The need for trust and safety inducing encounters: a qualitative exploration of women’s experiences of seeking perinatal care when living as undocumented migrants in Sweden

Abstract

BackgroundStudies from around the world have shown that women living as undocumented migrants have limited and deficient access to perinatal care, increasing their risks of both physical and psychological complications during pregnancy and childbirth. Failures to provide equal access to healthcare have been criticized extensively by the United Nations. In 2013, undocumented migrants’ rights to healthcare in Sweden were expanded to include full access to perinatal care. Research surrounding clinical encounters involving women living as undocumented migrants remains largely lacking. The present study aimed to provide a composite description of women’s experiences of clinical encounters throughout pregnancy and childbirth, when living as undocumented migrants in Sweden.MethodsTaking an inductive approach, qualitative content analysis was implemented. Thirteen women from ten different countries were interviewed. Meaning-units were extracted from the data collected in order to identify emergent overarching themes.ResultsIn clinical encounters where healthcare professionals displayed empathic concern and listening behaviours, women felt empowered, acknowledged, and encouraged, leading them to trust clinicians, diminishing fears relating to seeking healthcare services. Conversely, when neglectful behaviour on part of healthcare professionals was perceived in encounters, anxiousness and fear intensified. Vulnerability and distress induced by the women’s uncertain living circumstances were apparent across themes, and appeared exacerbated by traumatic memories, difficulties in coping with motherhood, and fears of deportation.ConclusionThe present study contributes unique and important knowledge surrounding women’s experience of being pregnant and giving birth when living as undocumented migrants. The overarching findings indicated that the needs of undocumented migrant women were largely similar to those of all expectant mothers, but that due to vulnerabilities relating to their circumstances, flexible and informed care provision is essential. Being knowledgeable on undocumented migrants’ rights to healthcare is vital, as clinical encounters appeared highly consequential to the women’s well-being and help-seeking behaviours. Negative encounters inflicted emotional distress and fear. Contrastingly, positive encounters promoted trust in clinicians, personal empowerment, and relief. Positive clinical encounters could provide rare opportunities to assist an otherwise elusive population at increased risk for both physical and psychological complications, highlighting the crucial need for adherence to ethical principles in clinical practice.

Transnationalism and care of migrant families during pregnancy, postpartum and early-childhood: an integrative review

“…Other forms of transnational ties (i.e., 'ways of being') were mentioned in fewer papers. This included references to families worrying about relatives, including children who remained in the home country [54,55,59,60,67,86,105] and families staying connected via phone/ communication technologies and/or visits as a source of social and emotional support, to maintain cultural identity, and/or for assistance with childcare [21,22,31,48,49,67,69,85,90,95,96,102,105]. It also included families sending money back home [105], women seeking healthcare in their country to give birth [21], and families using transnational networks to obtain advice and health information-partly due to local care not being adapted [21,49,88,94,96,105].…”

Immigrant parents' experiences of communicating with healthcare professionals at the neonatal unit: An interview study

“…Känslan som uppstår beskrivs som att förlora kontrollen över vad som händer. Föräldrar kan även möta vårdpersonal som inte har kunskap om deras rättighet till fri vård och är därför förberedda när de söker sjukvård att de är tvungna att argumentera för sin rätt till vård (Barkensjö, Greenbrook, Rosenlundh, Ascher & Elden, 2018). På flertal sjukvårdsinrättningar i Sverige finns en funktion som benämns olika, exempelvis kulturtolk, kulturlots eller hälsokommunikatör.…”

“…Kvinnor som är under asylprocess eller immigranter har visat sig ha ökad risk för graviditetskomplikationer, föda barn för tidigt eller få för tiden små barn (SGA) (Villadsen et al, 2010). En nyligen publicerad studie (Barkensjö et al, 2018) visar att när gömda gravida kvinnor söker sjukvård har inte vårdpersonalen kunskap om hur de ska bemöta föräldrarna gällande fri sjukvård. De föräldrar som tidigare varit i kontakt med sjukvård visste att de var tvungna att argumentera för sin rätt till vård.…”

“…Denna osäkerhet för föräldrarna ledde till stress och en rädsla för kvinnans säkerhet och det ofödda barnets mående. Att befinna sig i ett nytt land och bli tvungen att ta svåra beslut utan att ha ett socialt nätverk kring sig upplevdes som en känsla av panik (Barkensjö et al, 2018).…”

“…Personer som vistas i Sverige utan tillstånd, så kallade papperslösa, ska erbjudas samma hälso-och sjukvård som asylsökande. Det största hotet för papperslösa människor som söker vård är vårdpersonalens bristande kunskap om lagen (Barkensjö et al, 2018). Ett flertal av dessa immigranter är familjer och kvinnor i barnafödande ålder.…”