Avoiding obstetrical interventions among US-based Somali migrant women: a qualitative study

Abstract

Yet unknown is how they avoid obstetrical 17 interventions. This study sought to identify perceived protective mechanisms used to avoid obstetric 18 interventions as well as the underpinning factors that influence aversion to obstetrical interventions by 19 Somali refugee women. 20 Design: A descriptive, exploratory qualitative study purposively sampled Somali refugee women recruited 21 via snowball technique in Franklin County, Ohio, United States. Data was collected through audio-22 recordings of individual interviews and focus groups conducted in English and Somali languages. The 23 collected data were transcribed and analyzed using thematic analyses. 24 Results: Forty Somali refugee women aged 18 to 42 years were recruited. Participants reported engaging 25 in four perceived protective mechanisms to avoid obstetrical interventions during pregnancy and childbirth: 26 1) intentionally not seeking or misleading prenatal care, 2) changing hospitals and/or providers, 3) delayed 27 hospital arrival during labor, and 4) refusal of care. Underpinning all four avoidance mechanisms were their 28 significant fear of obstetrical interventions, and perceived lack of choice in their care processes as 29 influenced by: cultural and/or religious beliefs, feeling judged or undervalued by service providers, and a 30 lack of privacy provided to them while receiving care. 31 Conclusion: Like every woman, Somali women also have a right to choose or refuse care. If the intention 32 is to improve access to and experiences with care for this population, building trust, addressing their fears 33 and concerns, and respecting their culture is a critical first step. This should be well established prior to the 34 need for critical decisions surrounding pregnancy and childbirth wherein Somali women may feel 35 compelled to refuse necessary obstetrical care. Bridging gaps between Somali women and their providers 36 is key to advancing health equity for this vulnerable population.

The lived experience among Somali women of giving birth in Sweden: an interpretive phenomenological study

“…There is also a need for a structure to how this information is given and for adaptation regarding content and format. Group information and video training specifically for Somali women were appreciated by the women as these improved their care satisfaction through providing increased knowledge and reduced stress [39,40].…”

Navigating new lives: A scoping review and thematic synthesis of forced migrant women's perinatal experiences

“…Many women who had migrated to high- or middle-income countries expressed satisfaction with their maternity care overall, but this was usually framed in contrast to their previous maternity experiences in resource-poor settings with higher maternal mortality rates and gratitude for being taken care of within the host country health system ( Riggs et al., 2017 ; Niner et al., 2013 ; Korukcu et al., 2018 ; Henry et al., 2020 ; Bader et al., 2020 ; LaMancuso et al., 2016 ). In spite of this satisfaction, women in many studies identified being stigmatised and receiving disrespectful or discriminatory care, due to being foreign, their skin colour, immigration status or being unable to speak the host-country language ( Riggs et al., 2017 ; Chulach et al., 2016 ; Niner et al., 2013 ; McLeish, 2005 ; Lalla et al., 2020 ; Herrel et al., 2004 ; Agbemenu et al., 2019 ). They felt their needs were disregarded, they were treated rudely or as inferior to host-country women and, particularly with reference to female genital mutilation (FGM), put on display and ‘othered’ ( Stapleton et al., 2013 ; Agbemenu et al., 2019 ).…”

“…In spite of this satisfaction, women in many studies identified being stigmatised and receiving disrespectful or discriminatory care, due to being foreign, their skin colour, immigration status or being unable to speak the host-country language ( Riggs et al., 2017 ; Chulach et al., 2016 ; Niner et al., 2013 ; McLeish, 2005 ; Lalla et al., 2020 ; Herrel et al., 2004 ; Agbemenu et al., 2019 ). They felt their needs were disregarded, they were treated rudely or as inferior to host-country women and, particularly with reference to female genital mutilation (FGM), put on display and ‘othered’ ( Stapleton et al., 2013 ; Agbemenu et al., 2019 ). “I feel like that doctor did not look after me very well… I am not sure if it is because we are refugees that they don't treat us very well.…”

“…As a result, the disempowerment and disconnectedness of women from decision-making about their care or treatment was evidenced ( Tobin et al., 2014 ; Niner et al., 2013 ; McLeish, 2005 ; Lephard and Haith-Cooper, 2016 ; Herrel et al., 2004 ; Murray et al., 2010 ; Correa-Velez and Ryan, 2012 ; Agbemenu et al., 2019 ), leading to feelings of loss of control, fear, and for some women, trauma. Women described having procedures without fully understanding what or why these were taking place.…”

Paternal country of origin and adverse neonatal outcomes in births to foreign-born women in Norway: A population-based cohort study

“…Paternal origin was unregistered in as many as 1 in 5 births to women originating from sub-Saharan Africa. It is possible that a lack of information about fathers of the babies of sub-Saharan African women and their poorer outcomes might be explained by more limited health literacy [ 50 ], distrust in the healthcare system [ 51 , 52 ], or a delay in seeking antenatal care [ 52 – 54 ]. This might also be the case for other migrant women, such as those who have fled from wars and conflicts [ 44 ].…”