Challenges and barriers to optimal maternity care for recently migrated women - a mixed-method study in Norway

Abstract

Background Migrant women are at increased risk for complications related to pregnancy and childbirth, possibly due to inadequate access and utilisation of healthcare. Recently migrated women are considered a vulnerable group who may experience challenges in adapting to a new country. We aimed to identify challenges and barriers recently migrated women face in accessing and utilising maternity healthcare services. Methods In the mixed-method MiPreg-study, we included recently migrated (≤ five years) pregnant women born in low- or middle-income countries and healthcare personnel. First, we conducted 20 in-depth interviews with migrant women at Maternal and Child Health Centres (MCHC) and seven in-depth interviews with midwives working at either the hospital or the MCHCs in Oslo. Afterwards, we triangulated our findings with 401 face-to-face questionnaires post-partum at hospitals among migrant women. The data were thematically analysed by grouping codes after careful consideration and consensus between the researchers. Results Four main themes of challenges and barriers faced by the migrant women were identified: (1) Navigating the healthcare system, (2) Language, (3) Psychosocial and structural factors, and (4) Expectations of care. Within the four themes we identified a range of individual and structural challenges, such as limited knowledge about available healthcare services, unmet needs for interpreter use, limited social support and conflicting recommendations for pregnancy-related care. The majority of migrant women (83.6%) initiated antenatal care in the first trimester. Several of the challenges were associated with vulnerabilities not directly related to maternal health. Conclusion A combination of individual, structural and institutional barriers hinder recently migrated women in achieving optimal maternal healthcare. Suggested strategies to address the challenges include improved provision of information about healthcare structure to migrant women, increased use of interpreter services, appropriate psychosocial support and strengthening diversity- and intercultural competence training among healthcare personnel.

Use of non-governmental maternity services and pregnancy outcomes among undocumented women: a cohort study from Norway

“…Late presentation was particularly the case for women from countries outside the Africa and Middle East regions, who also had short stays in Norway. However, another study of documented migrants recently migrating (≤ 5 years) to Norway found that 16.4% came in late for their first antenatal visit [ 47 ]. Earlier studies have identified barriers to accessing health care, for example fear of deportation, financial concerns, being unfamiliar with their entitlements and not knowing where to seek help [ 12 , 17 ].…”

Barriers and enablers to emergency obstetric and newborn care services use in Wolaita Zone, Southern Ethiopia: a qualitative case study

“…Evidence from Nigeria also showed that women misinterpreted the signs of obstetric complications [ 32 ] and that the perceived susceptibility and threat, and perceived severity [ 22 ] of obstetric complications affected women’s decision to seek care from EmONC facilities [ 33 ]. This problem is not limited to LMICs [ 34 , 35 ]. Evidence shows that women’s expectations [ 34 ] and prior negative experiences with health services and care providers [ 35 ] negatively influenced maternity care utilization.…”

“…This problem is not limited to LMICs [ 34 , 35 ]. Evidence shows that women’s expectations [ 34 ] and prior negative experiences with health services and care providers [ 35 ] negatively influenced maternity care utilization. The better perception of women who recently visited health facilities implied that behavior change interventions could substantially impact marginalized women’s behavior.…”

“…In the current study, women’s experience of disrespectful care resulted in dissatisfaction with the obstetric care services. Besides, discrepancies between expectations and experienced care are also reported as important factors for women’s dissatisfaction with care [ 34 , 35 ]. Since negligence, disrespect, and abuse were serious obstacles to maternal health services utilization [ 37 ], and they rid women of their right to have care with dignity, they must be taken seriously, and relevant authorities, such as local health administrations, take measures – including training care providers on respectful care and make frequent supervisions.…”

Group antenatal care (gANC) for Somali-speaking women in Sweden – a process evaluation

“…Somali-born migrant women have demonstrated higher rates of severe pregnancy complications [ 5 – 9 ]. Qualitative studies [ 3 , 10 – 12 ] and systematic reviews [ 4 , 13 , 14 ] show that migrant women more often experience communication problems [ 4 , 14 – 16 ], lack of familiarity with care systems [ 4 , 14 , 15 ], sub-optimal care [ 4 , 13 , 15 , 17 , 18 ] and discrimination [ 4 , 14 , 16 , 17 ]. In Sweden, migrant women [ 19 ] including Somali-born women [ 6 ], commence ANC later, make fewer ANC visits and are less likely to contact their obstetric care provider for decreased fetal movements [ 5 ] than their Swedish-born counterparts.…”