Gewalt Sandra Claudia, Berger Sarah, Szecsenyi Joachim, Bozorgmehr Kayvan
Department of General Practice & Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
BMC Public Health. 2019 Mar 12;19(1):287. doi: 10.1186/s12889-019-6481-2.
Pregnant women and new mothers seeking asylum are highly vulnerable and have special needs, yet there is dearth of research related to this group in Germany. This paper reports on material circumstances and behavioural factors as social determinants of asylum seekers' health during pregnancy and early motherhood. The study aim was to gain in-depth insights into these women's experiences and perceived needs with a focus on material circumstances whilst living in state-provided accommodation in one federal state in Southern Germany.
A qualitative, prospective approach was taken with individual semi-structured interviews of participants during pregnancy and up to the six-week postnatal assessment, aiming at interviewing each woman twice during pregnancy and once after giving birth. Two female interviewers performed interviews assisted by female professional interpreters on the telephone. Interviews were recorded digitally and transcribed verbatim. An inductive approach was taken to perform content analysis of interview material.
21 interviews were performed with nine women seeking asylum in pregnancy and early motherhood. Content analysis of women's perceived health-related needs revealed significant health challenges due to considerable constraints in two major themes each with associated categories: a) material circumstances and b) behavioural factors. Participants' experiences of living conditions included significant challenges in terms of housing and neighbourhood quality e.g. poor hygiene standards with fear of disease and restless sleep due to threats of violence. Consumption potential was severely limited because of a minimal living allowance. Food was a major preoccupation for all participants. Catering services in state-provided accommodation were perceived as unsatisfactory and neglecting religious practices. Institutional food provided adequate calorific intake but participants reported loss of appetite due to bland food, limited variety, little choice and unfamiliar tastes. Self-catering was prohibited further exacerbating this problem.
Pregnant asylum seekers and new mothers living in state-provided accommodation experienced major restrictions related to material circumstances in this study. Key results identified housing and neighbourhood quality, consumption potential and nutrition as social determinants of health which women perceived to adversely affect their health, especially during pregnancy and early motherhood.
寻求庇护的孕妇和新妈妈极为脆弱且有特殊需求，但德国针对这一群体的研究匮乏。本文报告了物质环境和行为因素，将其作为寻求庇护者孕期及初为人母阶段健康状况的社会决定因素。研究目的是深入了解这些女性的经历和感知到的需求，重点关注她们在德国南部一个联邦州由政府提供的住所中的物质环境。
采用定性、前瞻性研究方法，在孕期及产后六周评估期间对参与者进行个体半结构化访谈，目标是在孕期对每位女性访谈两次，产后访谈一次。两名女性访谈员在女性专业口译员的协助下通过电话进行访谈。访谈进行数字录音并逐字转录。采用归纳法对访谈材料进行内容分析。
对九名孕期及初为人母阶段寻求庇护的女性进行了21次访谈。对女性感知到的与健康相关需求的内容分析显示，在两个主要主题及其相关类别中，由于诸多限制，她们面临重大健康挑战：a）物质环境和b）行为因素。参与者的生活条件体验包括住房和社区质量方面的重大挑战，例如卫生标准差，担心患病，以及因暴力威胁而睡眠不安。由于生活津贴微薄，消费能力受到严重限制。食物是所有参与者的主要关注点。政府提供住所中的餐饮服务被认为不尽人意，且忽视宗教习俗。机构提供的食物热量摄入充足，但参与者报告称，由于食物平淡、种类有限、选择少且口味陌生，导致食欲不振。自行烹饪被禁止，这进一步加剧了该问题。
在本研究中，居住在政府提供住所的寻求庇护孕妇和新妈妈在物质环境方面经历了重大限制。关键结果表明，住房和社区质量、消费能力和营养是健康的社会决定因素，女性认为这些因素会对她们的健康产生不利影响，尤其是在孕期和初为人母阶段。
