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Worabo HJ, Safi F, Gill SL, Farokhi M. "It's different here" Afghan refugee maternal health experiences in the United States. BMC Pregnancy Childbirth 2024; 24:479. [PMID: 39014313 PMCID: PMC11251342 DOI: 10.1186/s12884-024-06678-7] [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: 03/30/2024] [Accepted: 07/03/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND The number of Afghan families in the US has grown over the past two decades, yet there is a paucity of research focused on their maternal healthcare experiences. Afghan families have one of the highest fertility rates in the world and typically have large families. As the US faces rising maternal mortality rates, it is crucial to understand factors that affect health outcomes for culturally distinct groups. We aimed to better understand Afghan women's maternal health experiences in South Texas as a step toward designing culturally sensitive care. METHODS Using a qualitative descriptive design, twenty Afghan women who gave birth in the US within the past 2 years participated in audio-recorded interviews. The first and second authors conducted each interview using a semi-structured interview guide. The authors used an in vivo coding method and qualitative content analysis of the transcribed narrative data. RESULTS We identified three broad categories with corresponding sub-categories: 1) Maternal Healthcare Experiences: pregnancy, birthing, and postpartum, 2) Communication: language barrier, relationship with husband, and health information seeking, 3) Access to Care: transportation and financing healthcare. The participants expressed perspectives of gratefulness and positive experiences, yet some described stories of poor birth outcomes that led to attitudes of mistrust and disappointment. Distinct cultural preferences were shared, providing invaluable insights for healthcare providers. CONCLUSIONS The fact that the Afghan culture is strikingly different than the US mainstream culture can lead to stereotypical assumptions, poor communication, and poor health outcomes. The voices of Afghan women should guide healthcare providers in delivering patient-centered, culturally sensitive maternity care that promotes healthy families and communities.
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Affiliation(s)
- Heidi J Worabo
- School of Nursing, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive. Mail Code 7951, San Antonio, Texas, 78229‑3900, USA.
| | - Fatima Safi
- HCA Medical City Consortium, 3301 Matlock Road, Arlington, Texas, 76015, USA
| | - Sara L Gill
- School of Nursing, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive. Mail Code 7951, San Antonio, Texas, 78229‑3900, USA
| | - Moshtagh Farokhi
- School of Nursing, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive. Mail Code 7951, San Antonio, Texas, 78229‑3900, USA
- School of Dentistry, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive. Mail Code 7914, San Antonio, Texas, USA
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Essén B, Wickramasinghe A, Eriksson L, Vartanova I, Tibajev A, Strimling P. Assessing knowledge of migrant sexual reproductive health and rights: a national cross-sectional survey among health professionals in Sweden. FRONTIERS IN SOCIOLOGY 2024; 9:1356418. [PMID: 38873341 PMCID: PMC11169828 DOI: 10.3389/fsoc.2024.1356418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/15/2024] [Indexed: 06/15/2024]
Abstract
Introduction Despite the commitment of the Swedish government to ensuring equal access to Sexual Reproductive Health and Rights services for all citizens, shortcomings persist among the migrant population. In cases where healthcare providers lack sufficient knowledge or hold misconceptions and biases about these contentious issues, it can lead to the delivery of suboptimal care. Therefore, the objective of this study was to assess the level of knowledge of Swedish healthcare providers on global and Swedish migrant Sexual Reproductive Health and Rights. Methods A national cross-sectional study was conducted using a questionnaire consisting of seven questions related to global and Swedish migrant Sexual Reproductive Health and Rights. The questionnaire was distributed among midwives, nurses, gynecologists and obstetricians, and hospital social workers (N = 731). The analysis was guided by the Factfulness framework developed by Hans Rosling to identify disparities between healthcare providers' viewpoints and evidence-based knowledge. Results There was an overall lack of knowledge among the health care providers on these issues. The highest correct responses were on the question on abandonment of female genital cutting/mutilation after migration (74%). The findings indicated that healthcare providers originating from Sweden, physicians, those with fewer years of clinical experience, and exhibiting more migrant-friendly attitudes, demonstrated a higher level of knowledge regarding global and Swedish migrant Sexual and Reproductive Health and Rights. Conclusion This study demonstrates that healthcare providers lacked knowledge of global and Swedish migrant Sexual Reproductive Health and Rights, which was almost uniformly distributed, except among those with more comprehensive and recent education. Contrary to expectations, healthcare professionals did not primarily rely on their education and experiences but were influenced by their personal values and opinions. The study underscores the importance of upgrading knowledge in Sexual Reproductive Health and Rights and encourages policymakers, professionals, and students to base their opinions on well-founded facts, particularly in the context of a diverse and globalized society.
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Affiliation(s)
- Birgitta Essén
- Department of Women’s and Children’s Health, Faculty of Medicine, Uppsala University, Uppsala, Sweden
| | - Ayanthi Wickramasinghe
- Department of Women’s and Children’s Health, Faculty of Medicine, Uppsala University, Uppsala, Sweden
| | - Lise Eriksson
- Department of Women’s and Children’s Health, Faculty of Medicine, Uppsala University, Uppsala, Sweden
- Faculty of Social Sciences, Business and Economics, and Law, Åbo Akademi University, Turku, Finland
| | - Irina Vartanova
- Department of Women’s and Children’s Health, Faculty of Medicine, Uppsala University, Uppsala, Sweden
- Institute for Future Studies, Stockholm, Sweden
| | - Andrey Tibajev
- Department of Women’s and Children’s Health, Faculty of Medicine, Uppsala University, Uppsala, Sweden
- Institute for Future Studies, Stockholm, Sweden
| | - Pontus Strimling
- Department of Women’s and Children’s Health, Faculty of Medicine, Uppsala University, Uppsala, Sweden
- Institute for Future Studies, Stockholm, Sweden
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Hawkey AJ, Ussher JM, Perz J. What do women want? Migrant and refugee women's preferences for the delivery of sexual and reproductive healthcare and information. ETHNICITY & HEALTH 2022; 27:1787-1805. [PMID: 34569377 DOI: 10.1080/13557858.2021.1980772] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Migrant and refugee women experience inequities in sexual and reproductive health (SRH) care, reflected in the low uptake of SRH services. It is essential for healthcare providers and educators to be aware of women's preferences for SRH information and service delivery, to provide culturally responsive care. Identifying migrant and refugee women's preferences for SRH information and service delivery is the objective of this study. DESIGN This study investigated this issue, in communities of migrant and refugee women living in Australia and Canada. Eighty-four individual interviews and 16 focus groups comprising 85 participants were conducted (total n = 169), with migrant and refugee women aged 18 years and over from Afghanistan, India (Punjab), Iraq, Somalia, South Sudan, Sri-Lanka (Tamil), Sudan and various South American (Latina) backgrounds. Nine individual interviews were also undertaken with community interviewers, who were migrant or refugee women themselves. RESULTS Thematic analyses identified that migrant and refugee women are enthusiastic to learn about SRH across the lifespan, using a variety of modalities including group education delivered by community leaders; online and written material; and information provided by general practitioners. Participants emphasised the need for empathetic SRH care, which encompassed longer times for consultations, being seen as experts of their own bodies, privacy and healthcare provided by women practitioners. Greater engagement with migrant and refugee men was positioned as an additional solution to addressing SRH concerns of women. CONCLUSION Insights from this study can help facilitate the co-design and evaluation of acceptable and sustainable programs to address inequities in SRH experienced by migrant and refugee women.
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Affiliation(s)
- Alexandra J Hawkey
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Jane M Ussher
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Janette Perz
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
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Agbata EN, Buitrago-Garcia D, Nunez-Gonzalez S, Hashmi SS, Pottie K, Alonso-Coello P, Arevalo-Rodriguez I. Quality assessment of systematic reviews on international migrant healthcare interventions: a systematic review. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01390-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Yaghoubi F, Akbari N, Kashanian M, Lakeh MM, Sheikhansari N. Severe maternal outcome (SMO) in Afghan Immigrant Women; A Study in Tehran, Iran. Int J Gynaecol Obstet 2022; 159:302-312. [DOI: 10.1002/ijgo.14111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/26/2021] [Accepted: 01/20/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Fatemeh Yaghoubi
- Iran University of Medical Sciences Faculty of Nursing and Midwifery Tehran Iran
| | - Nahid Akbari
- Iran University of Medical Sciences Faculty of Nursing and Midwifery Tehran Iran
| | - Maryam Kashanian
- Iran University of Medical Sciences Department of Obstetrics & Gynecology, Akbarabadi Teaching Hospital Tehran Iran
| | - Maziar Moradi Lakeh
- Iran University of Medical Sciences Department of community and family medicine Tehran Iran
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Bains S, Sundby J, Lindskog BV, Vangen S, Diep LM, Owe KM, Sorbye IK. Satisfaction with maternity care among recent migrants: an interview questionnaire-based study. BMJ Open 2021; 11:e048077. [PMID: 34272220 PMCID: PMC8287626 DOI: 10.1136/bmjopen-2020-048077] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To examine factors associated with recently migrated women's satisfaction with maternity care in urban Oslo, Norway. DESIGN An interview-based cross-sectional study, using a modified version of Migrant Friendly Maternity Care Questionnaire. SETTING Face-to-face interview after birth in two maternity wards in urban Oslo, Norway, from January 2019 to February 2020. PARTICIPANTS International migrant women, ≤5 years length of residency in Norway, giving birth in urban Oslo, excluding women born in high-income countries. PRIMARY OUTCOME Dissatisfaction of care during pregnancy and birth, measured using a Likert scale, grouped into satisfied and dissatisfied, in relation to socio-demographic/clinical characteristics and healthcare experiences. SECONDARY OUTCOME Negative healthcare experiences and their association with reason for migration. RESULTS A total of 401 women answered the questionnaire (87.6% response rate). Overall satisfaction with maternal healthcare was high. However, having a Norwegian partner, higher education and high Norwegian language comprehension were associated with greater odds of being dissatisfied with care. One-third of all women did not understand the information provided by the healthcare personnel during maternity care. More women with refugee background felt treated differently because of factors such as religion, language and skin colour, than women who migrated due to family reunification. CONCLUSIONS Although the overall satisfaction was high, for certain healthcare experiences such as understanding information, we found more negative responses. The negative healthcare experiences and factors associated with satisfaction identified in this study have implications for health system planning, education of healthcare personnel and strategies for quality improvement.
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Affiliation(s)
- Sukhjeet Bains
- Norwegian Research Centre for Women's Health, Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Johanne Sundby
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Benedikte V Lindskog
- Department of International Studies and Interpreting, Section for Diversity Studies, Oslo Metropolitan University, Oslo, Norway
| | - Siri Vangen
- Norwegian Research Centre for Women's Health, Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lien M Diep
- Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Katrine M Owe
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Ingvil K Sorbye
- Norwegian Research Centre for Women's Health, Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
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Redden K, Safarian J, Schoenborn C, Shortall C, Gagnon AJ. Interventions to Support International Migrant Women's Reproductive Health in Western-Receiving Countries: A Systematic Review and Meta-Analysis. Health Equity 2021; 5:356-372. [PMID: 34084988 PMCID: PMC8170723 DOI: 10.1089/heq.2020.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: The reproductive health outcomes of international migrant women differ in comparison with receiving-country-born women, depending on country of birth and immigrant status. Effective interventions to support the reproductive health of international migrant women are not well known. Methods: We conducted a systematic review and meta-analysis of studies between 2010 and 2017 evaluating interventions directly or indirectly affecting the reproductive health (as defined by the World Health Organization) of international migrant women in Western-receiving countries. Results: Sixteen studies representing 5080 migrants were identified. Interventions consisted of linguistically (e.g., translated brochures) or culturally adapted (e.g., cultural narratives) routine care or new interventions. Meta-analysis showed that interventions increased rates of preventive reproductive health activities, including mammography, condom use, and Pap test completion, by almost 18% (95% confidence interval 7.61–28.3) compared with usual care or interventions not adapted to migrant women. Conclusion: Culturally and linguistically adapted care practices congruent with target populations of international migrant women are effective in improving their reproductive health outcomes, particularly their participation in preventative reproductive health activities.
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Affiliation(s)
- Kara Redden
- Ingram School of Nursing, McGill University, Montréal, Canada
| | | | - Claudia Schoenborn
- Research Centre in Health Policies and Health Systems, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Clare Shortall
- Doctors of the World UK, Part of the Médecins du Monde Network, London, United Kingdom
| | - Anita J Gagnon
- Ingram School of Nursing, McGill University, Montréal, Canada.,Reproductive Outcomes and Migration (ROAM) Collaboration
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Andersson E, Nazanin S, Estefania O, Small R. Swedish and Australian midwives' experiences of providing antenatal care for Somali-born women: A qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 28:100607. [PMID: 33714846 DOI: 10.1016/j.srhc.2021.100607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 11/18/2020] [Accepted: 02/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Women from Somalia have increased risks of adverse pregnancy outcomes compared with destination country populations, but little is known about midwives' experiences of caring for Somali women in pregnancy, knowledge which might help to improve care and outcomes. This study aimed to explore how midwives in Melbourne and Stockholm experienced caring for Somali women. METHOD Eight midwives in Stockholm and ten midwives in Melbourne, all working in antenatal care clinics, were interviewed about caring for Somali women and the interviews were analysed using thematic analysis. FINDINGS Both the Swedish and Australian midwives highlighted lack of time and challenges in communication as impacting on their capacity to provide good care; and all wished they had a better understanding of Somali culture. Some differences in midwife attitudes and approaches to care were apparent in the two settings, particularly in how accepting of Somali women the midwives were and the flexibility with which care could be provided in order to meet the needs of the women. The Australian midwives appeared both more accepting and also more flexible. CONCLUSION Differences in the culture of care were apparent between midwives in Sweden and Australia, particularly in how flexible care could be in order to meet the needs of migrant women and how accepting and responsive the midwives were. More attention in antenatal care on developing mutual understanding between midwives and Somali women would improve their care, and possibly also their outcomes.
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Affiliation(s)
- E Andersson
- Department of Women's and Children's Health, Reproductive Health Karolinska Institutet, Stockholm, Sweden.
| | - S Nazanin
- Department of Women's and Children's Health, Reproductive Health Karolinska Institutet, Stockholm, Sweden
| | - O Estefania
- Department of Women's and Children's Health, Reproductive Health Karolinska Institutet, Stockholm, Sweden
| | - R Small
- Department of Women's and Children's Health, Reproductive Health Karolinska Institutet, Stockholm, Sweden; Judith Lumley Centre, La Trobe University, Melbourne, Australia
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9
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Bwambale MF, Bukuluki P, Moyer CA, Van den Borne BHW. Utilisation of sexual and reproductive health services among street children and young adults in Kampala, Uganda: does migration matter? BMC Health Serv Res 2021; 21:169. [PMID: 33622341 PMCID: PMC7903651 DOI: 10.1186/s12913-021-06173-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 02/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While the nexus of migration and health outcomes is well acknowledged, the effect of rural-urban migration on the use of sexual and reproductive health (SRH) services has received less attention. We assessed the effect of rural-urban migration on the use of SRH services, while controlling for confounding, and whether there is a difference in the use of SRH services among migrant and non-migrant street children and young adults. METHODS Data were collected from 513 street children and young adults aged 12-24 years, using venue-based time-space sampling (VBTS). We performed multivariate logistic regression analysis using Stata 16.0 to identify factors associated with SRH services use, with rural-urban migration status as the main predictor. Participants were further classified as new migrants (≤ 2 years of stay in city), established migrants (> 2 years of stay in city) or non-migrants (lifelong native street children) with no rural-urban migration history. RESULTS Overall, 18.13% of the street children and young adults had used contraception/family planning, 58.67% had tested for human immunodeficiency virus (HIV) and knew their status and 34.70% had been screened for sexually transmitted infections (STIs). Non-migrants were 2.70 times more likely to use SRH services (HIV testing, STI screening and family planning) compared to the migrants (aOR = 2.70, 95% CI 1.23-5.97). Other factors associated with SRH services use among street children and young adults include age (aOR = 4.70, 95% CI 2.87-7.68), schooling status (aOR = 0.33, 95% CI 0.15-0.76), knowledge of place of care (aOR = 2.71, 95% CI 1.64-4.46) and access to SRH information (aOR = 3.23, 95% CI 2.00-5.24). CONCLUSIONS SRH services utilisation among migrant street children and young adults is low compared to their non-migrant counterparts and is independently associated with migration status, age, schooling status, knowledge of place of care and access to SRH information. Our findings call for the need to design and implement multi-dimensional interventions to increase the use of SRH services among street children and young adults, while taking into consideration their migration patterns.
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Affiliation(s)
- Mulekya F Bwambale
- Department of Health Promotion and Education, Faculty of Health Medicine and Life Sciences, Maastricht University Care and Public Health Research Institute (CAPHRI), Maastricht, Netherlands.
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University College of Humanities and Social Sciences, Kampala, Uganda.
| | - Paul Bukuluki
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University College of Humanities and Social Sciences, Kampala, Uganda
| | - Cheryl A Moyer
- Departments of Learning Health Sciences and Obstetrics and Gynaecology, University of Michigan Medical School, Ann Arbor, USA
| | - Bart H W Van den Borne
- Department of Health Promotion and Education, Faculty of Health Medicine and Life Sciences, Maastricht University Care and Public Health Research Institute (CAPHRI), Maastricht, Netherlands
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Hultstrand JN, Tydén T, Målqvist M, Ragnar ME, Larsson M, Jonsson M. Foreign-born women’s lifestyle and health before and during early pregnancy in Sweden. EUR J CONTRACEP REPR 2020; 25:20-27. [DOI: 10.1080/13625187.2019.1706078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Tanja Tydén
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Mats Målqvist
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | | | - Margareta Larsson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Maria Jonsson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Ortiz J, Diaz M, Araya B M, Quiroz J, Carroza B, Pavez J, Gutierrez L, Binfa L. Comparison of bio-sociodemographic, obstetric and perinatal characteristics among immigrant and native women in the Metropolitan Region in Chile. Midwifery 2019; 75:72-79. [DOI: 10.1016/j.midw.2019.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 04/11/2019] [Accepted: 04/17/2019] [Indexed: 11/24/2022]
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Zhou Y, Wang T, Fu J, Chen M, Meng Y, Luo Y. Access to reproductive health services among the female floating population of childbearing age: a cross-sectional study in Changsha, China. BMC Health Serv Res 2019; 19:540. [PMID: 31370834 PMCID: PMC6676621 DOI: 10.1186/s12913-019-4334-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 07/08/2019] [Indexed: 12/03/2022] Open
Abstract
Background The floating population serves an important role in economic and social development. However, little is known about the floating population’s reproductive health (RH) services, especially in low- and middle-income countries. This study aimed to assess the use of reproductive health services in the female floating population in China, which is a country with the largest floating population in the world. Methods A cross-sectional survey was conducted for more than 3 months. Six hundred twenty females of childbearing age in a floating population were recruited into the study by using random sampling, with these individuals being recruited from six community centres in Changsha, China. The use of reproductive health services was assessed by utilizing a self-designed questionnaire. Results A total of 555 participants returned the completed questionnaires (effective response rate of 89.5%), including 405 married women and 150 unmarried women. The utilization of RH services was poor in individuals who could access RH policies (39.3%), RH education (36.4%), RH counselling (27.4%), gratis contraceptives (36.0%), and free RH examinations (38.9%), and married women utilized these services at higher rates than unmarried women (P < 0.01), although 63.3% of the unmarried women had sexual lifestyles. The marital status was significantly associated with receiving RH education, RH counselling, gratis contraceptives, and free RH examinations. Age was significantly associated with the use of RH education and free RH examinations. The average personal monthly income had a significantly beneficial effect on the use of free RH examinations. Obstetrics and gynaecological disease prevention (67.2%) were the greatest needs of the RH services, and the use of the Internet was the best way to obtain these services. Most of the individuals (77.3%) hoped to receive gynaecological health screenings that were provided by obstetrics and gynaecology hospitals. Conclusions The female floating population exhibited poor awareness of RH and rarely used RH services, especially in unmarried women. The results suggest that educational interventions for the female floating population, as well as policy and resource developments should meet the demands for RH services, which are urgently needed in China. Electronic supplementary material The online version of this article (10.1186/s12913-019-4334-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yanhui Zhou
- Xiangya Nursing School, Central South University, No.172, Tongzipo Road, Changsha, Hunan province, 410013, People's Republic of China
| | - Ting Wang
- Xiangya Nursing School, Central South University, No.172, Tongzipo Road, Changsha, Hunan province, 410013, People's Republic of China
| | - Jingxia Fu
- Xiangya Nursing School, Central South University, No.172, Tongzipo Road, Changsha, Hunan province, 410013, People's Republic of China
| | - Mingzhu Chen
- Xiangya Nursing School, Central South University, No.172, Tongzipo Road, Changsha, Hunan province, 410013, People's Republic of China
| | - Yanting Meng
- Xiangya Nursing School, Central South University, No.172, Tongzipo Road, Changsha, Hunan province, 410013, People's Republic of China
| | - Yang Luo
- Xiangya Nursing School, Central South University, No.172, Tongzipo Road, Changsha, Hunan province, 410013, People's Republic of China.
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13
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Mohammadi S, Carlbom A, Taheripanah R, Essén B. Experiences of inequitable care among Afghan mothers surviving near-miss morbidity in Tehran, Iran: a qualitative interview study. Int J Equity Health 2017; 16:121. [PMID: 28687082 PMCID: PMC5500928 DOI: 10.1186/s12939-017-0617-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/28/2017] [Indexed: 11/29/2022] Open
Abstract
Background Providing equitable maternal care to migrants is a seriously challenging task for hosting countries. Iran, the second-most accessed country for refugees from Afghanistan, has achieved maternal health improvement. However, Afghan women with near-miss morbidity faced pre-hospital delays and disparity in maternal care at hospitals. This study explores experiences of maternal care among Afghan women surviving near-miss morbidity to increase insight into healthcare improvements for migrants. Methods A qualitative study was conducted at university hospitals in Tehran, from April 2013 to May 2014. A total of 11 Afghan women and 4 husbands were interviewed when women recovered from near-miss morbidity that occurred around the childbirth period. Mothers were identified prospectively using the WHO maternal near-miss approach. Thematic analysis was used along with a data-driven approach to organize data guided by the ‘three delays model’ theoretical framework. Results Mistreatment in the form of discrimination and insufficient medical attention were key experiences. Participants commonly perceived poor women–professional communication and delays in recognizing obstetric complications despite repeated care-seeking. Financial constraints, costly care, lack of health insurance, and low literacy were experienced barriers to accessing care to a lesser extent. Non-somatic consequences of near-miss morbidity affected mothers and families for extended periods. Conclusions Near-miss survivors’ experiences provided remarkable insights into maternal care of Afghans in Iran. The challenge for the health system and professionals is to provide equitable care with dignity and improve communication skills with caring attitudes toward ethnic minorities. Antenatal visits provide the best and most appropriate opportunities to tackle health illiteracy in Afghan women.
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Affiliation(s)
- Soheila Mohammadi
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, SE-751 85, Uppsala, Sweden. .,Infertility and Reproductive Health Research Center (IRHRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Aje Carlbom
- Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Robabeh Taheripanah
- Infertility and Reproductive Health Research Center (IRHRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Birgitta Essén
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, SE-751 85, Uppsala, Sweden
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Browne JL, Klipstein-Grobusch K, Koster MPH, Ramamoorthy D, Antwi E, Belmouden I, Franx A, Grobbee DE, Schielen PCJI. Pregnancy Associated Plasma Protein-A and Placental Growth Factor in a Sub-Saharan African Population: A Nested Cross-Sectional Study. PLoS One 2016; 11:e0159592. [PMID: 27532602 PMCID: PMC4988712 DOI: 10.1371/journal.pone.0159592] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/06/2016] [Indexed: 01/11/2023] Open
Abstract
Background Baseline distributions of pregnancy disorders’ biomarkers PlGF and PAPP-A levels are primarily based on Western European populations of Caucasian ethnicity. Differences in PAPP-A and PlGF concentrations by ethnicity have been observed, with increased levels in Afro-Caribbean, East Asian, and South Asian women. Baseline concentrations of sub-Saharan African women have not been evaluated. Objectives To investigate PlGF and PAPP-A in a sub-Saharan African population and assess the performance of existing reference values of PAPP-A and PlGF. Methods A nested cross-sectional study was conducted in two public hospitals in Accra, Ghana. Out of the original 1010 women enrolled in the cohort, 398 participants were eligible for inclusion with a normotensive singleton gestation and serum samples taken between 56–97 days of pregnancy. PAPP-A and PlGF concentrations were measured with an automated immunoassay. Multiple of the median (MoM) values corrected for gestation and maternal weight for PAPP-A and PlGF were calculated using reference values of a Dutch perinatal screening laboratory based on over 10.000 samples, and PlGF manufacturer reference values, respectively. Results The PAPP-A median MoM was 2.34 (interquartile range (IQR) 1.24–3.97). Median PlGF MoM was 1.25 (IQR 0.95–1.80). Median MoM values for PAPP-A and PlGF tended to be slightly different for various Ghanaian ethnic subgroups. Conclusions PAPP-A and PlGF MoM values appear to be substantially higher in a sub-Saharan African population compared to the Caucasian or Afro-Caribbean MoM values previously reported. The difference suggests the need for a specific correction factor for this population to avoid underestimation of risk for fetal aneuploidies or placental disorders when using PAPP-A and PlGF MoM for screening purposes.
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Affiliation(s)
- Joyce L. Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- * E-mail:
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maria P. H. Koster
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, The Netherlands
| | - Dhivya Ramamoorthy
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Edward Antwi
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Ghana Health Service, Greater Accra Regional Health Directorate, Accra, Ghana
| | - Idder Belmouden
- Center for Infectious Diseases Research, Diagnostics and Screening (IDS), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, The Netherlands
| | - Diederick E. Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter C. J. I. Schielen
- Center for Infectious Diseases Research, Diagnostics and Screening (IDS), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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