP/UJKZ), Ouagadougou, Burkina Faso
| | - Nathalie Sawadogo
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, (ISSP/UJKZ), Ouagadougou, Burkina Faso
| | - Assé Gnambani
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, (ISSP/UJKZ), Ouagadougou, Burkina Faso
| | - Gaëtan Bassinga
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, (ISSP/UJKZ), Ouagadougou, Burkina Faso
| | - Stephanie Robins
- Département Sciences Infirmières, Université du Québec en Outaouais, Saint-Jerôme, Québec, Canada
| | - Eric Tchouaket Nguemeleu
- Département Sciences Infirmières, Université du Québec en Outaouais, Saint-Jerôme, Québec, Canada
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Yeo S, Park Y, McClelland DJ, Ehiri J, Ernst K, Magrath P, Alaofè H. A scoping review of maternal health among resettled refugee women in the United States. Front Public Health 2023; 11:1157098. [PMID: 37250071 PMCID: PMC10214470 DOI: 10.3389/fpubh.2023.1157098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/05/2023] [Indexed: 05/31/2023] Open
Abstract
Background Globally, refugee women continue to face higher maternity-related risks from preventable complications during pregnancy and childbirth, partly due to high health care costs, unfamiliarity with the healthcare system, language barriers, and discrimination. Nevertheless, there is still a paucity of literature that evaluates the available evidence in the US. This scoping review delineated the body of literature on maternal health among refugee women resettled in the US in order to identify knowledge gaps in the literature and highlight future research priorities and directions for maternal health promotion. Methods Electronic databases were searched in PubMed, CINAHL, PsycINFO, and EMBASE from inception through July 2021. We included all peer-reviewed study designs; qualitative, quantitative, and mixed method if they reported on refugee women's perinatal health experiences and outcomes in the US. Results A total of 2,288 records were identified, with 29 articles meeting the inclusion criteria. Refugee women tend to initiate prenatal care late and have fewer prenatal care visits compared to women born in the US. Some of them were reluctant to get obstetric interventions such as labor induction and cesarean delivery. Despite numerous risk factors, refugee women had generally better maternal health outcomes. Studies have also highlighted the importance of health care providers' cultural competency and sensitivity, as well as the potential role of community health workers as a bridge between refugee women and health care providers. Conclusions The scoping review emphasizes the need for early prenatal care initiation and more frequent prenatal care visits among refugee women. Furthermore, more needs to be done to mitigate resistance to obstetric interventions and mistrust. The mechanism by which healthy migrant effects occur could be better understood, allowing protective factors to be maintained throughout the resettlement and acculturation process. The scoping review identifies critical gaps in the literature, such as the underrepresentation of different ethnic groups of refugee women in refugee maternal studies in the US. Since this invisibility may indicate unspoken and unaddressed needs, more attention should be paid to underrepresented and understudied groups of refugee women in order to achieve health equity for all.
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Affiliation(s)
- Sarah Yeo
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Yuae Park
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - John Ehiri
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Kacey Ernst
- Epidemiology and Biostatistics Department, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Priscilla Magrath
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Halimatou Alaofè
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
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Besera G, Goldberg H, Okoroh EM, Snead MC, Johnson-Agbakwu CE, Goodwin MM. Attitudes and Experiences Surrounding Female Genital Mutilation/Cutting in the United States: A Scoping Review. J Immigr Minor Health 2023; 25:449-482. [PMID: 36542264 PMCID: PMC10981529 DOI: 10.1007/s10903-022-01437-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
To identify research and gaps in literature about FGM/C-related attitudes and experiences among individuals from FGM/C-practicing countries living in the United States, we conducted a scoping review guided by Arksey and O'Malley's framework. We searched Medline (OVID), Embase (OVID), PubMed, and SCOPUS and conducted a grey literature search for studies assessing attitudes or experiences related to FGM/C with data collected directly from individuals from FGM/C-practicing countries living in the United States. The search yielded 417 studies, and 40 met the inclusion criteria. Findings suggest that women and men from FGM/C-practicing countries living in the United States generally oppose FGM/C, and that women with FGM/C have significant physical and mental health needs and have found US healthcare providers to lack understanding of FGM/C. Future research can improve measurement of FGM/C by taking into account the sociocultural influences on FGM/C-related attitudes and experiences.
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Affiliation(s)
- Ghenet Besera
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, USA
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, Atlanta, GA, 30341, Georgia
| | | | - Ekwutosi M Okoroh
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, Atlanta, GA, 30341, Georgia
| | - Margaret Christine Snead
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, Atlanta, GA, 30341, Georgia.
| | - Crista E Johnson-Agbakwu
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, Georgia
- Obstetrics and Gynecology, Valleywise Health, University of Arizona College of Medicine, Phoenix, AZ, Georgia
- Creighton University School of Medicine, Phoenix, AZ, Georgia
- District Medical Group, Phoenix, AZ, Georgia
| | - Mary M Goodwin
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, Atlanta, GA, 30341, Georgia
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Azugbene EA. Maternal Health Experiences and Health Care Utilization of African Immigrant Women: A Review of The Literature. Matern Child Health J 2023:10.1007/s10995-023-03644-1. [PMID: 36988796 DOI: 10.1007/s10995-023-03644-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION This systematic review summarizes the maternal health experiences and healthcare utilization of African immigrant women who have immigrated to the United States using an adapted version of the healthcare utilization model. METHODS Published journal articles from the year 2000 to 2022 were identified from seven large databases; 13 studies satisfied the inclusion criteria. RESULTS The results of the study are reported according to the individual and contextual factors for healthcare utilization for African immigrant women in the United States. Individual factors that facilitated the use of maternal healthcare were having transportation, higher health literacy levels, insurance, and family support. Contextual factors that facilitated maternal health utilization included access to interpreters and female doctors. DISCUSSION Facilitators and barriers to maternal health utilization were impacted by cultural and environmental factors. First, African immigrant women included in the studies, believe pregnancy and childbirth are safe and normal, therefore prenatal care is unnecessary. Second, the fear of obstetrical interventions, especially from women who have had female genital mutilation. Third, the misconceptions regarding pain medications and the roles of hospital staff. Further research is necessary for addressing the facilitators and barriers to healthcare utilization in African immigrant women.
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Affiliation(s)
- Ehiremen Adesua Azugbene
- Maternal and Child Health Translational Research Team (MCHTRT), College of Public Health Solutions, Arizona State University, Phoenix, AZ, United States.
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Min M, Wong T, Akinsulure-Smith AM. Exploring Beliefs and Attitudes Toward Female Genital Mutilation/Cutting Among Healthcare Providers in New York City. Violence Against Women 2022; 28:3174-3193. [PMID: 34817265 PMCID: PMC9423936 DOI: 10.1177/10778012211045710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Given the increase of African immigrants from countries with high female genital cutting (FGC) prevalence, this study explored U.S. healthcare providers' beliefs and attitudes regarding FGC. A total of 31 professionals who have provided services to FGC-experienced women in New York City were interviewed; data were analyzed using grounded theory. Results indicated that, although a majority of respondents emphasized maintaining a nonjudgmental and open-minded attitude toward clients' experiences, some only focused on the negative aspects of FGC. Also, multifaceted efforts by providers to understand the cultural meanings of FGC and resolve their own cultural dissonance were identified. The implications for practice were discussed.
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Affiliation(s)
- Moonkyung Min
- The City College of New York, NY, USA
- University of Calgary, AB, Canada
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Bogaert K, Kaplowitz E, Wagner S, Carroll-Bennett R, Fernando D, McVane B, Maru S. Gynecologic Care Utilization in Asylum-Seeking Women in New York City. J Migr Health 2022; 6:100116. [PMID: 35677659 PMCID: PMC9168178 DOI: 10.1016/j.jmh.2022.100116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/16/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Kelly Bogaert
- Division of Hospital Medicine, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, USA
- Corresponding author.
| | - Elianna Kaplowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, New York, NY, USA
| | - Sara Wagner
- Libertas Center, Elmhurst Hospital, 79-01 Broadway, Queens, NY, USA
| | - Rachel Carroll-Bennett
- Department of Obstetrics and Gynecology, Elmhurst Hospital, 79-01 Broadway, Queens, NY, USA
| | - Dinali Fernando
- Libertas Center, Elmhurst Hospital, 79-01 Broadway, Queens, NY, USA
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1176 5th Ave, New York, NY, USA
| | - Ben McVane
- Libertas Center, Elmhurst Hospital, 79-01 Broadway, Queens, NY, USA
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1176 5th Ave, New York, NY, USA
| | - Sheela Maru
- Libertas Center, Elmhurst Hospital, 79-01 Broadway, Queens, NY, USA
- Department of Obstetrics and Gynecology, Elmhurst Hospital, 79-01 Broadway, Queens, NY, USA
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, 1176 5th Ave, New York, NY, USA
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Njenga A. Somali Refugee Women’s Cultural Beliefs and Practices Around Pregnancy and Childbirth. J Transcult Nurs 2022; 33:484-490. [DOI: 10.1177/10436596221085299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: The purpose of this study was to explore the cultural beliefs and practices of resettled Somali refugee women around pregnancy and childbirth. This study took place in the Midwestern region of the United States. Methodology: Leininger’s theory of Culture Care Diversity and Universality served as the theoretical framework for the design of this qualitative descriptive study. Data were collected from 15 Somali refugee women through in-depth interviews. Results: Three major themes emerged from this study. This article focuses on one of the themes: It’s what women believe and do. This theme is reflective and indicative of the Somali refugee women cultural beliefs and practices during pregnancy, and during and after childbirth. Discussion and Conclusion: Somali refugee women approached, managed, and conceptualized pregnancy and childbirth in their cultural context. Western health care providers should strive to understand cultural beliefs and conceptualizations that may influence the utilization of prenatal health care.
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Assessing the reliability and validity of attitudes and confidence scales for the care of women and girls affected by female genital mutilation/cutting. BMC Public Health 2021; 21:1415. [PMID: 34273951 PMCID: PMC8285805 DOI: 10.1186/s12889-021-11455-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 07/06/2021] [Indexed: 11/29/2022] Open
Abstract
Background Approximately 545,000 women and girls in the USA have undergone Female Genital Mutilation/ Cutting (FGM/C) or have mothers from a country where FGM/C is practiced. Women and girls living with FGM/C in the USA may experience stigma and bias due to their FGM/C, immigration, racial, and language status. Health care provider attitudes toward FGM/C and confidence for related clinical care may affect the quality of care, yet there are no validated instruments to measure these constructs. Methods We developed the instruments via review of the FGM/C literature, the development of scale items, expert review, and pre-testing. We validated the instruments using a convenience sample of providers in Arizona and Maryland. We used exploratory factor analysis (EFA) to confirm factor structures, and compared scores between known groups to assess validity. Results The EFA revealed a two-factor solution for attitudes, including subscales for Negative Attitudes and Empathetic Attitudes toward FGM/C and those who practice with Cronbach’s alphas of 0.814 and 0.628 respectively. The EFA for confidence revealed a two-factor solution including Confidence in Clinical FGM/C Care and Confidence in Critical Communication Skills for FGM/C Care with Cronbach’s alphas of 0.857 and 0.694 respectively. Conclusions Health care provider attitudes and confidence toward FGM/C care may affect quality of care and health outcomes for women and girls. Our study describes the rigorous psychometric analysis to create reliable and valid instruments to assess health care provider attitudes and confidence for the care of women and girls who have experienced FGM/C. Trial registration ClinicalTrials.gov, NCT03249649. Registered on 15 August 2017. Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11455-8.
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Ghebrendrias S, Pfeil S, Crouthamel B, Chalmiers M, Kully G, Mody S. An Examination of Misconceptions and Their Impact on Cervical Cancer Prevention Practices among Sub-Saharan African and Middle Eastern Refugees. Health Equity 2021; 5:382-389. [PMID: 34095709 PMCID: PMC8175255 DOI: 10.1089/heq.2020.0125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/12/2022] Open
Abstract
Objective: The purpose of the study was to understand cervical cancer screening and prevention practices of refugee women in San Diego, California and identify desired components of a cervical cancer screening toolkit. Methods: We conducted a qualitative study utilizing semi-structured focus groups and identified common themes via grounded theory analysis. Results: There were 53 female refugee participants from Sub-Saharan Africa and the Middle East. Over half of all women surveyed expressed a fear of pelvic exams and loss of modesty as barriers to seeking gynecologic care, with nearly 34% avoiding routine pap tests. Of the 18 participants who were asked if they were aware of the Human Papilloma Virus (HPV) vaccination, only one had heard of the vaccine and none had received it for themselves or their children. Over 60% of participants were interested in educational materials surrounding HPV and pap tests. Conclusion: There is a significant lack of knowledge regarding cervical cancer screening and HPV vaccination among refugee women in San Diego, California. Refugee women in this study were interested in multi-modal educational materials as part of a cervical cancer screening toolkit.
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Affiliation(s)
- Selemawit Ghebrendrias
- Division of Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, San Diego, California, USA
| | - Sarah Pfeil
- Department of Obstetrics and Gynecology, University of California, San Diego, San Diego, California, USA
| | - Bonnie Crouthamel
- Department of Obstetrics and Gynecology, University of California, Davis, Davis, California, USA
| | - Morgen Chalmiers
- Department of Obstetrics and Gynecology, University of California, San Diego, San Diego, California, USA
| | - Gennifer Kully
- Department of Obstetrics and Gynecology, University of California, San Diego, San Diego, California, USA
| | - Sheila Mody
- Department of Obstetrics and Gynecology, University of California, San Diego, San Diego, California, USA
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Darivemula S, Bhatia R, Bhumi S. Dancing doctors: exploring the potential of cultural dance education to improve cultural competency and clinical communication. Public Health 2021; 195:22-23. [PMID: 34034001 DOI: 10.1016/j.puhe.2021.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE One of the largest barriers towards the utilization and overall success of health interventions for minority communities is the difference between the cultures of healthcare services and service users. Medical students, physicians, and healthcare systems are taught to be culturally competent, yet multiple studies demonstrate the persistence of differences in perception of care and disparities in outcomes for communities of colour. This article aims to offer a patient-centred, culturally nuanced medium for teaching cultural competency. STUDY DESIGN This is a brief report based on experiential learning, observations, and a short literature review on understanding culture through traditional dances. METHODS To address cultural disconnect between clinical medicine and diverse patients, we recommend encouraging patients from diverse backgrounds to teach physicians how to perform cultural dances. RESULTS Traditional dance appears to be a culturally rich source for holistically educating physicians on cultural competency. CONCLUSION This process of learning a cultural dance can improve cultural humility and cultural competency, and clinical communication between the provider and public.
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Affiliation(s)
- S Darivemula
- Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Dept of OBGYN, Lebanon, NH 03756, USA.
| | - R Bhatia
- Johns Hopkins Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, 401 North Broadway Baltimore, MD, 21287, USA.
| | - S Bhumi
- University of Connecticut Health, Department of Internal Medicine, 263 Farmington Avenue, Farmington, CT 06030-1235, USA.
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Marea CX, Warren N, Glass N, Johnson-Agbakwu C, Perrin N. Factors Associated with Health Care Provider Attitudes, and Confidence for the Care of Women and Girls Affected by Female Genital Mutilation/Cutting. Health Equity 2021; 5:329-337. [PMID: 34036217 PMCID: PMC8140356 DOI: 10.1089/heq.2020.0130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 11/12/2022] Open
Abstract
Background: Female genital mutilation/cutting (FGM/C) is a cultural practice that includes procedures that intentionally alter or cause harm to female genital organs for nonmedical reasons, affecting ∼200 million women and girls globally. Health care providers in the United States often lack confidence to provide appropriate FGM/C-related care, and experience attitudes that may negatively impact quality of care for FGM/C. Methods: We conducted a cross-sectional survey of health care providers to explore the associations between health care provider characteristics, awareness of health complications of FGM/C, attitudes, and confidence for FGM/C care. Results: Factors associated with more Confidence for Clinical FGM/C Care include awareness of health complications, ever cared for a woman with FGM/C, being a woman or person of color, and more than 5 years of clinical practice. Increased Confidence in Communication Skills for FGM/C Care was associated with awareness of more health complications for FGM/C. Women endorsed significantly less Negative Attitudes toward FGM/C compared with men; no other factors were associated with health care provider attitudes. Conclusion: Future research should further investigate factors associated with health care provider attitudes toward FGM/C and those affected by the practice to promote quality care. Health providers require adequate training for clinical FGM/C care and in the communication skills that promote patient/provider communication cross-culturally. Trial Registration: Clinical Trials.Gov ID no. NCT03249649, Study ID no. 5252. Public website: https://clinicaltrials.gov/ct2/show/NCT03249649.
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Affiliation(s)
- Christina X. Marea
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
- School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, USA
| | - Nicole Warren
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nancy Glass
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Crista Johnson-Agbakwu
- Arizona State University Southwest Interdisciplinary Research Center, Phoenix, Arizona, USA
| | - Nancy Perrin
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
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Vais S, Siu J, Maru S, Abbott J, St Hill I, Achilike C, Wu WJ, Adegoke TM, Steer-Massaro C. Rides for Refugees: A Transportation Assistance Pilot for Women's Health. J Immigr Minor Health 2020; 22:74-81. [PMID: 31758420 DOI: 10.1007/s10903-019-00946-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Transportation barriers can limit access to healthcare for refugee and asylum seeking women. This study assesses the efficacy of a healthcare-directed rideshare application for overcoming these barriers at an urban health clinic. A pilot study was conducted at Boston Medical Center's Refugee Women's Health Clinic from June 2018 to February 2019. Women with gynecologic visits reporting transportation difficulties were offered rides. The primary outcome was no-show rates. Secondary outcomes included cost, and patient/provider experiences. Of 102 eligible visits, 31 reported transportation insecurity and received rides. Those women had a 6% no-show rate, compared to 30% in women denying transportation barriers, and 50% amongst unreachable women (p < 0.0001). The intervention cost $2033 and generated $30,337 in charges. Minimal adverse experiences were reported. Healthcare-directed rideshare applications are an effective and cost-efficient strategy for refugee and asylum seeking women to access essential health services.
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Affiliation(s)
- Simone Vais
- Boston University School of Medicine, Boston, MA, USA
| | - Justin Siu
- Boston University School of Medicine, Boston, MA, USA
| | - Sheela Maru
- Department of Health System Design and Global Health, Department of Obstetrics, Gynecology, and Reproductive Science, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jodi Abbott
- Department of Obstetrics and Gynecology, Boston University School of Medicine, 85 East Concord St, 6th Floor, Boston, MA, 02118, USA
| | - Ingrid St Hill
- Department of Obstetrics and Gynecology, Boston University School of Medicine, 85 East Concord St, 6th Floor, Boston, MA, 02118, USA
| | - Confidence Achilike
- Department of Obstetrics and Gynecology, Boston University School of Medicine, 85 East Concord St, 6th Floor, Boston, MA, 02118, USA
| | - Wan-Ju Wu
- Department of Obstetrics and Gynecology, Boston University School of Medicine, 85 East Concord St, 6th Floor, Boston, MA, 02118, USA
| | - Tejumola M Adegoke
- Department of Obstetrics and Gynecology, Boston University School of Medicine, 85 East Concord St, 6th Floor, Boston, MA, 02118, USA
| | - Courtney Steer-Massaro
- Department of Obstetrics and Gynecology, Boston University School of Medicine, 85 East Concord St, 6th Floor, Boston, MA, 02118, USA.
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Zigdon A, Koren G, Korn L. Characteristics Related to Choice of Obstetrician-Gynecologist among Women of Ethiopian Descent in Israel. Healthcare (Basel) 2020; 8:E444. [PMID: 33143132 PMCID: PMC7712956 DOI: 10.3390/healthcare8040444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patient satisfaction with the quality of health care services is complex with many known factors impacting upon satisfaction, among them the choice of physician. Previous studies examined characteristics of a woman's choice of gynecologist, but information regarding reasons for these choices among women of Ethiopian descent is lacking. The objective of this study was to identify characteristics related preference of an obstetrician-gynecologist based on gender among women of Ethiopian descent. METHOD Analysis of anonymous self-reported questionnaire distributed to 500 women of Ethiopian descent who visited an obstetrician-gynecologist at least once in the past three years (Mean age 29.5; SD = 8.2). Trust in physician was examined using the TPS scale; service quality was checked using the SERVQUAL; and the 5Qs model was used to measure patient's satisfaction of health care. RESULTS Very religious (84.1%) and religious (53.6%) women of Ethiopian descent were more likely to prefer a female obstetrician-gynecologist compared to traditional (39.3%) or secular (34.4%) women (p < 0.001). Participants had higher probability to prefer a male gynecologist if they had more employment hours (OR = 3.57, 95% CI = 1.72-7.42, p < 0.001), and the responsiveness of the physician was less important to them (OR = 0.77, 95% CI = 0.60-0.99, p < 0.05). Age of participants, country of birth, years in Israel, family status, being a mother, education or health status were not associated with choosing a female obstetrician-gynecologist. Religious women would prefer to wait longer for a female gynecologist due to modesty imperatives, even at the cost of compromising their health as a result of waiting longer. CONCLUSIONS The findings of this research highlight the importance of accessibility to female obstetrician-gynecologists for women of Ethiopian descent and demonstrate that determinants in the host population rather than immigrant's past culture, affect the women's decision. This study demonstrates the importance of the health care system in Israel to enable more female obstetrician-gynecologists to treat women of Ethiopian descent.
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Affiliation(s)
- Avi Zigdon
- Department of Health Systems Management, School of Health Sciences, Ariel University, 40700 Ariel, Israel;
| | - Gideon Koren
- Adelson Faculty of Medicine, Ariel University, 40700 Ariel, Israel;
- Motherisk Israel Program, Shamir Medical Center, 70300 Be’er Ya’akov, Israel
| | - Liat Korn
- Department of Health Systems Management, School of Health Sciences, Ariel University, 40700 Ariel, Israel;
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Hoffman JR, Delaney MA, Valdes CT, Herrera D, Washington SL, Aghajanova L, Smith JF, Herndon CN. Disparities in fertility knowledge among women from low and high resource settings presenting for fertility care in two United States metropolitan centers. FERTILITY RESEARCH AND PRACTICE 2020; 6:15. [PMID: 32821417 PMCID: PMC7429753 DOI: 10.1186/s40738-020-00084-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/21/2020] [Indexed: 11/26/2022]
Abstract
Background Few studies have examined health literacy and fertility knowledge among women from low income, socio-culturally diverse communities presenting for fertility care in the United States. Our study sought to examine demographic predictors of fertility-related knowledge among infertile women from low and high-resource communities in two major metropolitan centers in the United States. Methods Fertility Knowledge Assessments were administered to women presenting for fertility care at county medical centers serving low-resource, largely immigrant patients and to women from largely affluent populations presenting to comprehensive fertility centers in two cities. The influence of demographic predictors on fertility knowledge was examined through regression analysis. Results A total of 143 women were included in our analysis. In the county hospital/low resource clinic (LR, n = 70), the mean age was 32.8 ± 6.1 years vs 35.0 ± 5.0 years in the fee-for-service/high resource clinic (HR, n = 73). Among the LR patients, 74% were immigrants, 71% had an annual income <$25,000 and 52% had completed high school. Among HR patients, 36% were immigrants, 60% had an annual income >$100,000, and 95% had some college or above. On average, women from HR settings scored 3.0 points higher on the Fertility Knowledge Assessment than their LR counterparts (p < 0.001). Upon multivariate analysis, education level remained the sole independent factor associated with fertility knowledge assessment score (p < 0.001). Stratifying by resource level revealed that income was highly associated with fertility knowledge (p < 0.01) among high resource individuals even when adjusting for education level. Conclusions Women from low resource, largely immigrant communities, seeking fertility care have greater disparities in fertility knowledge and lower health literacy compared to women from high resource clinical settings. Further studies are needed to understand these barriers and to develop targeted inventions to lower disparities and improve care for these vulnerable populations.
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Affiliation(s)
- Jacquelyn R Hoffman
- University of Arizona College of Medicine-Tucson, 1501 N Campbell Avenue, Tucson, AZ 85724 USA
| | - Meaghan A Delaney
- Department of Obstetrics & Gynecology, Baystate Medical Center, 759 Chestnut Street, Office S1661, Springfield, MA 01199 USA
| | - Cecilia T Valdes
- Department of Obstetrics & Gynecology, One Baylor Plaza, BCM 610, Houston, TX 77030 USA
| | - Diana Herrera
- Department of Obstetrics & Gynecology, The Houston Methodist Hospital, 1401 St. Joseph Pkwy. Susan K. Strake Building, 1st Floor SKS1106A, Houston, TX 77002 USA
| | - Samuel L Washington
- Department of Urology, University of California, 400 Parnassus, Box 0738, San Francisco, CA 94143 USA
| | - Lusine Aghajanova
- Division of Reproductive Endocrinology & Infertility Services, Department of Obstetrics & Gynecology, Stanford University School of Medicine, 1195 West Fremont Avenue, MC 7717, Sunnyvale, CA 94087 USA
| | - James F Smith
- Department of Urology, University of California, 400 Parnassus, Box 0738, San Francisco, CA 94143 USA.,UCSF Philip R. Lee Institute for Health Policy Studies, 3333 California St, San Francisco, CA 94118 USA
| | - Christopher N Herndon
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, University of Washington School of Medicine, 1959 NE Pacific St, Box 356460, Seattle, WA 98195-6460 USA
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Royer PA, Olson LM, Jackson B, Weber LS, Gawron L, Sanders JN, Turok DK. "In Africa, There Was No Family Planning. Every Year You Just Give Birth": Family Planning Knowledge, Attitudes, and Practices Among Somali and Congolese Refugee Women After Resettlement to the United States. QUALITATIVE HEALTH RESEARCH 2020; 30:391-408. [PMID: 31347453 PMCID: PMC7219277 DOI: 10.1177/1049732319861381] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
It is crucial for refugee service providers to understand the family planning knowledge, attitudes, and practices of refugee women following third country resettlement. Using an ethnographic approach rooted in Reproductive Justice, we conducted six focus groups that included 66 resettled Somali and Congolese women in a western United States (US) metropolitan area. We analyzed data using modified grounded theory. Three themes emerged within the family planning domain: (a) concepts of family, (b) fertility management, and (c) unintended pregnancy. We contextualized these themes within existing frameworks for refugee cultural transition under the analytic paradigms of "pronatalism and stable versus evolving family structure" and "active versus passive engagement with family planning." Provision of just and equitable family planning care to resettled refugee women requires understanding cultural relativism, social determinants of health, and how lived experiences influence family planning conceptualization. We suggest a counseling approach and provider practice recommendations based on our study findings.
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Affiliation(s)
| | | | | | | | - Lori Gawron
- University of Utah, Salt Lake City, Utah, USA
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Agbemenu K, Auerbach S, Murshid NS, Shelton J, Amutah-Onukagha N. Reproductive Health Outcomes in African Refugee Women: A Comparative Study. J Womens Health (Larchmt) 2019; 28:785-793. [PMID: 30767694 PMCID: PMC6909669 DOI: 10.1089/jwh.2018.7314] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: African refugee women in the United States are at risk of poor reproductive health outcomes; however, examination of reproductive health outcomes in this population remains inadequate. We compared: (1) prepregnancy health and prenatal behavior; (2) prenatal history and prenatal care utilization; and (3) labor and birth outcomes between African refugee women and U.S.-born Black and White women. Methods: A secondary data analysis of enhanced electronic birth certificate data was used. Univariate comparisons using chi-squared tests for dichotomous variables and analysis of variance and/or Kruskal-Wallis tests for continuous variables were conducted for Refugee versus Black versus White women. A p-value <0.05 was considered statistically significant. Results: From 2007 to 2016, 789 African refugee, 17,487 Black, and 59,615 White women in our population gave birth. African refugees experienced more favorable health outcomes than U.S.-born groups on variables examined. Compared to U.S.-born women, African refugee women had fewer prepregnancy health risks (p < 0.001), fewer preterm births (p < 0.001), fewer low birth weight infants (p < 0.001), and higher rates of vaginal deliveries (p < 0.001). These favorable outcomes occurred despite later initiation of prenatal care (p < 0.001) and lower scores of prenatal care adequacy among refugee women compared to U.S.-born groups (p < 0.001). Conclusions: The healthy immigrant effect appears to extend to reproductive health outcomes in our studied population of African refugee women. However, based on our data, targeted, culturally-congruent education surrounding family planning and prenatal care is recommended. Insight from reproductive health care experiences of African refugee women can provide understanding of the protective factors contributing to the healthy immigrant effect in reproductive health outcomes, and knowledge gained can be utilized to improve outcomes in other at-risk groups.
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Affiliation(s)
- Kafuli Agbemenu
- School of Nursing, The State University of New York (SUNY), University at Buffalo, Buffalo, New York
| | - Samantha Auerbach
- School of Nursing, The State University of New York (SUNY), University at Buffalo, Buffalo, New York
| | - Nadine Shaanta Murshid
- School of Social Work, The State University of New York (SUNY), University at Buffalo, Amherst, New York
| | - James Shelton
- Department of Obstetrics and Gynecology, Jacobs School of Medicine and Biomedical Sciences, The State University of New York (SUNY), University at Buffalo, Buffalo, New York
| | - Ndidiamaka Amutah-Onukagha
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
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