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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