a Obstetrics and Gynecology , Maricopa Integrated Health System , Phoenix , AZ , USA.
Ethn Health. 2014 Aug;19(4):440-57. doi: 10.1080/13557858.2013.828829. Epub 2013 Aug 20.
OBJECTIVES: Somali women are at increased risk of adverse pregnancy outcomes. Anxiety and perceived stigmatization toward female genital cutting (FGC) further fuels an atmosphere of miscommunication and distrust, contributing to poorer health outcomes. While the attitudes and experiences of Somali refugee women toward healthcare are widely known, the views of Somali refugee men are largely unknown. This study examines the perspectives of Somali men toward FGC and women's childbirth experiences in one refugee community in the USA. DESIGN: Community-based participatory research partnerships with key stakeholders within the Somali refugee community incorporated qualitative methods comprising semi-structured focus groups and individual interviews to elicit male participants' perspectives on FGC, experiences during childbirth, and the perception of increased cesarean deliveries among Somali women. Qualitative analyses involved a framework and team-based approach using grounded theory and conventional content analysis. RESULTS: Acculturation influenced changes in traditional gender roles fostering new dynamics in shared decision-making within the household and during childbirth. Participants were aware of FGC-related morbidity, ongoing matriarchal support for FGC, and were generally not supportive of FGC. They perceived health-care providers as being unfamiliar with caring for women with FGC fueling profound aversion to cesarean deliveries, miscommunication, and distrust of the health-care system. CONCLUSION: Our work yields new insights into Somali reproductive healthcare through Somali men, namely: strong matriarchal support of FGC, discomfort in men's presence during delivery, and a strong aversion to cesarean delivery. Our findings support the need for advocacy to engage Somali women, their partners/spouses, and health-care providers in facilitating greater continuity of care, building greater trust as men become engaged throughout the spectrum of care in the decision-making process while respecting traditional norms. Cultural health navigators should bridge communication and support between providers and patients. Our work provides foundational knowledge to inform culturally appropriate health interventions within a Somali refugee community.
目的:索马里妇女面临不良妊娠结局的风险增加。焦虑和对女性割礼(FGC)的认知污名化进一步加剧了沟通不畅和不信任的氛围,导致健康状况恶化。虽然人们广泛了解索马里难民妇女对医疗保健的态度和经验,但索马里难民男子的观点在很大程度上尚不清楚。本研究考察了美国一个难民社区的索马里男性对 FGC 和女性分娩经历的看法。
设计:与索马里难民社区内的主要利益相关者建立基于社区的参与式研究伙伴关系,采用定性方法,包括半结构化焦点小组和个人访谈,以了解男性参与者对 FGC、分娩经历的看法,以及对索马里妇女剖腹产率增加的看法。定性分析涉及使用扎根理论和常规内容分析的框架和团队方法。
结果:文化适应影响了传统性别角色的变化,在家庭内部和分娩期间形成了新的共同决策动态。参与者了解与 FGC 相关的发病率,母系社会对 FGC 的持续支持,并且普遍不支持 FGC。他们认为医疗保健提供者不熟悉照顾接受过 FGC 的女性,这导致他们对剖腹产产生强烈的反感、误解和对医疗保健系统的不信任。
结论:我们的工作通过索马里男性获得了对索马里生殖健康护理的新见解,即:强大的母系社会对 FGC 的支持、男性在分娩时感到不适以及对剖腹产的强烈反感。我们的发现支持需要倡导让索马里妇女、她们的伴侣/配偶和医疗保健提供者参与进来,以促进更大的连续性护理,在男性参与整个护理过程并在决策过程中尊重传统规范的同时,建立更大的信任。文化健康导航员应在提供者和患者之间架起沟通和支持的桥梁。我们的工作为在索马里难民社区内提供文化上适当的健康干预措施提供了基础知识。
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