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Zaidi M, Fantasia HC, Penders R, Koren A, Enah C. Increasing U.S. Maternal Health Equity Among Immigrant Populations Through Community Engagement. Nurs Womens Health 2024; 28:11-22. [PMID: 38072010 DOI: 10.1016/j.nwh.2023.09.004] [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: 06/09/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 01/09/2024]
Abstract
Immigrant women in the United States are at an elevated risk of poor maternal health outcomes due to cultural, linguistic, or socioeconomic barriers that may lead to critical delays in obtaining adequate health care. Ensuring access to high-quality, culturally appropriate perinatal health care is crucial to improve the health and well-being of immigrant mothers and their children. Various aspects of perinatal health care for immigrant women can be improved through community engagement strategies. Barriers can be addressed by involving community members in designing and delivering culturally appropriate maternal health services. Some strategies discussed in this commentary include working with community health workers, encouraging telehealth through community health workers, providing breastfeeding and mental health support within cultural norms, and involving community-based doulas and midwives.
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Besera G, Vu M, Dogbe A, Ta D, Escoffery C, Copeland H, Hall KS. "My culture doesn't 100% like these kinds of services, but you decide what to do": Female refugees' experiences with sexual and reproductive healthcare in the Southeastern U.S. PEC INNOVATION 2023; 2:100172. [PMID: 37384152 PMCID: PMC10294046 DOI: 10.1016/j.pecinn.2023.100172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/30/2023]
Abstract
Objective This study investigates female refugees' experiences accessing and utilizing sexual and reproductive (SRH) services in the state of Georgia. Methods We conducted in-person, in-depth semi-structured interviews with 26 female refugee adolescents and adults from Burma, Bhutan or Nepal, and the Democratic Republic of Congo living in Georgia. Questions inquired about perceptions and experiences while accessing and utilizing SRH services. Data were analyzed using thematic analysis. Results Participants discussed the importance but also varying influence of social and cultural norms on SRH service utilization. Challenges to accessing and utilizing SRH services included communication and cost barriers. Facilitators included accessible clinic locations, transportation, and positive interactions with clinic providers and staff. Conclusion Understanding female refugees' experiences accessing and utilizing SRH services is critical to meet their SRH needs adequately. Through community engagement, practitioners and researchers can gain insights into cultural influences on SRH, address communication and cost barriers, and enhance existing facilitators to increase female refugees' access and use of services. Innovation Our community-engaged study incorporated perspectives of diverse groups of refugee women and adolescents in the Southeastern U.S. Findings from this study highlight lived experiences with SRH services and identify barriers to and facilitators of SRH services access and utilization.
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Affiliation(s)
- Ghenet Besera
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Milkie Vu
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Aku Dogbe
- Embrace Refugee Birth Support, Clarkston, GA, USA
| | - Danny Ta
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Kelli S. Hall
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
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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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DeYoung SE, Jackson V, Callands TA. Maternal stress and social support during Hurricane Florence. Health Care Women Int 2023; 44:198-215. [PMID: 35616344 DOI: 10.1080/07399332.2022.2046750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In theoretical research on disaster vulnerability, access to resources is critical for optimal outcomes. Studying the impact of a hurricane on maternal stress can expand theories of disaster vulnerability. This is a cross-sectional mixed-methods prospective study of maternal stress during Hurricane Florence in the United States. Results from chi-squares compared the proportion of respondents who reported having support for a financial emergency were significant, specifically that higher income respondents indicated the ability to rely on someone in case of an emergency. A regression analysis indicated that social support was significant and negatively related to stress as a dependent variable, while evacuation status and pregnancy status were not significant predictors of stress. Five themes emerged from the overall qualitative data: concerns about infant feeding, evacuation logistics, general stress, family roles, and 'other' issues.
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Kirkendall A, Dutt A. Refugee women's pregnancy and childbirth experiences in the US: Examining context through a reproductive justice framework. FEMINISM & PSYCHOLOGY 2023. [DOI: 10.1177/09593535221149166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Maternal health in the United States is an area of immediate concern. The compounded disadvantages and unique global positions of refugee women highlight the need for research that explores the experiences of refugee women during pregnancy and childbirth. The present study examines how contextual factors shape pregnancy and childbirth experiences for Syrian, Afghan, Congolese, and Karen women living in Clarkston, Georgia, US. Qualitative data were collected via focus groups facilitated by community interpreters. We used a reproductive justice framework to center women's desires, needs, and experiences, and to highlight the importance of structural factors in the findings and analysis of this study. Using codebook thematic analysis, three themes were developed: (1) isolation and alienated knowledge, (2) gendered disparities and structural inequities, and (3) community support and precarity. The findings reflect both the diversity and constancy of women's experiences and highlight how the context of the US impacts women's ability to exercise agency during pregnancy and childbirth. Systemic change is needed to improve women's access to tools that increase their capacity to exercise agency both during pregnancy and childbirth, and beyond.
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Olcoń K, Rambaldini-Gooding D, Degeling C. Implementation gaps in culturally responsive care for refugee and migrant maternal health in New South Wales, Australia. BMC Health Serv Res 2023; 23:42. [PMID: 36650536 PMCID: PMC9843667 DOI: 10.1186/s12913-023-09066-7] [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: 06/10/2022] [Accepted: 01/16/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Refugee and migrant women are at higher risk of childbirth complications and generally poorer pregnancy outcomes. They also report lower satisfaction with pregnancy care because of language barriers, perceived negative attitudes among service providers, and a lack of understanding of refugee and migrant women's needs. This study juxtaposes health policy expectations in New South Wales (NSW), Australia on pregnancy and maternity care and cultural responsiveness and the experiences of maternal healthcare providers in their day-to-day work with refugee and migrant women from non-English speaking backgrounds. METHODS This study used a qualitative framework method to allow for a comparison of providers' experiences with the policy expectations. Sixteen maternal health service providers who work with refugee and migrant women were recruited from two local health districts in New South Wales, Australia and interviewed (November 2019 to August 2020) about their experiences and the challenges they faced. In addition, a systematic search was conducted for policy documents related to the provision of maternal health care to refugee and migrant women on a state and federal level and five policies were included in the analysis. RESULTS Framework analysis revealed structural barriers to culturally responsive service provision and the differential impacts of implementation gaps that impede appropriate care resulting in moral distress. Rather than being the programmatic outcome of well-resourced policies, the enactment of cultural responsiveness in the settings studied relied primarily on the intuitions and personal responses of individual service providers such as nurses and social workers. CONCLUSION Authentic culturally responsive care requires healthcare organisations to do more than provide staff training. To better promote service user and staff satisfaction and wellbeing, organisations need to embed structures to respond to the needs of refugee and migrant communities in the maternal health sector and beyond.
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Affiliation(s)
- Katarzyna Olcoń
- grid.1007.60000 0004 0486 528XSchool of Health and Society, Faculty of the Arts, Social Sciences and Humanities, The University of Wollongong, Wollongong, NSW 2522 Australia
| | - Delia Rambaldini-Gooding
- grid.1007.60000 0004 0486 528XSchool of Health and Society, Faculty of the Arts, Social Sciences and Humanities, The University of Wollongong, Wollongong, NSW 2522 Australia
| | - Chris Degeling
- grid.1007.60000 0004 0486 528XSchool of Health and Society, Faculty of the Arts, Social Sciences and Humanities, The University of Wollongong, Wollongong, NSW 2522 Australia
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Vu M, Besera G, Ta D, Escoffery C, Kandula NR, Srivanjarean Y, Burks AJ, Dimacali D, Rizal P, Alay P, Htun C, Hall KS. System-level factors influencing refugee women's access and utilization of sexual and reproductive health services: A qualitative study of providers' perspectives. Front Glob Womens Health 2022; 3:1048700. [PMID: 36589147 PMCID: PMC9794861 DOI: 10.3389/fgwh.2022.1048700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
Refugee women have poor outcomes and low utilization of sexual and reproductive health (SRH) services, which may be driven by access to and quality of SRH services at their resettled destinations. While healthcare providers offer valuable insights into these topics, little research has explored United States (U.S.) providers' experiences. To fill this literature gap, we investigate U.S. providers' perspectives of healthcare system-related factors influencing refugee women's access and utilization of SRH services. Between July and December 2019, we conducted in-depth, semi-structured interviews with 17 providers serving refugee women in metropolitan Atlanta in the state of Georgia (United States). We used convenience and snowball sampling for recruitment. We inquired about system-related resources, facilitators, and barriers influencing SRH services access and utilization. Two coders analyzed the data using a qualitative thematic approach. We found that transportation availability was crucial to refugee women's SRH services access. Providers noted a tension between refugee women's preferred usage of informal interpretation assistance (e.g., family and friends) and healthcare providers' desire for more formal interpretation services. Providers reported a lack of funding and human resources to offer comprehensive SRH services as well as several challenges with using a referral system for women to get SRH care in other systems. Culturally and linguistically-concordant patient navigators were successful at helping refugee women navigate the healthcare system and addressing language barriers. We discussed implications for future research and practice to improve refugee women's SRH care access and utilization. In particular, our findings underscore multilevel constraints of clinics providing SRH care to refugee women and highlight the importance of transportation services and acceptable interpretation services. While understudied, the use of patient navigators holds potential for increasing refugee women's SRH care access and utilization. Patient navigation can both effectively address language-related challenges for refugee women and help them navigate the healthcare system for SRH. Future research should explore organizational and external factors that can facilitate or hinder the implementation of patient navigators for refugee women's SRH care.
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Affiliation(s)
- Milkie Vu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Ghenet Besera
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Danny Ta
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Namratha R. Kandula
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Amanda J. Burks
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- Emory University Physician Assistant Program, School of Medicine, Emory University, Atlanta, GA, United States
| | - Danielle Dimacali
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Pabitra Rizal
- Center for Pan Asian Community Services, Atlanta, GA, United States
| | - Puspa Alay
- Center for Pan Asian Community Services, Atlanta, GA, United States
| | - Cho Htun
- Center for Pan Asian Community Services, Atlanta, GA, United States
| | - Kelli S. Hall
- Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States
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Shahawy S, Onwuzurike C, Premkumar A, Henricks AA, Simon MA. Perspectives of women of refugee background on healthcare needs in a major urban metropolitan community in the US: A qualitative needs assessment. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5637-e5646. [PMID: 36111793 DOI: 10.1111/hsc.13989] [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: 07/06/2021] [Revised: 07/15/2022] [Accepted: 08/13/2022] [Indexed: 06/02/2023]
Abstract
The objective of this study was to describe the healthcare needs and experiences of women of refugee background in Chicago-home to one of the largest and most diverse refugee populations in the United States. We used a phenomenological study design with a desire-centered rather than damage-centered approach to conduct a series of focus group discussions with 24 women of refugee background in their native languages in Chicago, Illinois between December 2018 and February 2019. Convenience sampling was used to recruit women of refugee background at least 18 years of age living in the Chicago metropolitan area who attended educational women's health workshops at local refugee community centers. An inductive approach to the analysis was used to code transcripts and generate themes. Our study identified four major healthcare priorities for women of refugee background in a major metropolitan area: (1) central and centralised healthcare, (2) continuity of care, (3) trauma-informed care and (4) community engagement and partnerships. The healthcare priorities identified by the participants in this study should inform existing and future healthcare models and clinics providing care for women of refugee background in urban and sub-urban contexts across the United States.
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Affiliation(s)
- Sarrah Shahawy
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Obstetrics and Gynecology, Harvard Medical School, Boston, Massachusetts, USA
| | - Chiamaka Onwuzurike
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Obstetrics and Gynecology, Harvard Medical School, Boston, Massachusetts, USA
| | - Ashish Premkumar
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA
- Department of Anthropology, The Graduate School, Northwestern University, Evanston, Illinois, USA
| | - Andrea A Henricks
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Obstetrics & Gynecology, University of North Carolina, Raleigh, North Carolina, USA
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine (IPHAM) - Center for Health Equity Transformation, Chicago, Illinois, USA
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Barua M, Saha A, Chowdhury S, Chowdhury S, Sajow SH, Sarker M. Implementation of a community-based referral project to improve access to emergency obstetric and newborn care in Rohingya population during COVID-19 pandemic in Bangladesh. BMJ INNOVATIONS 2022; 8:247-254. [PMID: 37556264 PMCID: PMC9157323 DOI: 10.1136/bmjinnov-2021-000831] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 04/28/2022] [Indexed: 11/07/2022]
Abstract
Introduction The delay in seeking emergency obstetric care leads to significant maternal morbidity and mortality and can worsen during pandemics, especially in humanitarian conflict settings with low uptake of obstetric services. To mitigate the challenges related to the second delay caused by lack of transport in the COVID-19 pandemic, the organisation United Nations Population Fund implements a community-based referral project called Referral Hub in the Rohingya refugee population in Bangladesh. The objective of the paper is to describe the implementation process of the Referral hub and present clients' utilisation and perception of the service. Methods Findings from part of a larger mixed-method study, the analysis of the standard operating protocol of the intervention, secondary data of routine utilisation of the 12 referral hubs between January and August 2020, 21 key informant interviews and a community survey among 100 pregnant women are presented in this paper. Results The findings show an increasing trend in the referral hub utilisation and a strong recommendation of the service. Conclusion Due to a robust referral mechanism by collaborating with the community and engaging accessible and free of cost transport service, the intervention has high potential to improve access to facility care in low-resource and humanitarian contexts, especially during pandemics.
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Affiliation(s)
- Mrittika Barua
- BRAC University James P Grant School of Public
Health, Dhaka,
Bangladesh
| | - Avijit Saha
- BRAC University James P Grant School of Public
Health, Dhaka,
Bangladesh
| | - Srizan Chowdhury
- International Centre for Diarrhoeal Disease
Research, Dhaka,
Bangladesh
| | | | | | - Malabika Sarker
- BRAC University James P Grant School of Public
Health, Dhaka,
Bangladesh
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Mosley EA, Pratt M, Besera G, Clarke LS, Miller H, Noland T, Whaley B, Cochran J, Mack A, Higgins M. Evaluating Birth Outcomes From a Community-Based Pregnancy Support Program for Refugee Women in Georgia. Front Glob Womens Health 2021; 2:655409. [PMID: 34816209 PMCID: PMC8593936 DOI: 10.3389/fgwh.2021.655409] [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] [Received: 01/18/2021] [Accepted: 05/18/2021] [Indexed: 11/28/2022] Open
Abstract
Refugee women face numerous and unique barriers to sexual and reproductive healthcare and can experience worse pregnancy-related outcomes compared with U.S.-born and other immigrant women. Community-based, culturally tailored programs like Embrace Refugee Birth Support may improve refugee access to healthcare and health outcomes, but empirical study is needed to evaluate programmatic benefits. This community-engaged research study is led by the Georgia Doula Access Working Group, including a partnership between academic researchers, Emory Decatur Hospital nurses, and Embrace. We analyzed hospital clinical records (N = 9,136) from 2016 to 2018 to assess pregnancy-related outcomes of Embrace participants (n = 113) and a comparison group of women from the same community and racial/ethnic backgrounds (n = 9,023). We controlled for race, language, maternal age, parity, insurance status, preeclampsia, and diabetes. Embrace participation was significantly associated with 48% lower odds of labor induction (OR = 0.52, p = 0.025) and 65% higher odds of exclusive breastfeeding intentions (OR = 1.65, p = 0.028). Embrace showed positive but non-significant trends for reduced cesarean delivery (OR = 0.83, p = 0.411), higher full-term gestational age (OR = 1.49, p = 0.329), and reduced low birthweight (OR = 0.77, p = 0.55). We conclude that community-based, culturally tailored pregnancy support programs like Embrace can meet the complex needs of refugee women. Additionally, community-engaged, cross-sector research approaches could ensure the inclusion of both community and clinical perspectives in research design, implementation, and dissemination.
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Affiliation(s)
- Elizabeth A. Mosley
- Georgia State University School of Public Health, Atlanta, GA, United States,Emory University Rollins School of Public Health, Atlanta, GA, United States,*Correspondence: Elizabeth A. Mosley
| | | | - Ghenet Besera
- Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Lasha S. Clarke
- Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Heidi Miller
- Embrace Refugee Birth Support, Clarkston, GA, United States
| | - Tracy Noland
- Embrace Refugee Birth Support, Clarkston, GA, United States
| | - Bridget Whaley
- Emory University Rollins School of Public Health, Atlanta, GA, United States
| | | | - Amber Mack
- Healthy Mothers, Healthy Babies Coalition of Georgia, Atlanta, GA, United States
| | - Melinda Higgins
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, United States
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Ajjarapu A, Story WT, Haugsdal M. Addressing Obstetric Health Disparities among Refugee Populations: Training the Next Generation of Culturally Humble OB/GYN Medical Providers. TEACHING AND LEARNING IN MEDICINE 2021; 33:326-333. [PMID: 33956548 DOI: 10.1080/10401334.2020.1813585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Issue: The burden of increasing obstetric morbidity and mortality in the United States disproportionately affects marginalized and vulnerable populations, including refugees. Many factors have been attributed to this disparity in birth outcomes, such as linguistic, cultural, and health system limitations. However, refugee health disparities have received little attention in the U.S., especially as it relates to the training of healthcare providers. Evidence: Poor obstetric outcomes among refugee communities have been historically attributed to delayed initiation of prenatal care, failure to detect co-morbidities, as well as higher rates of Cesarean sections in comparison to host-country mothers. These inequities are often linked to poor communication due to cultural misunderstandings, which ultimately leads to mistrust and reduced utilization of healthcare services. In 2017, a Midwest academic hospital, refugee community, and health system came together to form the Congolese Health Partnership (CHP). The CHP was formed to improve access to quality healthcare for expecting Congolese mothers and their families experiencing poor quality of obstetric care. Discussions that arose from this partnership identified issues of mistrust in healthcare providers within the community, worry about misjudgment and overuse of C-sections, and a lack of understanding about health insurance during pregnancy and childbirth. Therefore, it is apparent that understanding the contextual nuances that play a role in these poor outcomes among refugee communities in the U.S. is critical in order to narrow the healthcare gap. Implications: Since pregnancy and its surrounding events are intricately tied to the ways in which different societies define culture, we argue for a focus on culture when training future healthcare providers to work with refugees in the U.S. Specifically, we focus on the necessity of cultural humility, rather than cultural competence, when caring for obstetric patients from diverse backgrounds. Cultural humility forces providers to think about power imbalances that exist between a patient and provider when cultural differences exist. We describe specific barriers to care among Congolese refugees living in eastern Iowa and explore ways to utilize community-provider partnership and cultural humility training to address obstetric morbidity. Finally, we propose ways to incorporate cultural humility training among OB/GYN residents to address community-identified barriers to improve overall health outcomes locally with implications for refugee communities across the U.S.
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Affiliation(s)
- Avanthi Ajjarapu
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - William T Story
- Department of Community and Behavioral Health, University of Iowa, Iowa City, Iowa, USA
| | - Michael Haugsdal
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa, USA
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Toker E, Aktaş S. The childbirth experiences of Syrian refugee mothers living in Turkey: a qualitative study. J Reprod Infant Psychol 2021; 39:544-560. [PMID: 33896296 DOI: 10.1080/02646838.2021.1913487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective:The study aims to examine the childbirth experiences of Syrian refugee mothers living in Turkey.Methods: This qualitative study was conducted with 12 mothers who had a vaginal birth and were assisted by midwives. The data were collected using an in-depth interview form and analyzed with the thematic analysis technique.Results: The childbirth experiences of the mothers were grouped under two main headings as negative and positive experiences. "Negative childbirth experiences" were divided into 4 main themes as "negative emotions experienced during childbirth, lack of effective communication due to the language barrier, difficulties experienced related to hospital policies and dissatisfaction with midwives". "Positive birth experiences", were categorized under three main themes as "satisfaction with the midwife, finding the country safe to give birth, and mother' s positive attitude towards birth process". The mothers were satisfied with "the attitudes and behaviors of the midwives and their professional practices", and the positive attitude of mothers towards birth in religious and cultural terms contributed to the positive birth perception.Conclusion: Refugee mothers were found to have both positive and negative childbirth experiences. Individualized, empathic communication-based, culturally sensitive and evidence-based care may contribute to the positive childbirth experiences of refugee women.
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Affiliation(s)
- Eylem Toker
- Faculty of Health Sciences, Department of Midwifery, Tarsus University, Tarsus/Mersin, Turkey
| | - Songül Aktaş
- Faculty of Health Sciences, Department of Birth and WomenDiseaseNursing, Karadeniz Technical University, Trabzon, Turkey
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