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Table 2 Studies specific to immigrant women’s experiences of maternity care

From: Immigrant and non-immigrant women’s experiences of maternity care: a systematic and comparative review of studies in five countries

Country and study

Problems with care as reported by immigrant women

Key findings about what immigrant women want

Author conclusions and key recommendations

AUSTRALIA

   

Rice & Naksook[26, 27]

Inadequate information about care

Attention to individual needs

Thai women have diverse needs, perceptions and experiences. Women did not receive adequate information about care. An environment needs to be created that acknowledges diversity and meets the needs of individual women.

1998, 1999

Difficulties communicating, though some believed care was better in Australia than in Thailand

Support and kindness

30 Thai women

In-depth interviews about antenatal, intrapartum and postnatal care

Women felt they were unable to follow traditional customs in hospital.

  

Small et al.[2831]

Communication difficulties

Respectful, understanding caregivers

Vietnamese, Turkish and Filipino women reported similar wants and needs from maternity care as Australian-born women in the companion Survey of Recent Mothers 1994, however these three groups of immigrant women were less likely to experience care that met their needs.

1998(2), 1999, 2002

Being left alone in labour

Attention to individual needs, not cultural stereotypes

Recommendations included: more attention to the quality of care immigrant women receive and particularly to strategies for overcoming language barriers to effective communication; and better information provision.

Mothers in a New Country’ (MINC) study

Not feeling welcomed when came to hospital in labour

107 Vietnamese women

Experience of discrimination by some staff

Active say in decisions about care

108 Turkish women

Not enough support about own and infant care postnatally

Information and explanations from staff

104 Filipino women

Rushed caregivers

Supportive care

Semi-structured interviews about antenatal, intrapartum and postnatal care

Long waits at antenatal appointments

Recognition of the need to rest and recover post-birth

 

Staff experienced sometimes as unkind or rude and care experienced as culturally stereotyped

  

Tsianakas & Liamputtong[32, 33]

Communication difficulties

Caregivers who show warmth and humanity, and are caring and supportive

Suggestions for care improvement included provision of sufficient information and culturally sensitive services. Health care providers need to attend to individual preferences and circumstances and avoid discrimination.

2002

15 Muslim women from Lebanon, Turkey, Jordan, Egypt, Kuwait, Malaysia, Singapore, Morocco and Pakistan

Perceived stereotyping by caregivers

Female caregivers wherever possible

In-depth interviews about prenatal testing and antenatal care

Lack of familiarity with services

Good information and explanations, especially about how care is provided and available services

Problems with male caregivers

Caregivers sensitive to cultural differences, but able to provide care that responds to individual (not stereotyped) needs

 

Care experienced as discriminatory

  

Tran et al.[34]

Difficulties communicating with caregivers

Choice about care options

Authors recommended focus on improvement of service delivery and equity; improving access to interpreter services and bilingual staff; and integrating the biomedical model for maternity services with health beliefs of the diverse cultures.

2001

160 Vietnamese women Focus group discussions, in-depth interviews and survey about care among Vietnamese women who opted for early discharge

Women reported feeling anxious and being fearful when approaching staff for assistance and experiencing discriminition

Adequate advice about self care

Disempowerment in culturally unfamiliar hospital surroundings.

Involvement in making decisions about care

Supportive caregivers, with enough time to discuss concerns

  

Adequate support and advice about baby care

 

Liamputtong & Watson[35, 36]

Communication difficulties

Adequate information about options for care

Improving communication and access to information identified as essential to ensure women understand all the options available to them.

2002 and 2006

67 Cambodian, Lao and Vietnamese women with experience of childbirth in Australia

Lack of familiarity with care options

Good communication and involvement in decision-making

In-depth interviews about prenatal testing, and experiences of caesarean birth

Women of ethnic minorities do not have the same access to information and do not understand the implications of services offered to them.

Appropriate help with communication via interpreters and/or support people

 

Chu[37]

Language difficulties

Caregivers who are friendly and understanding

Authors recommend a focus on empowerment for women and cooperation with community organisations, and service providers to improve cross-cultural communication.

2005

Long waiting times

30 women from Hong Kong, Taiwan and China about childbirth beliefs and care experiences

Insufficient information and advice

Quality in service provision: shorter waiting times

Semi-structured interviews

Bilingual staff and/or interpreters

Supportive after birth care so mother can rest; helpful advice about infant care

  

Adequate information about care options

 

Shafiei et al.[38]

Despite care often being seen as better than in Afghanistan, problems identified included:

Unrushed care

Recommendations for care that is more consistently supportive, respectful and caring; strategies to reduce waiting times for antenatal visits, sufficient time for women to ask questions and receive adequate information and explanations, particularly when unfamiliar with how care is provided and when in need of assistance with communication.

2012

Time and encouragement to ask questions

40 Afghan women

Long waiting times for antenatal care, rushed staff

Kindness and respect

Structured telephone interviews about maternity care received when giving birth, with follow-up in-depth face-to-face interviews with 10 women

Problems with communication, lack of interpreting support

 

Insufficient time for adequate information and explanations

Preference for female caregivers

At times, unkind, rude staff

For some, having male caregivers

 

Problems with hospital food (non-Halal)

  

Hoang et al.[39]

Communication difficulties due to lack of English

Supportive care

Authors noted the important role of family and community as in supporting migrant women through their maternity care. Better provision of interpreter services recommended; better social support for women; and reducing cultural barriers through cross-cultural training for health care providers to improve maternity services.

2009

Insufficient information offered in other languages

Information and explanations

10 women from Asia (Vietnam, China, Japan, Korea, Philippines) living in rural Tasmania

Reluctance to express preferences, and make wishes known

Acknowledgment of need for rest and care of mother post-birth

Semi-structured interviews about care experiences

   

CANADA

   

Chalmers & Hashi[40]

Insensitivity of staff to women’s experiences of pain in labour

Involvement in decision-making

Authors highlight need to enhance awareness of cross-cultural practices; address women’s perceptions and needs; use fewer interventions; and provide more respectful treatment. Need also to educate caregivers about traditional female genital cutting.

2000

432 Somali women Structured interviews about experiences of maternity care in Canada in the context of female circumcision

Inappropriate responses to traditional female circumcision (surprise, disgust)

Respectful and sensitive care

 

Felt concerns not listened to

  

Grewal et al.[41]

Language difficulties

Family-centred care

Changes in care needed to ensure culturally safe care for immigrant Punjabi women.

2008

Lack of familiarity with services and care

Acknowledgement of individual differences in beliefs and preferences

15 women from Punjab, India In-depth interviews about their perinatal experiences in Canada

Preferences and concerns not acknowledged

Good information about how care is provided and childbirth classes

  

Support for maternal rest after birth

 

Reitmanova & Gustafson[42]

Inadequate support and inattentive care in labour and postpartum

Adequate information, especially about pain and labour management in labour

Mainstream information and practices designed for Canadian-born women lacks flexibility to meet the needs of immigrant Muslim women. Recommendations included cultural and linguistically appropriate maternity and health information and establishing partnerships with immigrant communities.

2008

Not enough respect for rest and privacy after birth

In-depth semi-structured interviews with 6 Muslim women from five countries (not specified) about their experiences of care

Experience of discrimination

Care sensitive to individual needs and beliefs

 

Insensitivity and lack of knowledge on the part of staff about their cultural/religious practices

Appropriate language support and information in community languages

 

Brar et al.[43]

Language barriers

Multilingual staff and information/education in community languages, especially about available services and care

Recommendations of authors include the need for multilingual staff and provision of educational materials in a variety of formats.

2009

Unfamiliarity with care provided

Supportive care and adequate help with infant care

Structured interviews with 30 south Asian and 30 Canadian-born women about maternity care and perceived barriers

Lack of explanations for tests and procedures

Women caregivers

 

Lack of assistance with baby care after birth

  

SWEDEN

   

Essen et al.[44]

Lack of knowledge among staff for handling traditional female circumcision

Good monitoring of health of mother and checks during pregnancy, and of infant after birth

Authors conclude that health providers need to improve their knowledge about female circumcision and also provide culturally sensitive perinatal surveillance in order to address women’s concerns and any cultural misconceptions about pregnancy and birth.

2000

15 Somali women

Not enough emotional support

Kind, attentive care; sensitivity to individual needs, especially care for female circumcision

In-depth interviews about childbirth and experiences of care in Sweden

Fear of caesarean section

  

Berggren et al.[45]

Although pleased with high standard of clinical care, made to feel ashamed of their traditional female circumcision by some staff

Sensitive and understanding care

Authors recommend culturally adjusted care and providing systematic education about female circumcision.

2006

21 women from Somalia, Eritrea and Sudan

Requests not dealt with sensitively

Good communication

Exploratory interviews about maternity care in the context of traditional female circumcision

Language difficulties

Attention to individual needs

 

Felt unable to follow certain cultural beliefs/traditions

  

UNITED KINGDOM

   

Woollett & Dosanjh-Matwala[46, 47]

Communication difficulties

Sensitive, respectful care attentive to individual needs and concerns

Authors discuss issues and implications of differences between women and services in what is considered ‘normal’ maternal behaviour and the need to improve the quality of care to immigrant women, especially to attend to individual and cultural diversity.

1990

Long waiting times

Careful monitoring of health of mother, and fetus/infant

32 women, 19 of whom were immigrants (countries not specified: India, Pakistan and Bangladesh??).

Staff rushed, no time for discussion

Good explanations and information about care and tests; careful physical checks

Women spoke Hindi, Punjabi and Urdu and/or English Semi-structured interviews

Lack of support from staff, especially postnatally when women most of all wanted to rest

Good support for rest and care of infant in hospital after birth

 

McCourt & Pierce[48]

Communication/language difficulties

Good communication and information about options for care

Authors note that minority ethnic women in fact shared similar values and had expectations of services similar to the wider population, but that conventional services did not provide minority ethnic women with high quality of maternity care. The authors suggest this is related to the institutional organisation of care which needs to become more focused on addressing all women’s individual needs.

2000

Inadequate information about care options

Friendly, kind staff

20 ‘minority ethnic’ women interviewed, including 6 Somali women about experiences with maternity care (half caseload and half standard care)

Staff rude or off-hand (standard care)

Good access to interpreting services when needed

Qualitative interviews

Concerns not listened to

Attention to individual concerns

Not enough support for rest after birth

Primary care provider who gets to know each woman and her needs

  

Acknowledgement of need for rest and support after birth

 

Davies & Bath[49]

Poor communication with staff

Good care and adequate information about options for care

Key underlying problem considered to be poor communication between non-English speaking Somali women and health workers. This needs to be addressed with better use of interpreters and more individualised care.

2001

Limited use of interpreters

13 Somali women:

Prejudiced attitudes of staff

Attention to specific individual needs

Focus group and structured interviews about ‘maternity information concerns’.

Lack of information

Supportive care and rest after birth

 

Harper Bulman & McCourt[50]

Poor communication and inadequate provision of interpreting services led to needs not being met

Kind and attentive staff

Need for better integrated and more appropriately used interpreting services that enable greater continuity for women. Advocacy or link-worker schemes may also be appropriate.

2002

12 Somali women:

Not enough information and discussions about important topics, such as managing pain

Better interpreting services

Six Individual in-depth interviews and two focus groups

Stereotyping and racism from staff

Staff who understand when interpreters are needed

 

Lack of understanding of cultural differences

  

Jayaweera et al.[51]

Language difficulties (but assisted when interpreters available)

Good use of interpreters to assist communication and provision of information

Considerations need to be made for social and economic circumstances of migrant families.

2005

 

Reduced care options when English lacking

9 Bangladeshi women (8 immigrants)

Semi-structured interviews about childbirth experiences and needs

   

USA

   

Herrel et al.[52]

Experiences of discrimination in interactions with nurses believed to be due to skin colour and/or lack of English

Supportive, non-discriminatory care with a known care provider

Need culturally appropriate health education materials on labour and delivery for the Somali refugee community. Health care teams need to receive training on Somali culture, traditions and values and Somali women’s expectations.

2004

14 Somali women

Inadequate information about pain relief and side effects

Full explanations

Two focus groups with 20-item interview guide, facilitated by Somali-speaking group moderator

Poor explanations (eg for caesarean birth, which women feared)

Hospital tour with language support

Communication problems and concern about the competence of interpreters.

Education for partners to familiarise them with women’s needs for pregnancy and birth

  

Information about services in accessible language & format (eg videos)

 

Jambunathan and Stewart[53]

Communication problems with health care providers

Preference for minimal intervention in pregnancy and birth

Health care providers need to better understand Hmong women, eg when touching and communicating with women and informing them about hospitalisation and medical procedures.

1995

Miscarriage feared if touched by doctors and nurses which resulted in delayed prenatal visits

Understanding from care providers about women’s own experiences and concerns

52 Hmong women

Semi-structured interviews conducted 4-6 months after birth

Wary about interventions and procedures for labour and birth

Lazarus and Phillipson[54]

Long clinic waits

Reduced waiting times

Few differences reported: Puerto Rican and ‘white’ women wanted the same things from care.

1990

Insufficient time at appointments

More time at appointments

27 Puerto Rican women (17 immigrant, 10 born in the US) and 26 indigent ‘white’ women; and 150 observations of clinical interactions

Poor communication and explanations

Known care providers

Many different physicians for prenatal care: contradictory advice, lack of familiarity with woman’s concerns and circumstances

Sound information and explanations that can be understood

Qualitative interviews about prenatal care conducted prospectively from early pregnancy, combined with anthropological observations of prenatal care interactions

 

Better communication about care (not just because of language problems)

 

Shaffer[55]

Problems with communication due to language barriers

Being able to communicate with health care providers in own language

Authors recommend culturally appropriate health care to meet Hispanic migrant women’s needs.

2002

46 Hispanic migrant women Qualitative interviews during pregnancy exploring factors influencing access to prenatal care

 

Culturally appropriate health care