Migrant women's experiences of pregnancy, childbirth and maternity care in European countries: A systematic review

'At the heart of the community' - a Somali woman's experience of 'alignment' of support to escape social isolation in pregnancy and early motherhood

PURPOSE

Stresses in pregnancy and early motherhood can affect women's health and wellbeing, and babies' development. Migrant women face compounding stressors from the intersection of gender, race, social class, migration, and language. We explored one Somali woman's experience of pregnancy and the transition to motherhood, following migration to an urban environment in the Global North, aiming to understand resilience in this specific socio-cultural context.

METHODS

This case study used interpretative phenomenological analysis of a single two-hour semi-structured interview with a Somali woman in the UK to explore how this experience may have relevance for communities and practitioners in the Global North.

RESULTS

We identified two overarching themes in this woman's experience: "vicious" and "virtuous" circles, attempting to make sense of her experience of isolation and lack of wellbeing, and subsequent confidence, engagement, and community-building.

CONCLUSIONS

An experience of "alignment" in social relationships appeared to make possible the shift from "vicious" to "virtuous" circle, which enabled escape from social isolation. This account of transformation-from social isolation to community contribution-underlines the role of community organizations facilitating positive social networks and peer support during pregnancy and early motherhood.

Migrant women with cultural doula support during pregnancy and after childbirth as a complement to midwifery care in Sweden - An interview study

BACKGROUND

For migrant women, it may feel unsafe to give birth in a new, unfamiliar country. This group of women has an increased risk for adverse outcomes for mothers and children. Migrant women may experience stress and they have a higher likelihood of childbirth fear, childbirth complications, and maternal death.

AIM

To explore migrant women's experiences of cultural doula support during pregnancy and after childbirth as a complement to midwifery care.

METHODS

A qualitative exploratory study design was adopted, using Braun and Clarke's theoretical thematic analysis process. A total of 21 migrant women from non-European countries in Sweden were interviewed via female language interpreters.

FINDINGS

The overarching theme 'Cultural doula support facilitates migrant women's transition into motherhood in a new country' was explored. The theme was described by: The offer of cultural doula support was initially not always fully understood; The support replaced the lack of family and friends; The support developed women's understanding of maternity care; The support increased women's knowledge of childbirth and parental role; and The support facilitated women's integration into a new country.

CONCLUSION

The migrant women valued being supported by cultural doulas because this facilitated their transition into motherhood in an unfamiliar social context. Therefore, migrant women with limited language knowledge and understanding of becoming mothers in a new country should be offered support from a cultural doula as a complement to midwifery care.

Improving Diversity in Recruitment: Lessons Learned During the REACH Pregnancy Circles Pilot Trial

INTRODUCTION

Our ability to address inequities in health outcomes is hampered by the under-representation of underserved groups in research. Research exploring this topic has focused on observational studies in the American context. This is a pivotal concern for maternity research in the UK as perinatal outcome variables vary by ethnicity, socioeconomic and linguistic background. This paper reports the findings of an analysis of the diversity achieved by different recruitment strategies used within a feasibility study and pilot trial of group antenatal care (Pregnancy Circles).

METHOD

A pilot randomised controlled trial involved implementation of Pregnancy Circles across three maternity services in an area of high ethnic, socioeconomic and linguistic diversity. Following findings of high ethnic diversity but low levels of educational and linguistic diversity amongst participants recruited in our prior feasibility study, equity-informed strategies were put into place to attempt to increase recruitment diversity in the pilot trial, addressing organisational barriers (additional language support); attitudinal barriers (staff training to counteract recruitment bias) and practical barriers (extending the recruitment period to reach women accessing care late). Women who declined participation were invited to complete a short anonymous questionnaire covering demographic details and reasons for declining. The demographic characteristics of participants in the feasibility and pilot studies, and the pilot study decliners, were compared using descriptive statistics and free-text reasons for declining were analysed thematically.

RESULTS

The targeted recruitment processes were successful in widening the diversity of participants in this study, in particular for women with limited English proficiency and low educational achievement. Nevertheless, comparison of participants to those who declined showed some barriers persisted. The most common reason to decline was lack of time, most commonly due to caring responsibilities, and this was more likely to be cited by ethnically minoritized women.

CONCLUSION

Recruitment plans focused on widening diversity can be effective but are likely to require additional resources such as funding longer recruitment periods or interpreting services. The gendered nature of maternity research poses particular challenges, and our study suggests that addressing barriers such as those around childcare would enhance the recruitment of socio-economically deprived and minoritized women.

PATIENT OR PUBLIC CONTRIBUTION

Our study team included two service user representatives as co-investigators, feeding into all aspects of the study. The focus of the work reported here was to increase the participation of underserved communities in the pilot trial and to inform the Pregnancy Circles RCT, to enable them to contribute their data and lived experience to the findings and evaluation of this intervention.

TRIAL REGISTRATION

Due to an administrative oversight, trial registration for this pilot trial was applied for during the 6-week recruitment period, rather than before recruitment commencing (ISRCTN66925258. Retrospectively registered 3 April 2017). Registration occurred before programme intervention, outcomes and process data collection and all data analysis.

"In some ways it feels like a specialism": Exploring the lived experience of multilingual maternity professionals - A qualitative interview study

Objective

This study aimed to investigate the experience of multilingual maternity staff working in UK NHS hospitals.

Methods

As part of an exploratory qualitative descriptive approach, semi-structured interviews were conducted with multilingual healthcare professionals, working in perinatal care in different NHS trusts across the United Kingdom. Interviews were audio-recorded, transcribed and subsequently analyzed using thematic analysis.

Results

Where practitioners were able to draw on their linguistic skills, they felt that multilingualism was a specialism and appreciated by colleagues. Practitioners also felt that the utilisation of shared languages could boost the confidence of women and birthing people, as well as improving their understanding and sense of wellbeing. Conversely, several practitioners felt an obligation to offer linguistic support, noting that it added to a workload burden, and fear of litigation, that was not experienced by monolingual colleagues.

Conclusion

Strategic utilisation of linguistically skilled NHS practitioners may hold the potential for advancing equity of care for migrant populations, who are regularly and disproportionately represented in data recording adverse outcomes.

Innovation

Investing in institutional support and formal accreditation for multilingual health professionals would enable them to be able to operate with confidence, redress (invisibilized) workloads and contribute to advancing parity of care for migrant patients.

An evaluation of the Syrian pregnant women's prenatal care satisfaction: a cross-sectional study

OBJECTIVE

This study aims to examine the satisfaction levels of Syrian migrant pregnant women living in Mardin with prenatal care services and the factors influencing their satisfaction.

METHOD

This is a cross-sectional study. The population of the study consisted of Syrian pregnant women who applied to Mardin Training and Research Hospital between August 15 and September 16, 2023. A total of 146 Syrian pregnant women who met the inclusion criteria participated in the study. The sociodemographic information form and the Prenatal Care Satisfaction Scale were used as data collection tools.

RESULTS

The rate of those who received prenatal care from a midwife/nurse is 80.1% and those who received less than 4 prenatal care was 89.7%. The most common reason for not receiving adequate prenatal care was lack of information with a rate of 39.7%. The mean score of the PCSS was 73.39 ± 14.78.

CONCLUSION

The study findings indicate that lack of information is one of the major barriers to healthcare access for migrant pregnant women. In addition, receiving prenatal care services from midwives/nurses affected satisfaction with prenatal care.

Do migrant women have equity of access to midwife continuity of care?

BACKGROUND

Migrant populations are recognised to be at increased risk of adverse health outcomes including perinatal outcomes. Structural barriers to maternity care and racism are recognised globally as an urgent issue for migrants. Midwife continuity of care (MCoC) has well known improved perinatal benefits.

AIM

To investigate if duration since migration was associated with reduced access to MCoC.

METHODS

We conducted a retrospective cohort study from June 2020-November 2023 at six Australian hospitals. MCoC was investigated by hospital and self-identified ethnic group for women who migrated < 5 years, ≥ 5 years compared to the Australian born population. Regression models adjusted for significant factors including use of interpreter and co-morbidities.

FINDINGS

There were 48,240 participants for analysis. Most in the cohort were Australian born (54.7 %, n = 26,365), migrants of < 5 years comprised 13.2 % (n = 6388) and those who migrated ≥ 5 years 32.1 % (n = 15,487). At all study hospitals, new migrants had the least access to MCoC. Compared to Australian born women, new migrants were 70 % less likely to receive MCoC (aOR 0.30; 95 %CI 0.27-0.34) and migrants of ≥ 5 years were 49 % less likely (aOR 0.51; 95 %CI 0.48-0.56). We identified a difference to access to MCoC between ethnic groups.

DISCUSSION

Health literacy needs of women who are migrants should be addressed to improve equity of access to a model of care that is evidenced based to improve perinatal outcomes.

CONCLUSION

It is incumbent on health services to measure equity of access and adjust services to ensure equity of access for all populations.

'I was 'only' seen as a birthing woman:' the pregnancy, birth and postpartum experiences of women with refugee backgrounds in Norway

BACKGROUND

Norway is recognised for its high-quality maternal healthcare. However, health equity has yet to be achieved. This study explored the experiences of women with refugee backgrounds during pregnancy, birth, and postpartum in Norway. We aimed to understand how the diversity of their backgrounds and current life circumstances, influenced the women's health, well-being, and interactions with maternal healthcare services. The study focused on the perspectives of women whose needs have not been fully acknowledged in maternal healthcare services both at national and local levels.

METHOD

Consistent with our Feminist Participatory Action Research approach, we included multicultural doulas, women with lived experience of migration and giving birth in Norway, as co-researchers. We also collaborated with practitioners such as midwives and other relevant actors. We recruited and conducted qualitative interviews with ten women with refugee backgrounds who had given birth in Norway.

RESULTS

Our findings revealed that the women's intersecting identities were crucial in shaping their maternal healthcare needs during pregnancy, birth and postpartum. The structural inequities faced in maternal healthcare services during pregnancy such as lack of language and communication support, limited access to social support networks, and unfamiliarity with healthcare services were also apparent during birth and postpartum. Adjusting to a new country while raising children compounded these challenges, impacting experiences of pregnancy, birth, and postpartum.

CONCLUSION

This study highlights the importance of adopting an intersectional approach to maternal healthcare, and not treating race, class, gender and migration experiences in isolation, but taking them into consideration when designing and implementing services. Our results suggest that current policies and services often overlook the specific needs of women with refugee backgrounds. To achieve true health equity in maternal healthcare services, policies should prioritize these women's unique needs and experiences, ensure that services are adapted and properly funded, and that initiatives guarantee active participation and representation from women with refugee backgrounds.

Parent's experiences of the impact of ethnicity and skin pigmentation on perinatal care

OBJECTIVES

This study aimed to explore the perceived impact of ethnicity and race on perinatal care among parents from diverse ethnic minority backgrounds or who had a Black, Asian, or ethnic minority child born in the UK within the last five years to better understand areas of ethnic inequality within perinatal care.

DESIGN

This study employed a focused ethnography, recruiting a purposive sample through posters, professional organisations, and social media platforms. Efforts to ensure maximum phenomenon variation included diverse ethnic and geographical representation. Semi-structured interviews using the digital platform, Zoom, explored experiences of accessing and receiving care, with a focus on challenges and perceptions related to ethnicity, race or skin pigmentation. Interview schedules underwent stakeholder validation and pilot testing. NVivo software facilitated qualitative analysis, employing an inductive approach with rigorous coding and thematic analysis.

RESULTS

Ethnic minority parental experiences (n = 24) revealed significant systemic challenges within the healthcare system. Three major themes were observed: Parent's voices not being heard, Systemic factors and Discrimination. Participants expressed feelings of marginalisation and inadequate communication with healthcare providers. Instances where concerns were dismissed or belittled, coupled with issues related to consent, highlighted pervasive systemic shortcomings. Structural barriers such as difficulties in scheduling appointments and perceived organisational neglect further compounded these challenges. Discriminatory attitudes and racial stereotypes also influenced the quality of care received, contributing to disparities in health outcomes and maternal wellbeing. Participants noted feelings of social isolation, exacerbated by pandemic-related restrictions and a lack of tailored support networks.

CONCLUSION

These findings underscore the urgent need for systemic reforms aimed at ensuring culturally safe and anti-racist practice, addressing communication barriers, and reducing discriminatory practices to enhance healthcare experiences and outcomes for ethnic minority parents. This includes training all healthcare staff around cultural safety.

Screening instruments for antenatal and postpartum mental health disorders in migrant women: a systematic review

PURPOSE

Maternal mental health disorders are prevalent among migrant women. Due to the association of these disorders with adverse pregnancy outcomes, early recognition, and referral are important. This review aims to provide an overview of the literature on mental health screening for migrant women during pregnancy and the postpartum period.

METHODS

We systematically searched PubMed, EMBASE, and PsycINFO, covering publications before July 15th, 2024. Database searches were supplemented by a grey literature search, which included a systematic Google and Google Scholar search, hand searching of reference lists, and citation searches. Quantitative, qualitative, and mixed-method studies published in any language were included if they evaluated or validated screening methods for maternal mental health disorders in first-generation migrants. Screening for eligibility, data extraction, and quality appraisal were conducted by two independent researchers. Results were summarized narratively.

RESULTS

Among the 3035 records screened, 30 articles met the inclusion criteria. Our findings indicate that health care providers and migrant women recognize a substantial need for maternal mental health screening, especially for depression, and in a lesser quantity for anxiety and PTSD. We describe a range of barriers and facilitators that impact the quality and feasibility of mental health screening. Research on available screening instruments in migrant populations reports reasonable accuracy, reliability, and validity. However, qualitative evaluations question the screening instruments' cultural appropriateness and translatability.

CONCLUSIONS

There is an urgent need for the development and implementation of maternal mental health screening programs tailored to pregnant or postpartum migrants. Further research is essential to enhance the effectiveness and cultural sensitivity of these screening programs.

Fostering empowerment through communication: The needs, expectations, and experience of maternity care among polish migrant women in Iceland

OBJECTIVE

Over recent decades, Iceland has evolved into a more diverse society, revealing disparities in perinatal outcomes for migrant women. This study explored the needs, expectations, and experiences of Polish migrant women regarding midwifery care during childbirth in Iceland.

METHODS

This longitudinal qualitative study involved semi-structured interviews conducted from December 2021 to May 2022. Eight Polish women participated in two interviews: one during their third trimester pregnancy (T1) and another within 12 weeks postpartum (T2). The interviews were analyzed using reflexive thematic analysis.

RESULTS

The longitudinal analysis generated two overarching themes: (1) Wishing for respectful individualized care and (2) The importance of receiving adequate information and sharing preferences. Additionally, one theme was constructed from T1: (1) Feeling misunderstood, isolated, and longing for support. From T2, two themes were deweloped: (1) The value of emotional and practical support from both midwives and partners during pregnancy and birth and (2) The importance of having a voice in the care process.

CONCLUSION

Insecurity about pain management and communication challenges were common. Open dialogue and strong connections with midwives were essential for positive care experiences. This study highlights gaps in language support, cultural sensitivity, and tailored information in Icelandic maternity care for Polish migrant women. Providing individualized care, marked by respect and clear communication, empowers women to make informed decisions and fosters a sense of control during childbirth. Addressing these gaps is vital for improving perinatal outcomes and ensuring equitable, comprehensive support for all women during this transformative life event.

Perspectives of women from migrant and refugee backgrounds accessing the Cross Cultural Worker Service in maternity and early childhood services-a qualitative study

Introduction

Women from migrant and refugee backgrounds living in high-income countries have an increased risk of adverse perinatal outcomes and lower satisfaction with healthcare. A Cross Cultural Workers (CCWs) Service was implemented in Sydney, Australia, supporting women and families throughout pregnancy to their child being 5 years old.

Methods

This study aimed to describe women's experience of the CCW Service and recommendations for improvement using interviews at 6 or 12 months postpartum. A framework approach was used for analysis.

Results

Four themes were generated from 23 interviews; (1) gaining knowledge, (2) strengthening capacity, (3) providing support; and (4) sharing culture, language, and migration journey. The impact of COVID-19 was a cross-cutting issue.

Discussion

The CCW Service was highly regarded, helpful, informative, and enhanced women's care experience. Recommendations for improvement were increased CCW workforce and provision of group education. This model has the potential to improve perinatal care of women from migrant and refugee backgrounds.

Immigrant and minority parents' experiences in a neonatal intensive care unit: A meta-ethnography review

AIMS

To examine immigrant and minority parents' experiences of having a newborn infant in the neonatal intensive care unit and explore healthcare professionals' experiences in delivering care to immigrant and minority families.

DESIGN

A meta-ethnographic review informed by eMERGe guidelines.

METHODS

We conducted a systematic literature review. Studies were included if they explored immigrant or minority parent experiences in neonatal intensive care units and health professional experiences delivering care to immigrant and minority families in neonatal intensive care. Reporting followed ENTREQ guidelines.

DATA SOURCES

Database searches included CINAHL, MEDLINE, PubMed, PsycINFO, Scopus and Google Scholar. Boolean search strategies were used to identify qualitative studies. No limitations on commencement date; the end date was 23rd August 2022. PRISMA guidelines used for screening and article quality assessed using Joanna Briggs Institute criteria for qualitative studies.

RESULTS

Initial search yielded 2468 articles, and nine articles met criteria for inclusion. Three overarching themes were identified: (1) Overwhelming Emotions, (subthemes: Overwhelming Inadequacy; Cultural Expressions of Guilt; Not Belonging), (2) Circles of Support, (subthemes: Individual Level-Spirituality; External Level-Connecting with Family; Structured Peer-to-Peer Support), (3) Negotiating Relationships with Healthcare Professionals (subthemes: Connecting; Disconnected; Linguistic Barriers). Interactions between healthcare professionals and immigrant and minority parents were the strongest recurring theme.

CONCLUSIONS

There can be a mismatch between immigrant and minority families' needs and the service support provided, indicating improvements in neonatal intensive care are needed. Despite challenges, parents bring cultural and family strengths that support them through this time, and many neonatal intensive care staff provide culturally respectful care.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Professionals should be encouraged to identify and work with family strengths to ensure parents feel supported in the neonatal intensive care unit. Findings can inform policy and practice development to strengthen health professionals capabilities to support immigrant and minority families in neonatal units.

REPORTING METHOD

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklists were used to report the screening process.

An educational approach to develop intercultural nursing care for refugees from Ukraine: A qualitative study

AIM

To describe how nurses and nursing students in Poland and the United States perceive the practice of intercultural care of refugees from Ukraine.

BACKGROUND

Millions of Ukrainian citizens sought safety in other countries when Russia invaded Ukraine in February 2022.

INTRODUCTION

Nurses in Poland and the United States are positioned to provide nursing care for refugees from Ukraine yet lack intercultural knowledge, skills, and attitudes to meet refugee needs.

METHODS

This education-focused qualitative description study was conducted in Spring 2023. Eighteen MSN and BSN students from one university in Poland and one university in the United States completed an international virtual exchange course that concentrated on the health and well-being of refugees from Ukraine. Students' reflection papers generated the data for this study. Content analysis was used to systematically structure the data, and themes were inductively derived for an initial understanding of intercultural care for refugees. The COREQ guidelines were followed for reporting study findings.

RESULTS

Major themes were troubled communication, overlooked trauma-informed care, and compromised vaccine status. Language differences, a gap in nursing knowledge, and cultural variations impeded intercultural care.

DISCUSSION

To address intercultural care for refugees from Ukraine, macro- and microlevel factors should be considered. Healthcare facilities need certified interpreters or adequate language-access technology for nurses. Nursing programs might evaluate content on trauma-informed care and cultural competency to meet the needs of war-affected refugees. Leaders from Ukrainian refugee communities could partner with nurses to deliver culturally relevant information to increase vaccine uptake.

IMPLICATIONS

Nurses should advocate for inclusion of the WHO competency standards of care for refugees in healthcare policies with emphasis on communication and evidence-informed practice. Placing Ukrainian community leaders on health councils could bridge the gap between refugees and mainstream society.

Increased risk of adverse maternal pregnancy outcomes among undocumented migrants in Norway

Background

Migrants are known to have an increased risk for adverse complications during delivery. However, it is not known whether undocumented migrants have a different risk profile compared to documented migrants and non-migrants. Better knowledge about undocumented migrants' reproductive outcomes is crucial to enable targeted preventive interventions.

Method

We performed a historical register-based population study based on numbers from the Medical Birth Registry of Norway (MBRN) from 1999 to 2020. Women aged 18-49 years with singleton births were included, in total 1,247,537 births. Legal status, i.e., undocumented migrants (without a Norwegian identity number), documented migrants (with a Norwegian identity number and born abroad) and non-migrants (with a Norwegian identity number and born in Norway), was used as the exposure. We used logistic regression to estimate the association between legal status and adverse maternal birth outcomes.

Results

In total 5856 undocumented migrant women gave birth during the study period, representing 0.5 % of all births in Norway. Undocumented migrants had an odds ratio (OR) of 1.39 (95 % Confidence Interval (CI) 1.28-1.50) for an acute CS and OR=0.86 (95 % CI 0.76-0.98) for a planned CS, both compared to non-migrants. Similarly, the OR for severe postpartum haemorrhage (PPH) was =1.22 (95 % CI 1.03-1.43) and OR=0.69 (95 % CI=0.56-0.85) for anal sphincter injury. None of the results were significantly different when documented migrants were used as the reference group.

Conclusion

Undocumented migrants have an increased risk of adverse maternal birth complications compared to non-migrants, but not different from documented migrants. This indicates that for maternal birth complications, factors concerning migration may affect the risk profile to a larger degree than legal status.

Experiences and concerns of pregnant refugee women from Nigeria seeking for asylum in Germany - A qualitative analysis

PROBLEM

Insights into and data of the experiences of pregnant women seeking asylum in Germany are largely lacking.

BACKGROUND

Due to multiple stress factors, pregnant refugees are considered a vulnerable group. Gender-specific causes of flight, traumatic experiences during flight, and numerous stressors in the respective host country have a decisive impact on the health of women and affect pregnancy and childbirth.

AIM

This study aims to assess the perspectives and needs of pregnant refugee women from Nigeria, that are residing in an initial reception center in Germany.

METHODS

Experiences and concerns of N = 20 pregnant refugee women from Nigeria relating to pregnancy and impending childbirth were assessed in semi-structured interviews, conducted by three psychologists in English.

FINDINGS

Findings emphasize the need for continuous medical and psychotherapeutic care due to the multiple stressors and the partial lack of social support, especially for single women. The participants described their concerns particularly related to their personal and their family's health, as well as their impending birth, their optimistic attitude about the parenting experience, and confidence in medical care in Germany. Their wishes were predominantly related to items necessary for the care of their children, information about the pregnancy and birth process as well as for their integration. Utilization of resources and positive activities were indicative of adapting coping styles and resilience factors of pregnant refugee women.

CONCLUSION

This study highlights the importance of the context-sensitive medical and psychotherapeutic care to adequately support the women during pregnancy and around childbirth. Furthermore, the study demonstrates the necessity of counteracting the negative effects of experiences on their health and that of their children.

Immigrant experiences of harm in sexual and reproductive healthcare in Spain

The medical encounter represents a site where patients may be harmed, with intersecting vulnerabilities shaping the risk and nature of this harm. Sexual and reproductive healthcare is an important site for exploring this dynamic. Questions concerning how immigrant women experience sexual and reproductive healthcare abound, with researchers and practitioners calling for greater attention to a population whose experiences are underrepresented in existing literature. As a case site, Spain is a high migration country with a stressed healthcare system where 'good' biomedical outcomes are complicated by institutional and routinised failures in patient care. Semi-structured interviews were conducted with 121 respondents concerning health experiences since immigrating to Spain. This paper draws from 69 respondents, primarily from the Philippines, the Americas, and Europe. Overarching themes included: 1) practitioners expressing dismissive attitudes; 2) practitioners behaving inappropriately and with prejudice; 3) practitioners failing to respect patient autonomy and consent; 4) practitioners mistreating patients during procedures. These issues recurred across treatment contexts, including diagnosis, routine examinations, preventative care, pre-natal care, abortion, pregnancy loss, and childbirth. Consequences include delayed and missed care, physical and psychological harm, and implications regarding migratory, medical, and reproductive futures. Informed by feminist scholarship, this study considers the identities, relations, and practices which contour this institutionally produced harm. The study provides recommendations for improvements in medical training and clinical practice based on identified failures in the care of immigrant patients.

Thalassemias and Sickle Cell Diseases in Pregnancy: SITE Good Practice

Background: Hereditary hemoglobin disorders are the most common globally distributed monogenic red cell diseases. The rights of women with thalassemia or sickle cell disease (SCD) to motherhood need to be protected by creating a roadmap to guide her, and her family network, along all the phases of the event. In fact, pregnancy in these vulnerable patients requires special attention and guidelines from the counseling stage (giving information about the special requirement and risks posed by their pregnancy with respect to the general population) the pre-conception stage, the early and mid-late pregnancy stage, to labor and lactation. The biocomplexity of these diseases requires a multidisciplinary team synergizing with gynecologists and obstetricians. In addition, the presence of a multicultural scenario requires healthcare workers to overcome stereotypes and adopt appropriate anthropological tools that might help them integrate the different cultural models of disease and motherhood. Methods: The Management Committee of the Society for Thalassemia and Hemoglobinopathies (SITE) selected and brought together a multidisciplinary and multiprofessional group made up of experts in hemoglobinopathies and experts in anthropology, flanked along with by experts with methodological and organizational expertise in order to create recommendations based on the integration of available scientific evidence together with expert opinion. Results: The panelists critically analyzed the literature, combining in a single document practices developed over several years of managing young women with hemoglobinopathies in a sensitive phase of their lives. Conclusions: This good practice document is the result of a collegial effort by Italian experts on hemoglobinopathies who are members of SITE. (SITE).

Childbirth Experience, Mistreatment, and Migrant Status: A Retrospective Cross-Sectional Study

INTRODUCTION

Childbirth experience can affect women's long-term health and well-being. However, there is limited knowledge on whether migrant status affects woman's experience during childbirth. We aimed to answer the following research questions: (1) Is there a difference in childbirth experience between migrant and native-born women in Iceland; and (2) Are migrant women more likely to experience mistreatment in childbirth compared to native-born women in Iceland?

METHODS

An online survey was developed including the Childbirth Experience Questionnaire 2 to assess overall childbirth experience, and descriptive analysis and linear regression were conducted to determine differences between migrant and native-born women in Iceland. The mistreatment by care providers in childbirth indicators were used to evaluate mistreatment in childbirth, and frequencies and logistic regression were conducted. Both regression models were adjusted for sociodemographic and obstetric factors.

RESULTS

A total of 1365 women participated. Migrant women reported statistically significantly lower scores for birth experience compared to native-born women (F [12, 1352] = 23.97, p < 0.001). There was no statistical difference between groups regarding mistreatment in childbirth. One in four of all women reported at least one form of mistreatment.

CONCLUSION

This study suggests that there are areas in maternity care that can be improved upon, particularly in providing care for migrant women and addressing mistreatment in childbirth for all. Our results suggest further research in this area as well as evaluation of maternity systems, training in cultural competency and effective communication.

Racialized migrant women's discrimination in maternal care: a scoping review

BACKGROUND

Despite equality and quality being the core of good healthcare, racial and ethnic inequalities continue to persist. Racialized groups, including racialized migrant women, experience various forms of discrimination-particularly during maternal care encounters, where intersectional forms of discrimination may occur. Experiences of discrimination in maternal care have been associated with poor health-seeking behavior and adverse maternal health outcomes. However, research on racialized migrant women's discrimination in maternal care is limited. This scoping review aims to give an overview of the state of current research on the discriminatory experiences of racialized migrant women when utilizing maternal healthcare and its gaps to ensure equity in global maternal healthcare.

METHODOLOGY

This scoping review mapped out all available English-language scientific empirical literature published between 2012 and 2023. All authors agreed on the inclusion criteria. Collecting, charting, and reviewing the included material were done using the 2018 Preferred Reporting Items for reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The search strategy included electronic databases, such as Pubmed, CINAHL, MEDLINE, Web of Science, and PsycInfo.

RESULTS

A total of 57 articles were included and analyzed. The majority were qualitative and conducted in European and North American countries. None of the included article's aims originally intended to focus on discrimination. However, their findings exposed the many ways racialized migrant women experienced discrimination when using maternal healthcare services-from accessibility problems, non-utilization of interpreters, and untimely and delayed care to disrespect, abuse, and differential care. Racialized migrant women's discrimination resulted in a lack of agency and being excluded from decision-making.

CONCLUSIONS

While the included articles allude to some issues related to discrimination in maternal healthcare experienced by racialized migrant women, this review delineated knowledge gaps warranting discussion. Few articles focus on and conceptualize discrimination from a racialized lens in maternal healthcare. A limited geographical scope in research and knowledge generation on discrimination and racialization exist in this field as does a lack of sufficient articles on discrimination and racism from healthcare personnel. Lastly, many of the existing studies lack an intersectional lens in exploring discrimination in maternal care against racialized migrant women.

Resettlement needs of refugee women in the United States: An American Academy of Nursing consensus paper

When people must flee their homes due to persecution or conflict, they embark on a journey from loss toward safety that is a global concern and the resettlement country's responsibility. Refugees experience stressors as they secure basic needs such as adequate nutrition, healthcare, transportation, housing, education, and income-generating activities. For refugee women, these stressors are further exacerbated by gender-related roles and experiences. Addressing the unique healthcare needs of refugee women is vital to their well-being as they resettle into life in the United States. Access to care that is provided with cultural humility and fosters trust is critical. Policies are needed that expand health literacy programs and interpreting services, grow, diversify, and train the physical healthcare workforce, grow and diversify the mental healthcare workforce, expand Medicaid coverage in all 50 states, develop and fund peer-to-peer education programs for refugee women, finance access to care and programmatic services, and expand federal funding toward refugee health research.

Contested and nervous spaces: exploring the environment of healthcare provision for international migrants in the Gauteng province of South Africa

BACKGROUND

Notwithstanding the global goal of inclusive universal health coverage, and the notion of migrant-sensitive health systems, limited healthcare access or the exclusion of migrants from national health systems persists. South Africa has a rights-based constitution, but there is an inability or a failure of the health system to recognise and address the health needs of migrants.

OBJECTIVE

To explore the intersection of the environment of healthcare provision for migrants and the everyday practices and behaviours of health workers and patients in the Gauteng province of South Africa.

METHODS

The conceptual frameworks of health system responsiveness and social exclusion informed this institutional ethnographic study at 13 healthcare facilities in Gauteng province. We developed an observation guide to explore the intersection of culture and environment and its influence on healthcare provision to patients, especially migrants. Following ethics approval, we observed the facilities for 234 person-days. We used thematic analysis to analyse the data.

RESULTS

Busy, frantic or nervous spaces, and contestations between patients and health workers, and among health workers formed part of the social and cultural environment of healthcare provision. The presence of migrant patients during busy periods served as a detonator for rude or discriminatory remarks, exacerbated by staff shortages and language barriers. Simultaneously, migrants exercised their agency by rebutting or confronting rude health workers. We also observed encouraging examples of kindness, caring and professionalism of health workers.

CONCLUSION

The study has implications for achieving a migrant-sensitive health system in South Africa.

Maternity Care Experiences of African-Born Women Living in Melbourne, Australia: A Qualitative Descriptive Study

BACKGROUND

African-born women in Australia are more likely to experience poorer perinatal outcomes than their Australian-born counterparts. This disparity may be attributed to difficulties in accessing maternity care services. With a rapidly growing African-born population in Australia, understanding African-born women's experiences with maternity care is crucial for ensuring equitable access.

AIM

This study aimed to explore the access to and experiences of maternity care among African-born women living in Melbourne, Australia.

METHODS

A qualitative descriptive study was conducted from September to December 2023, involving 15 purposively selected African-born women. An apriori analytic approach was applied to present the findings using the World Health Organization's Availability, Accessibility, Acceptability, and Quality framework. Data management and analysis were undertaken using NVivo 14.

RESULTS

Participants from nine different African countries shared their experiences regarding their most recent encounters with maternity care in Australia. Key challenges identified included difficulties navigating the healthcare system, lack of social support, discomfort with male clinicians, experiences of discrimination, inadequate information, transportation issues, perceived lack of empowerment, financial constraints, and clinician cultural insensitivity. These factors negatively impacted their maternity care experiences.

CONCLUSIONS

This study provides empirical evidence to inform policies, practices, and strategies aimed at improving maternity care experiences for African-born women in Australia. There is a need for clinicians to be more aware of and sensitive to these women's cultural needs. Developing and implementing a culturally responsive service model could mitigate negative experiences and enhance access to adequate maternity care, ultimately improving perinatal health outcomes for these women.

Public health, policy, and clinical interventions to improve perinatal care for migrant women and infants in high-income countries: a systematic review

Background

Migrant women who are pregnant or postpartum and their infants are often at increased risk of poorer perinatal outcomes compared to host country populations. This review aimed to identify public health, policy, and clinical interventions to improve maternity care for migrant women and their infants in high-income countries (HICs).

Methods

In this systematic review we searched EMBASE, EMCARE, MEDLINE and PsycINFO, CENTRAL, Scopus, CINAHL Plus, Web of Science, and grey literature from inception to 13th March 2024, with no language or date restrictions (PROSPERO: CRD42022380678). Interventional and observational studies assessing the effectiveness of any intervention to improve perinatal care for migrant women and their infants in HICs delivered in the pregnancy, peripartum, or postpartum period (up to one year after birth) were included. Quantitative outcomes were extracted. Qualitative studies were excluded. The main outcomes of interest were preterm birth, birthweight, and appointment attendance. Quantitative synthesis was conducted using Harvest plots and binomial exact calculations.

Findings

15,689 records were retrieved, 29 studies comprising data from 16,763,837 women were included. 22 studies (75.9%) included multiple interventions. Five interventions had strong evidence of effectiveness. Two clinical interventions: 100.0% of studies including specialist multidisciplinary teams improved one or more of the main outcomes of interest, namely preterm birth, birthweight, and appointment attendance (95% confidence interval 73.5-100.0%; p < 0.001); and 90.9% of studies including specialist in-person interpreting improved one or more of the main outcomes of interest (58.7-100.0%; p = 0.012). Three public health or policy interventions: 100.0% of social welfare interventions (75.3%-100.0%; p < 0.001) improved one or more of the main outcomes of interest; 100.0% of maternal education interventions (71.5-100.0%. p < 0.001), and 83.3% of studies assessing access to free healthcare (51.6-97.9%; p = 0.039).

Interpretation

The findings suggest that multicomponent interventions comprising multidisciplinary teams, in-person interpreting, maternal education, and social welfare support can improve perinatal outcomes for migrant women and their infants. Removing financial barriers to care may improve perinatal outcomes and be cost saving to healthcare systems. However, these findings should be interpreted with caution given that most included studies were of poor quality and that sensitivity analysis restricting to interventional studies only did not demonstrate any effect on the main outcomes of interest.

Funding

KS is supported by a National Institute for Health Research (NIHR) Doctoral Fellowship (NIHR302577). HRJ is supported by an NIHR Advanced Fellowship (NIHR303183). HRJ is supported by NIHR Applied Research Collaboration (ARC) South London. MM is supported by a Medical Research Council Clinical Research Training Fellowship (Grant number MR/W01498X/1). GF is supported by a Nuffield Department of Population Health Clinical Research Fellowship. MK is an NIHR Senior Investigator (NIHR303806). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Ukrainian women's maternity care strategies in Poland after the outbreak of the full-scale war: Understanding unequal access to quality care

The outbreak of the full-scale war launched by Russia against Ukraine and, following it, significant migrations have not only increased the diversity of the Ukrainian migrant population in Poland, but also added to the complexity of their health needs and strategies. This study seeks to explore Ukrainian migrant women's experiences and practices related to the use of maternity care services. The article is based on fieldwork conducted between February and October 2023 and included 23 semi-structured interviews with Ukrainian migrant women who gave birth in Poland after February 24, 2022. To understand Ukrainian women's pathways to maternity care in Poland and unpack the differences in experiences within this group of migrants, we explore participants' healthcare strategies against the background of existing inequalities in access to quality care in Poland and Ukraine, in particularly the division between private and public services. We consider the role of financial, social and cultural resources and distinguish for this purpose between three groups of permanent, circular and wartime migrants. We show the decisive role of economic resources, nonetheless in articulation with the creation and mobilisation of social networks and time spent in Poland, which play a role in shaping migrant women's capacity to access better maternity care.

D, Shanmugam Rajendran S. Care and support for women during labour: A review

The experience of childbirth significantly impacts a woman's mental, emotional and physical well-being requiring unique care varying throughout the process. The World Health Organization (WHO) emphasizes the importance of safe, effective, timely and woman-centred maternal and infant health care. Effective communication, respect and emotional support during labour are critical. However, unclear communication and mistreatment can lead to distress. Nonetheless, empathetic care enhances satisfaction during labour. Labour flexibility also contributes to comfort and control, underscoring the need for holistic, dignified and respectful maternal care. It should be noted that further research is essential to address postnatal care gaps and ensure women's psychological and emotional needs are met globally.

Let this be a safe place: a qualitative study into midwifery care for forcibly displaced women in the Netherlands

BACKGROUND

Forcibly displaced women in the Netherlands face increased chances of perinatal mortality and other adverse pregnancy and childbirth outcomes compared to the resident country population, which has been linked to suboptimal care. This study was conducted to gain insights from the experiences of Dutch midwives to inform and enhance the provision of tailored and equitable care for forcibly displaced women.

METHODS

We conducted a qualitative study using semistructured interviews with community midwives who provide care for forcibly displaced women (asylum seekers and recognized refugees) in the Netherlands. Through thematic analysis, we identified the barriers midwives encounter in providing care and explored their strategies for navigating these barriers, aiming to inform recommendations that advance equitable care provision.

RESULTS

Interviews with eleven midwives revealed barriers across three thematic levels: (1) the interactional level, where barriers related to language and interpreters, cultural differences, and building trust impeded positive interactions between midwives and forcibly displaced women; (2) the organizational level, where barriers concerning relocations of asylum seekers, delays in accessing care, and interdisciplinary collaboration impeded optimal care; and (3) the contextual level, where barriers related to women's housing conditions, the resettlement process and the mental health of forcibly displaced women impeded midwives' to respond to clients' needs. These levels of barriers culminated in a core theme of imbalance between midwives' expanded responsibilities and the limited resources and strategies available to them in care for forcibly displaced women. This imbalance forced midwives into multiple roles, increased both the practical and emotional burden on them, and undermined their ability to provide optimal, equitable care.

CONCLUSIONS

To enhance the provision of equitable pregnancy and childbirth care for forcibly displaced women in the Netherlands, it is crucial to target the imbalance between the responsibilities that midwives bear and the resources available to them. This requires dismantling barriers at the interactional, organizational and contextual level of care through targeted policy interventions. Structural determinants that perpetuate the imbalance in midwives' work and restrict their scope of influence, such as restrictive migration policies that contribute to socioeconomic marginalization and poor housing conditions, need to be addressed. Ultimately, midwives themselves require more support and education to recognize and combat injustices in pregnancy and childbirth care for forcibly displaced women.

The "Doing" of Compassionate Care in the Context of Childbirth from a Women's Perspective

Women who are giving birth need to be met with compassion and understanding from healthcare professionals. However, there are growing concerns about the perceived lack of compassion in the delivery of healthcare services in general and maternity care in particular. We conducted 15 qualitative interviews with women who had given birth in Norway within the previous year, asking them to describe their experiences of compassionate care. We aimed to explore what healthcare professionals "do" that is experienced as compassionate. The analysis was informed by Paul Gilbert's theory of compassion and a concept analysis of compassionate midwifery undertaken by Ménage and colleagues. The compassionate caring actions of healthcare professionals that were identified in the women's narratives generated five themes: attuning actions, validating actions, contextualizing actions, empowering actions, and small acts of kindness. The findings build on the prior theoretical concepts used for the study and provide a nuanced account of how women perceive compassionate care from healthcare professionals. They could contribute to understanding more of the meaning and nature of compassionate care during childbirth. The analysis indicates the importance of ensuring that compassionate care is at the very core of maternity care services.

Are rates of clinical interventions during pregnancy and childbirth different for refugees and asylum seekers in high-income countries? A scoping review

BACKGROUND

Adequate maternity care and appropriate clinical interventions during labour and delivery can reduce adverse perinatal outcomes, but unnecessary interventions may cause harm. While studies have shown that refugees and asylum seekers face important barriers when accessing maternity care, there is a lack of high-quality quantitative data on perinatal health interventions, such as induction of labour or caesarean sections, among refugees and asylum seekers and the findings reported in the literature tend to be inconsistent. Our goal was to examine and synthesise the evidence regarding the rates of intrapartum clinical interventions in women who are refugees and asylum seekers in high-income countries compared to other population groups.

METHODS

We conducted a scoping review of peer-reviewed studies published in English since 2011 that report original quantitative findings regarding intrapartum clinical interventions among refugees and asylum seekers in high-income countries compared to those in non refugee, non asylum seeker populations. We examined reported rates of clinical pain relief, labour induction and augmentation, episiotomies, instrumental deliveries, and caesarean sections.

RESULTS

Twenty-five papers were included in the review. Findings indicate that refugees and asylum seekers were less likely to receive pain relief, with 16 out of 20 data points showing unadjusted ORs ranging from 0.20 (CI: 0.10-0.60) to 0.96 (CI: 0.70-1.32). Similarly, findings indicate lower odds of instrumental delivery among refugees and asylum seekers with 14 of 21 data points showing unadjusted ORs between 0.25 (CI: 0.15-0.39) and 0.78 (CI: 0.47-1.30); the remaining papers report no statistically significant difference between groups. There was no discernable trend in rates of labour induction and episiotomies across studies.

CONCLUSIONS

The studies included in this review suggest that asylum seekers and refugees are less likely to receive clinical pain relief and experience instrumental delivery than non-refugee groups in high-income countries. This review strengthens our understanding of the links between immigration status and maternity care, ultimately informing policy and practice to improve perinatal health and the provision of care for all.

Perinatal outcome of immigrant women with and without refugee status compared to non-immigrant women: results of the pregnancy and obstetric care for refugees (PROREF) cross-sectional study

PURPOSE

International studies show conflicting evidence regarding the perinatal outcome of immigrant women with and without refugee status compared to non-immigrant women. There are few studies about the situation in Germany. The research question of this article is: Is the perinatal outcome (Apgar, UApH (umbilical artery pH), NICU (neontatal intensive care unit) transfer, c-section rate, preterm birth, macrosomia, maternal anemia, higher degree perinatal tear, episiotomy, epidural anesthesia) associated with socio-demographic/clinical characteristics (migration status, language skills, household income, maternal education, parity, age, body mass index (BMI))?

METHODS

In the Pregnancy and Obstetric Care for Refugees (PROREF)-study (subproject of the research group PH-LENS), funded by the German Research Foundation (DFG), women giving birth in three centers of tertiary care in Berlin were interviewed with the modified Migrant Friendly Maternity Care Questionnaire between June 2020 and April 2022. The interview data was linked to the hospital charts. Data analysis was descriptive and logistic regression analysis was performed to find associations between perinatal outcomes and migration data.

RESULTS

During the research period 3420 women (247 with self-defined (sd) refugee status, 1356 immigrant women and 1817 non-immigrant women) were included. Immigrant women had a higher c-section rate (36.6% vs. 33.2% among non-immigrant women and 31.6% among women with sd refugee status, p = 0.0485). The migration status did not have an influence on the umbilical artery pH, the preterm delivery rate and the transfer of the neonate to the intensive care unit. Women with self-defined refugee status had a higher risk for anemia (31.9% vs. 26.3% immigrant women and 23.4% non-immigrant women, p = 0.0049) and were less often offered an epidural anesthesia for pain control during vaginal delivery (42.5% vs. 54% immigrant women and 52% non-immigrant women, p = 0.0091). In the multivariate analysis maternal education was explaining more than migration status.

CONCLUSION

Generally, the quality of care for immigrant and non-immigrant women in Berlin seems high. The reasons for higher rate of delivery via c-section among immigrant women remain unclear. Regardless of their migration status women with low degree of education seem at increased risk for anemia.

Maternal birthplace and experiences of perinatal healthcare in Belgium: Evidence from a cross-sectional survey

BACKGROUND

Patient experience is an important part of perinatal care quality. Migrant women in high-income countries often report more negative experiences than non-migrants, but evidence in Europe is patchy. In this study, we compared the experiences of two migrant populations with non-migrants, taking into account socioeconomic characteristics.

METHODS

We surveyed mothers born in Belgium, North-Africa, and Sub-Saharan Africa (n = 877) using an adapted version of the Migrant-Friendly Maternity Care Questionnaire. Two patient experience scores were created using multiple correspondence analyses: a) information and communication with healthcare professionals and overall satisfaction with pregnancy care, and b) patient-centred aspects and satisfaction with delivery care. Through descriptive analyses and multivariable logistic regressions we estimated the associations of maternal characteristics with each score.

RESULTS

Overall, positive experiences were reported in terms of communication (83 %) and patient-centred care (86 %). North African immigrants with low language proficiency had higher odds of negative communication experience (especially problems understanding information) (ORa: 2.30, 95 %CI 1.17-4.50), regardless of socioeconomic position. Among women with language barriers, 88 % were never offered a professional interpreter, relying on family members for translation. Patient-centred care was not associated with maternal birth region but was rated more negatively by older mothers, those with longer residence in Belgium, and higher majority-language proficiency.

CONCLUSION

In Belgium, perinatal care experiences were generally positive, although communication with immigrants was suboptimal. Language barriers, single motherhood, and unstable housing increased communication issues. Our findings underline the necessity to improve information-exchange with immigrants and socioeconomically vulnerable women.

South Asian women's views on and experiences of maternity care services in Hong Kong: A qualitative study

BACKGROUND

Health disparities among ethnic minority and migrant women can lead to adverse maternal and neonatal outcomes. This study explores the maternity care experiences of South Asian women in Hong Kong, providing insights for woman-centred and culturally responsive care in the East Asia.

OBJECTIVE

To understand South Asian women's views and experiences regarding maternity care services in Hong Kong.

METHODS

A qualitative descriptive study was conducted with 20 English-speaking South Asian women who had used maternity care services in Hong Kong within the past 5 years. Data were analysed by thematic analysis.

FINDINGS

Four themes were identified: 1) Comparing maternity care services in their home country versus Hong Kong; birth location, mode of birth and care. 2) Navigating Hong Kong maternal medical care system; including private public dual care and learning information from other South Asians. 3) The discrepancy in perception of optimum care; including a preferring for assistance with daily tasks, epidural anaesthesia, doctor-led care, and priority to infants' health. 4) The impact of the COVID-19 pandemic on maternity care experiences, including the cancellation of translation services and limited visiting hours.

DISCUSSION

South Asian appreciate Hong Kong's public maternity services due to its perceived greater cost-effectiveness. The major incongruence between expectations and services provided being women-staff communication.

CONCLUSION

The quality of healthcare in Hong Kong is appreciated. Individualized care should be offered to cater to diverse needs. Improvements in staff attitude and provision of detailed information should help alleviate feelings of differential treatment.

Out of pocket health-care services in Germany during pregnancy under consideration of migration and acculturation

PURPOSE

More than a quarter of the German population has a migration background (MB). As various studies in the healthcare sector have already shown, ethnic background and migration status can have an influence on individual patient care. The aim of our study was to evaluate whether there are differences in utilization of out of pocket health-care services and the consultation situation in the context of prenatal care, taking into account migration status, acculturation and socio-demographic aspects.

METHODS

In the period from 01.03.21-01.03.22, a total of 511 women in childbed at the University Women's Hospital Ulm were interviewed in a retrospective survey using a standardized questionnaire translated into 9 languages and asked about their prenatal care. Due to the COVID pandemic, the study had to be terminated after one year.

RESULTS

Women with MB-particularly 1st generation migrant women-used significantly fewer out of pocket prenatal care services (p < 0.001) and felt less informed and counselled regarding costs and benefits of possible prenatal care examinations (p < 0.001) compared to women without MB. Consistent with these results, there were associations between the assimilation index (AI) of patients with MB and both utilization and perception of individual healthcare services.

CONCLUSION

Our study indicates that even today there are still differences in the treatment and perception of various health services in the context of prenatal care between women with and those without MB.

Effect of access to antenatal care on risk of preterm birth among migrant women in Italy: A population-based cohort study

Objective

To evaluate the association between maternal migration status and preterm birth, and whether a better adherence to antenatal care during pregnancy mitigates the risk of preterm birth.

Design

Population-based cohort.

Setting

Administrative databases of the Lombardy region, Italy.

Population

First singleton births of women aged 15-55 years at 22-42 gestational weeks, between 2016 and 2021.

Methods

Assessed the risk of preterm birth (<37 weeks).

Main outcome measures

A multivariable logistic regression mediation model calculated the mediation effect of adherence to antenatal care in the association between maternal migrant status and preterm birth and the residual effect not mediated by it. Analyses were adjusted for the socio-demographic and pregnant characteristics of the women.

Results

Of 349,753 births in the cohort, Italian nationality accounted for 71 %; 28.4 % were documented migrants and 0.4 % undocumented migrants. Among them, 5.3 %, 6.4 %, and 9.3 % had a preterm birth, respectively. Using deliveries of Italian citizens as referent, migrants had a significantly increased risk of preterm birth (adjusted relative risk: 1.22, 95 % confidence interval: 1.18-1.27). Adherence to antenatal care mediated the 62 % of such risk. We have calculated that adherence to antenatal pathways set to the highest level for the whole population could lead to a 37 % reduction in preterm birth risk.

Conclusion

Part of the excess of preterm birth among documented and undocumented migrants in Italy can be explained by a lack of adherence to the antenatal care path despite equal access to National Health care. The adherence of all pregnant women to antenatal care would reduce the risk of preterm birth by about one-third.

Enablers of and Barriers to Perinatal Mental Healthcare Access and Healthcare Provision for Refugee and Asylum-Seeking Women in the WHO European Region: A Scoping Review

Perinatal mental health is a growing public health concern. Refugee and asylum-seeking women are particularly susceptible to experiencing perinatal mental illness and may encounter a range of challenges in accessing healthcare. This scoping review sought to identify the enablers of and barriers to healthcare access and healthcare provision for refugee and asylum-seeking women experiencing perinatal mental illness in the WHO European Region. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was applied. Nine databases and six grey literature sources were initially searched in April 2022, and an updated search was completed in July 2023. The search identified 16,130 records, and after the removal of duplicates and the screening process, 18 sources of evidence were included in this review. A data extraction table was used to extract significant information from each individual source of evidence, which was then mapped to the seven dimensions of the candidacy framework. Empirical (n = 14; 77.8%) and non-empirical (n = 4; 22.2%) sources of evidence were included. The literature originated from seven countries within the WHO European Region, including the United Kingdom (n = 9; 50%), Germany (n = 3; 16.7%), Denmark (n = 2; 11.2%), Norway (n = 1; 5.6%), Greece (n = 1; 5.6%), Sweden (n = 1; 5.6%), and Switzerland (n = 1; 5.6%). The results indicate that, although enablers and barriers were apparent throughout the seven dimensions of candidacy, barriers and impeding factors were more frequently reported. There was also a notable overall lack of reported enablers at the system level. Unaddressed language barriers and lack of attention to the diversity in culturally informed perceptions of perinatal mental illness were the main barriers at the individual level (micro-level) to identifying candidacy, navigating healthcare systems, and asserting the need for care. The lack of culturally appropriate alignment of healthcare services was the key organizational (meso-level) barrier identified. The wider structural and political contexts (macro-level factors), such as lack of funding for consultation time, focus on Western diagnostic and management criteria, and lack of services that adequately respond to the needs of refugee and asylum-seeking women, negatively influenced the operating conditions and wider production of candidacy. It can be concluded that there are multilevel and interconnected complexities influencing access to and provision of perinatal mental healthcare for refugee and asylum-seeking women.

Barriers and facilitators of access to maternity care for African-born women living in Australia: a meta-synthesis of qualitative evidence

BACKGROUND

Adverse perinatal health outcomes are notably high among African-born women living in Australia. This problem is partly attributed to their lower engagement in maternity care services as compared to Australian-born women. Various barriers might limit African-born women's access to and use of services; however, these barriers are not well documented. Therefore, this review aimed to synthesise current qualitative evidence on barriers and facilitators of access to maternity care for African-born women living in Australia.

METHODS

The search was conducted in MEDLINE, CINAHL, Embase, PsychInfo, and Maternity and Infant Care databases on 16 April 2023. All articles retrieved were meticulously screened for eligibility by two independent reviewers with any disagreements resolved through discussion. The quality of the included articles was evaluated using the Mixed Methods Appraisal Tool. Studies were screened in Covidence and analysed in NVivo. The findings were organised and presented using Levesque's framework of healthcare access.

RESULTS

Out of 558 identified papers, 11 studies comprising a total of 472 participants met the eligibility criteria. The review highlighted provider-side barriers such as shortage of information, unmet cultural needs, long waiting times, low engagement of women in care, discrimination, and lack of continuity of care. User-side barriers identified include communication issues, difficulty navigating the health system, and lack of trustful relationships with healthcare providers. In contrast, the review pinpointed provider-side facilitators including positive staff attitudes, service availability, and the proximity of facilities to residential homes, while user-side facilitators such as cultural assimilation and feeling valued by healthcare providers were noted.

CONCLUSIONS

This review identified barriers and facilitators of access to maternity care for African-born women living in Australia. Empirical evidence that would inform potential changes to policy and practice to address African-born women's unique health needs was highlighted. Designing and implementing a culturally safe service delivery model could remove the identified access barriers and improve African-born women's engagement in maternity care. Moreover, reinforcing factors associated with positive healthcare experiences is essential for improving maternity care access for this priority population.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42023405458.

Investigating cultural conflicts in everyday self-care among Chinese first-time pregnant migrants in Australia

BACKGROUND

Given the fast-growing migration and globalisation trends in the last decades, women increasingly experienced pregnancy as migrants and often faced complex and unique challenges related to both migration and pregnancy in a foreign land, affecting their psychological wellbeing during pregnancy. Cultural conflicts between pregnant migrants' home and host cultures could play a critical role affecting their pregnancy experiences and psychological wellbeing.

AIMS

This study aimed to explore cultural conflicts that challenge Chinese first-time expectant mothers living in Australia regarding their pregnancy self-care and their psychological wellbeing.

METHOD

A qualitative methodology was adopted utilising interpretative phenomenological analysis. Participants were 18 Chinese-born first-time pregnant migrants in Australia. A semi-structured interview schedule focused on their pregnancy self-care and psychological wellbeing and any effects of Chinese-Western/Australian cultural conflicts.

FINDINGS

Two psychosocial approaches were identified to explain how all the participants were psychologically challenged by self-care cultural conflicts to some extent: 1) challenging decision-making processes about self-care cultural conflicts and 2) interpersonal tension if the decisions conflicted with someone's advice/beliefs/opinions.

CONCLUSION

Emotional, cognitive, and social factors were relevant in shaping the participants' engagement with and their experiences of various pregnancy self-care activities.

Impact of collegial midwifery assistance during second stage of labour on women's experience: a follow-up from the Swedish Oneplus randomised controlled trial

OBJECTIVE

To compare experiences of the second stage of labour in women randomised to assistance by one or by two midwives to reduce severe perineal trauma (SPT).

DESIGN

Analysis of a secondary outcome within the Swedish Oneplus multicentre randomised trial.

SETTING

Five obstetric units in Sweden between December 2018 and March 2020.

PARTICIPANTS

Inclusion criteria in the Oneplus trial were women opting for their first vaginal birth from gestational week 37+0 with a singleton pregnancy and a live fetus in the vertex presentation. Further inclusion criteria were language proficiency in Swedish, English, Arabic or Farsi. Exclusion criteria were multiple pregnancies, intrauterine fetal demise and planned caesarean section. Of the 3059 women who had a spontaneous vaginal birth, 2831 women had consented to participate in the follow-up questionnaire.

INTERVENTIONS

Women were randomly assigned (1:1) to assistance by two midwives (intervention group) or one midwife (standard care) when reaching the second stage of labour.

OUTCOME MEASURES

Data were analysed by intention to treat. Comparisons between intervention and standard care regarding experiences of the second stage of labour were evaluated with items rated on Likert scales. The Student's t-test was used to calculate mean differences with 95% CIs.

RESULTS

In total 2221 (78.5%) women responded to the questionnaire. There were no statistically significant differences regarding women's experiences of being in control, feelings of vulnerability or pain. Women randomised to be assisted by two midwives agreed to a lesser extent that they could handle the situation during the second stage (mean 3.18 vs 3.26, 95% CI 0.01 to 0.15). Conducted subgroup analyses revealed that this result originated from one of the study sites.

CONCLUSIONS

The intervention's lack of impact on the experience of the second stage is of importance considering the reduction in SPT when being assisted by two midwives.

TRIAL REGISTRATION NUMBER

NCT03770962.

Considerations for specialized maternal-fetal care in the Somali-American community

OBJECTIVE

This study describes the perceptions, personal and community experiences, and barriers to care of Somali-American families regarding specialized maternal-fetal care from their viewpoint.

STUDY DESIGN

We conducted a semi-structured focus group study of Somali-American women (March 2023). We used qualitative analysis techniques to identify and report thematic findings.

RESULTS

Fifty Somali-American women were interviewed in focus groups. Five themes were identified: 1) adherence to religious belief (namely Islamic) was paramount, including devotions of predestination (e.g. divine will) and permissibility of fetal intervention, 2) participants valued consensus among clinicians and were guided by prior experiences, 3) confidence in the medical team was important, and included the need to communicate effectively with clinicians and concerns regarding the accuracy of diagnosis, 4) decisional factors prioritized saving the life of the baby, and 5) treatment considerations included reluctance to intervene before birth.

CONCLUSIONS

For the Somali-American participants, their faith identity was central when considering their medical needs, including a hesitance to treat a baby before birth due to Islamic belief in divine will. In addition, these community members highlighted the importance of trustworthy interpretation, cultural competence, clinician consensus, prior pregnancy experiences as well as experiences of other community members as having an impact on their trust in their medical care and diagnosis.

Black Women's Maternal Health: Insights From Community Based Participatory Research in Newark, New Jersey

This study on Black women's maternal health engaged a group of six community members in a community based participatory research project in a state with one of the largest racial disparities in maternal mortality and severe maternal morbidity in the United States. The community members conducted 31 semi-structured interviews with other Black women who had given birth within the past 3 years to examine their experiences throughout the perinatal and post-partum period. Four main themes emerged: (1) challenges related to the structure of healthcare, including insurance gaps, long wait times, lack of co-location of services, and financial challenges for both insured and uninsured people; (2) negative experiences with healthcare providers, including dismissal of concerns, lack of listening, and missed opportunities for relationship building; (3) preference for racial concordance with providers and experiences with discrimination across multiple dimensions; and (4) mental health concerns and lack of social support. CBPR is a research methodology that could be more widely deployed to illuminate the experiences of community members in order to develop solutions to complex problems. The results indicate that Black women's maternal health will benefit from multi-level interventions with changes driven by insights from Black women.

Suboptimal factors in maternal and newborn care for refugees: Lessons learned from perinatal audits in the Netherlands

INTRODUCTION

Refugees and their healthcare providers face numerous challenges in receiving and providing maternal and newborn care. Research exploring how these challenges are related to adverse perinatal and maternal outcomes is scarce. Therefore, this study aims to identify suboptimal factors in maternal and newborn care for asylum-seeking and refugee women and assess to what extent these factors may contribute to adverse pregnancy outcomes in the Netherlands.

METHODS

We conducted a retrospective analysis of national perinatal audit data from 2017 to 2019. Our analysis encompassed cases with adverse perinatal and maternal outcomes in women with a refugee background (n = 53). Suboptimal factors in care were identified and categorized according to Binder et al.'s Three Delays Model, and the extent to which they contributed to the adverse outcome was evaluated.

RESULTS

We identified 29 suboptimal factors, of which seven were related to care-seeking, six to the accessibility of services, and 16 to the quality of care. All 53 cases contained suboptimal factors, and in 67.9% of cases, at least one of these factors most likely or probably contributed to the adverse perinatal or maternal outcome.

CONCLUSION

The number of suboptimal factors identified in this study and the extent to which they contributed to adverse perinatal and maternal outcomes among refugee women is alarming. The wide range of suboptimal factors identified provides considerable scope for improvement of maternal and newborn care for refugee populations. These findings also highlight the importance of including refugee women in perinatal audits as it is essential for healthcare providers to better understand the factors associated with adverse outcomes to improve the quality of care. Adjustments to improve care for refugees could include culturally sensitive education for healthcare providers, increased workforce diversity, minimizing the relocation of asylum seekers, and permanent reimbursement of professional interpreter costs.

Cross-cultural nursing care for immigrant women during pregnancy and childbirth: experiences and vulnerabilities

OBJECTIVE

To understand the experiences and vulnerabilities for cross-cultural nursing care for immigrant women during pregnancy and delivery.

METHOD

Exploratory, qualitative research, in the light of the Theory of Diversity and Universality of Cultural Care, in Foz do Iguaçu, Brazil, through interviews with eight postpartum woman and 18 nurses, between February and September 2022. The interpretation of meanings was adopted for analysis.

RESULTS

The categories of analysis emerged: Experiences, vulnerabilities and acculturation of immigrant women during pregnancy and delivery; Cross-cultural care and vulnerabilities experienced by immigrants in Brazilian health services. Vulnerabilities were identified in Cultural and Social Structure Dimensions expressed in access to work, low socioeconomic conditions, lack of family and social support and specific services for this population. The potentialities experienced included good care provided by health services, quality of the multidisciplinary team and appreciation of professional knowledge, however, the understanding of expectations and cultural aspects needs to be deepened.

FINAL CONSIDERATIONS

Understand that immigrant women experience situations of vulnerability in pregnancy and childbirth, in the Brazilian context, mainly related to social and programmatic dimensions. However, potentialities were also experienced, evidenced by positive aspects in cross-cultural nursing care in Brazil.

Latina paradox in Spain? Arrival-cohort effects on the birthweight of newborns of Latina mothers

This study analyses the arrival-cohort effects on the newborn birthweight of Latina women residing in Spain. First, it has been tested whether women of Latin American origin in Spain have an advantage in terms of birth outcomes, a pattern previously documented in the United States and referred to as the 'Latin American paradox'. Second, it has been examined whether this health advantage of Latina mothers varies by arrival cohort.A novel database provided by the Spanish National Statistics Office that links the 2011 Census with Natural Movement of the Population records from January 2011 to December 2015 has been used. Poisson regression models were applied to test for differences in the incidence rates of low birthweight (LBW) and high birthweight (HBW) among children of Latina and native mothers, controlling for various demographic, socio-economic, and birth characteristics.Two distinct arrival-cohort effects on perinatal health were observed. On one hand, first-generation Latina women were found to be at a lower risk of giving birth to LBW infants; however, they experienced a higher incidence of HBW during the study period. Second, Latina women of 1.5 generation, likely stressed by increased exposure to the receiving country, exhibited adverse birthweight results.

Advanced Midwifery Practice in Switzerland: Development and challenges

Midwifery is undergoing increasing complexity attributed to global epidemiological, socio-economic and technological shifts. Coupled with a shortage of workforce and the imperative for cost-effectiveness and high-quality care, there is an ongoing international discourse and establishment of new care models and specialized roles, notably Advanced Midwifery Practice (AMP). While countries like the UK and Ireland have embraced AMP roles, Switzerland lags behind with only a few pioneering roles. The absence of regulatory frameworks for AMP within the Swiss legal and healthcare system, hinders the evolution of APM roles necessary to address contemporary needs in perinatal healthcare provision. To effectively harness the midwifery workforce and mitigate premature attrition, Switzerland must formulate distinct career trajectories for postgraduate midwives, particularly for Advanced Practice Midwives (APM). This involves establishing legal standards for educational and clinical prerequisites, delineating guidelines for APM responsibilities and competencies, and devising compensation schemes that mirror the autonomy and leadership competencies integral to these advanced roles within inpatient and outpatient perinatal care models. The incorporation of evaluation and research into AMP is indispensable, contributing to improved patient outcomes and the ongoing professionalization of midwifery. In conjunction with the Swiss Federation of Midwives, all Universities of Applied Sciences in Switzerland have collaboratively drafted a national position paper underscoring the significance of developing APM roles to ensure the provision of high-quality perinatal care. This article aims to elucidate current developments in perinatal care within the Swiss context, providing a comprehensive definition for AMP, delineating its contribution to enhancing and sustaining the quality of care.

Obstetric care for environmental migrants

BACKGROUND

Migration due to environmental factors is an international crisis affecting many nations globally. Pregnant people are a vulnerable subgroup of migrants.

AIM

This article explores the potential effects of environmental migration on pregnancy and aims to draw attention to this rising concern.

METHODS

Based on the study aim, a semi-structured literature review was performed. The following databases were searched: MEDLine (PubMed) and Google Scholar. The search was originally conducted on 31st January 2021 and repeated on 22nd September 2022.

RESULTS

Pregnant migrants are at increased risk of mental health disorders, congenital anomalies, preterm birth, and maternal mortality. Pregnancies exposed to natural disasters are at risk of low birth weight, preterm birth, hypertensive disorders, gestational diabetes, and mental health morbidity. Along with the health risks, there are additional complex social factors affecting healthcare engagement in this population.

CONCLUSION

Maternity healthcare providers are likely to provide care for environmental migrants over the coming years. Environmental disasters and migration as individual factors have complex effects on perinatal health, and environmental migrants may be at risk of specific perinatal complications. Obstetricians and maternity healthcare workers should be aware of these challenges and appreciate the individualised and specialised care that these patients require.

Key dimensions of women's and their partners' experiences of childbirth: A systematic review of reviews of qualitative studies

BACKGROUND

The World Health Organization 2018 intrapartum guideline for a positive birth experience emphasized the importance of maternal emotional and psychological well-being during pregnancy and the need for safe childbirth. Today, in many countries birth is safe, yet many women report negative and traumatic birth experiences, with adverse effects on their and their families' well-being. Many reviews have attempted to understand the complexity of women's and their partners' birth experience; however, it remains unclear what the key dimensions of the birth experience are.

OBJECTIVE

To synthesize the information from reviews of qualitative studies on the experience of childbirth in order to identify key dimensions of women's and their partners' childbirth experience.

METHODS

Systematic database searches yielded 40 reviews, focusing either on general samples or on specific modes of birth or populations, altogether covering primary studies from over 35,000 women (and >1000 partners) in 81 countries. We appraised the reviews' quality, extracted data and analysed it using thematic analysis.

FINDINGS

Four key dimensions of women's and partners' birth experience (covering ten subthemes), were identified: 1) Perceptions, including attitudes and beliefs; 2) Physical aspects, including birth environment and pain; 3) Emotional challenges; and 4) Relationships, with birth companions and interactions with healthcare professionals. In contrast with the comprehensive picture that arises from our synthesis, most reviews attended to only one or two of these dimensions.

CONCLUSIONS

The identified key dimensions bring to light the complexity and multidimensionality of the birth experience. Within each dimension, pathways leading towards negative and traumatic birth experiences as well as pathways leading to positive experiences become tangible. Identifying key dimensions of the birth experience may help inform education and research in the field of birth experiences and gives guidance to practitioners and policy makers on how to promote positive birth experiences for women and their partners.

Obstetric outcomes and uptake of care among 149 non-Swedish speaking migrant women attending a birth preparation visit during pregnancy - An observational study from Sweden

Introduction

In Sweden almost one third of the population is born in another country and a large number of the women who do not speak Swedish are of reproductive age. Women migrating from low-income countries have higher risks for poor obstetric outcomes than receiving country-born citizens. INFOR (a Swedish word for "before" or "ahead of") is an intervention offering language-assisted, individual birth preparation for non-Swedish speaking pregnant women unfamiliar with the maternity care system. The aim of this study was to describe the uptake of care and obstetric outcomes among non-Swedish speaking migrant women attending INFOR.

Methods

A descriptive study of the obstetric outcomes and uptake of care was conducted of the 149 non-Swedish speaking pregnant women who participated in INFOR between 2016 and 2020. The data were accessed retrospectively from the medical record system Obstetrix and the population-based Swedish Pregnancy Registry and analysed descriptively.

Results

Women participating in INFOR originated from 44 countries and spoke 35 different languages. During late pregnancy, 20 percent of the women sought care for decreased fetal movements and 80 percent of the women attended the postpartum visit. While the majority of the participants were offered professional language support during pregnancy, almost none had a professional interpreter present during labour and birth. After birth, 80 percent of the primiparous women were asked to rate their birth experience, but only half of the multiparous women were asked. Further, only half of the primiparous women attending the postpartum visit were asked about their self-rated health.

Conclusion

INFOR may increase uptake of some important aspects of care during pregnancy, birth and postpartum among migrants of diverse backgrounds. The findings raise concerns however about communication support for migrant women, especially during labour and birth. The offer of professional interpreting as part of standard maternity care for women who need it is essential and must be improved in order to provide equitable care for all.

Equity in prenatal healthcare services globally: an umbrella review

BACKGROUND

Timely, appropriate, and equitable access to quality healthcare during pregnancy is proven to contribute to better health outcomes of birthing individuals and infants following birth. Equity is conceptualized as the absence of differences in healthcare access and quality among population groups. Healthcare policies are guides for front-line practices, and despite merits of contemporary policies striving to foster equitable healthcare, inequities persist. The purpose of this umbrella review is to identify prenatal healthcare practices, summarize how equities/inequities are reported in relation to patient experiences or health outcomes when accessing or using services, and collate equity reporting characteristics.

METHODS

For this umbrella review, six electronic databases were searched (Medline, EMBASE, APA PsychInfo, CINAHL, International Bibliography of the Social Sciences, and Cochrane Library). Included studies were extracted for publication and study characteristics, equity reporting, primary outcomes (prenatal care influenced by equity/inequity) and secondary outcomes (infant health influenced by equity/inequity during pregnancy). Data was analyzed deductively using the PROGRESS-Plus equity framework and by summative content analysis for equity reporting characteristics. The included articles were assessed for quality using the Risk of Bias Assessment Tool for Systematic Reviews.

RESULTS

The search identified 8065 articles and 236 underwent full-text screening. Of the 236, 68 systematic reviews were included with first authors representing 20 different countries. The population focus of included studies ranged across prenatal only (n = 14), perinatal (n = 25), maternal (n = 2), maternal and child (n = 19), and a general population (n = 8). Barriers to equity in prenatal care included travel and financial burden, culturally insensitive practices that deterred care engagement and continuity, and discriminatory behaviour that reduced care access and satisfaction. Facilitators to achieve equity included innovations such as community health workers, home visitation programs, conditional cash transfer programs, virtual care, and cross-cultural training, to enhance patient experiences and increase their access to, and use of health services. There was overlap across PROGRESS-Plus factors.

CONCLUSIONS

This umbrella review collated inequities present in prenatal healthcare services, globally. Further, this synthesis contributes to future solution and action-oriented research and practice by assembling evidence-informed opportunities, innovations, and approaches that may foster equitable prenatal health services to all members of diverse communities.

From co-regulation to self-regulation: Maternal soothing strategies and self-efficacy in relation to maternal reports of infant regulation at 3 and 7 months

This study, conducted in Germany, examines the role of maternal soothing strategies to explain the association of maternal self-efficacy with infant regulation (crying and sleeping behavior). Questionnaire data of 150 mothers, living in Germany, with mixed ethnic and educational backgrounds were collected when infants were 3 and 7 months old. Two types of maternal soothing strategies were distinguished: close soothing, involving close physical and emotional contact, and distant soothing, involving physical and emotional distancing from the infant. A cross-sectional SEM at 3 months indicated that maternal self-efficacy is associated with reported infant regulation through distant soothing strategies. Low maternal self-efficacy was associated with frequent maternal use of distant soothing, which in turn was related to reported infant regulation problems, that is, non-soothability and greater crying frequency. Frequent use of close soothing was associated with reported infant sleeping behavior, that is, frequent night-time awakenings. A longitudinal SEM further indicated that the effects of close soothing persisted at least until the infants' age of 7 months. The study showed how low maternal self-efficacy, increased use of distant soothing, and reported early infant regulation problems are intertwined and that, due to their persisting positive effect on infant soothability, close soothing better supports infant development.

Exploring South Asian women's perspectives and experiences of maternity care services: A qualitative evidence synthesis

BACKGROUND

The United Nations Women and other sources have highlighted the poor maternal and neonatal care experienced by South Asian women, emphasizing the need to understand the cultural factors and specific experiences that influence their health-seeking behavior. This understanding is crucial for achieving health equity and improving health outcomes for women and infants.

OBJECTIVES

This study aims to examine and synthesize qualitative evidence on the perspectives and experiences of South Asian women regarding maternity care services in destination countries.

METHODS

A systematic review was conducted using the Joanna Briggs Institute's approach. Eight databases were searched for studies capturing the qualitative views and experiences of South Asian women - Medline, EMBASE, CINAHL Plus, Global Health, Scopus, PsycInfo, British Nursing Index and the Applied Social Science Index and Abstracts. Qualitative and mixed method studies written in English are included. The methodological quality of the included studies was assessed using the JBI's QARI checklist for qualitative studies and the MMAT checklist for mixed-methods studies.

RESULTS

Fourteen studies, including twelve qualitative and two mixed-methods studies, were identified and found to be of high methodological quality. The overarching theme that emerged was "navigating cross-cultural maternity care experiences." This theme encapsulates the challenges and complexities faced by South Asian women in destination countries, including ethnocultural and religious differences, communication and language barriers, understanding different medical systems, and the impact of migration on their maternity care experiences.

CONCLUSIONS

South Asian migrant women often have expectations that differ from the services provided in destination countries, leading to challenges in their social relationships. Communication and language barriers pose additional obstacles that can be addressed through strategies promoting better communication and culturally sensitive care. To enhance the utilization of maternity healthcare services, it is important to address these factors and provide personalized, culturally sensitive care for South Asian migrant women.