Patterns of postpartum contraceptive use among Somali immigrant women living in Minnesota

"Using contraceptives is abandoning our culture": A qualitative study of contraceptive use among Somali women in Finland

OBJECTIVE

Several studies have reported that Somalis have negative attitudes about using modern contraceptives. However, little attention has been paid to the differences in Somali women's attitudes toward contraceptives across generations and the attitude change happening overtime in Somali women's attitudes toward contraception. This study explores attitudes toward contraceptives and factors influencing contraceptive use, among first- and second-generation Somali women living in Finland.

METHODS

The study follows a qualitative design with data collection using in-depth interviews. Sixteen women were interviewed regarding their knowledge of, attitude toward, and use of contraceptives. Eight of the study participants were first-generation and eight were second-generation Somali women living in Finland. The data were analyzed using a thematic approach guided by a cultural anthropology framework.

RESULTS

Three main themes emerged in the data analysis: (1) Culture influencing Somali women's attitudes toward contraceptives; (2) information sources can work differently within the same cultural group; and (3) Somali women's perspectives on contraceptives change over time. Cultural, religion, taboo, and knowledge resources are used to understand the whole concept of Somali women's attitude toward and use of contraceptives. Hence, the study shows the diverse opinions of Somali women. According to the informants the main underlying factors influencing Somali women's attitudes toward contraceptives were education, culture, misinterpreted religion, and social pressure.

CONCLUSIONS

According to the Finish resident women interviewed for this study, Somali culture do not support the use of modern contraceptives. Even though attitudes towards contraceptives are slowly changing, there is a need for SRH education, particularly among first-generation Somalis. Second-generation women are generally more open to the use of modern contraceptives. The study also draws attention to the need to improve the training of health care professionals regarding the handling of culturally sensitive topics such as contraception use.

Family Planning Research in African Immigrant and Refugee Women: A Scoping Review

INTRODUCTION

African immigrants are a vulnerable population who are seldom seen in the literature, however, the scant research available reports that they experience increased challenges when making family planning decisions. A robust understanding of their specific family planning practices is imperative to providing appropriate, culturally congruent care. Considering this disparity, a scoping review was conducted to synthesize empirical knowledge and identify gaps in the literature around family planning in African immigrant populations in the United States.

METHODS

Guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) framework, EMBASE, Global Health Database, PsycINFO, CINAHL, and PubMed were searched for literature regarding family planning topics such as decision-making and health care access among African immigrant women in the United States in June 2020.

RESULTS

The small number of retrieved studies for the literature review clearly highlights a dearth of research. Available evidence indicates stark disparities in health care access, unmet individual needs, and unacknowledged preferences.

DISCUSSION

Ignoring cultural considerations for the growing African immigrant population perpetuates the divide in family planning practices.

Family planning trends among community-dwelling African refugee women

PURPOSE

From 2009 to 2019, more than 175,000 refugees were admitted into the United States from African countries. What is known about sexual and reproductive health in this population is focused on perinatal outcomes; beliefs and attitudes towards family planning and related behaviors, which can impact perinatal health, have not been explored. Understanding these beliefs and attitudes can guide future work with this population.

STUDY DESIGN

A cross-sectional, convenience survey of 100 community-dwelling African refugee women was conducted.

RESULTS

The following research questions guided analysis: What are African refugee women's family planning attitudes (pregnancy intention, desired timing, perceived fecundity)? What are African refugee women's family planning behaviors (use vs. non-use of methods, type of methods used)? and What socio-demographic factors and family planning attitudes are related to family panning behaviors (use or non-use of methods)? Almost 49% of participants reported ever using a method of family planning and 35% reported current use. Reasons for non-use included desire for more children (28.8%), infrequent intercourse (22.0%), and fear of side effects (16.9%). Nearly two thirds expressed a desire for a future pregnancy (63.4%), but the majority reported wanting to become pregnant in two or more years (25.7%) or "when God wants" (24.8%). No significant relationship was found between family planning method use and future pregnancy intention, desired timing of future pregnancy, perceived fecundity, marital status, religious affiliation, number of years in the US. Having had any formal schooling decreased the likelihood of using a family planning method.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Low family planning method use rates among African refugee women are not completely explained by desires for future pregnancy, perceived fecundity, marital status, or other sociodemographic factors. Concern for future fertility and fear of side effects were identified as potentially modifiable reasons appropriate for community based culturally congruent educational interventions on family planning use.

Postpartum Contraception Usage Among Somali Women in Olmsted County, Minnesota

OBJECTIVE

To compare postpartum contraception use between Somali and non-Somali women.

METHODS

A retrospective cohort study was performed using the Rochester Epidemiology Project. All Somali women aged 18 and older with live singleton births in Olmsted County, Minnesota, in 2009-2015 (n=317) were included, and a group of age-matched non-Somali women (n=317) were identified. Postpartum contraception was defined as the use of any method within 12 months after the first delivery within the study period. Rates of contraception use and types of contraception used were compared between groups using χ analysis. Among Somali women, an a priori list of factors was evaluated for associations with postpartum contraception use by including these factors in a multivariable logistic regression model.

RESULTS

After the index birth, 33 Somali women did not present for follow-up, compared with 12 non-Somali women (10.4% vs 3.8%, difference 6.6%, 95% CI 2.3-10.9%). Somali women were less likely to use postpartum contraception than non-Somali women (69.4% vs 92.8%, odds ratio [OR] 0.18, 95% CI 0.11-0.29). Among those using postpartum contraception, both groups had comparable use of long-acting reversible contraception (LARC) (19.9% vs 23.7%, difference -3.8%, 95% CI -11.8% to 4.0%) and non-LARC hormonal contraception (39.3% vs 42.4%, difference -3.1%, 95% CI -12.7% to 6.0%). However, Somali women were more likely to use less reliable methods (40.3% vs 20.8%, difference 19.5%, 95% CI 11.0-28.5%). Among Somali women, contraception use was less likely with older maternal age (OR 0.12 for oldest vs youngest quartile, 95% CI 0.04-0.37) and more likely with prepregnancy contraception use (OR 15.46, 95% CI 5.18-46.18).

CONCLUSION

Somali women were less likely to use postpartum contraception. Similar practices and beliefs may also be present in other immigrant populations. Recognition of sociocultural differences in immigrant populations and potential health care provider biases may improve patient-provider relationships and counseling practices.