Community-based doulas for migrant and refugee women: a mixed-method systematic review and narrative synthesis

Abstract

BackgroundCommunity-based doulas share the same cultural, linguistic, ethnic backgrounds or social experiences as the women they support. Community-based doulas may be able to bridge gaps for migrant and refugee women in maternity settings in high-income countries (HICs). The aim of this review was to explore key stakeholders’ perceptions and experiences of community-based doula programmes for migrant and refugee women during labour and birth in HICs, and identify factors affecting implementation and sustainability of such programmes.MethodsWe conducted a mixed-method systematic review, searching MEDLINE, CINAHL, Web of Science, Embase and grey literature databases from inception to 20th January 2022. Primary qualitative, quantitative and mixed-methods studies focusing on stakeholders’ perspectives and experiences of community-based doula support during labour and birth in any HIC and any type of health facility were eligible for inclusion. We used a narrative synthesis approach to analysis and GRADE-CERQual approach to assess confidence in qualitative findings.ResultsTwelve included studies were from four countries (USA, Sweden, England and Australia). There were 26 findings categorised under three domains: (1) community-based doulas’ role in increasing capacity of existing maternity services; (2) impact on migrant and refugee women’s experiences and health; and (3) factors associated with implementing and sustaining a community-based doula programme.ConclusionCommunity-based doula programmes can provide culturally-responsive care to migrant and refugee women in HICs. These findings can inform community-based doula organisations, maternity healthcare services and policymakers. Further exploration of the factors that impact programme implementation, sustainability, strategic partnership potential and possible wider-reaching benefits is needed.

From global recommendations to (in)action: A scoping review of the coverage of companion of choice for women during labour and birth

“…Afulani and colleagues (2018) found similar results: women who were literate, wealthy, and employed were more likely to benefit from labour companionship [25]. These inequities in who receives support from a labour companion have also led to the development of critical programmes to support socially marginalised women, for example via community-based doula support for Indigenous women in Canada [88], Black and Latinx women in New York [89], and women from migrant and refugee backgrounds in Australia and the United Kingdom [90,91]. Only 28.6% of studies included in the scoping review reported that women were allowed to choose their companion.…”

Refugee women’s and providers’ perceptions of person-centered maternity care: a qualitative study in two refugee camps in Chad

“…In general, IRC has prioritized respectful care in this setting through refresher trainings, supportive supervision, coaching and mentoring, which have also shown some success elsewhere [ 30 ]. Integrating the refugee providers into the maternity team may contribute to better care for women as they are from the community, and also fill a complementary role with training to support and reduce the burden on the midwives, similar to on-call birth companions piloted in Tanzania or community-based doulas for refugees in high income countries [ 48 , 49 ]. However, refugee providers in particular mentioned feeling overworked while also seeing their compensation reduced resulting in their feeling undervalued, similar to findings elsewhere [ 30 ].…”