School of Nursing, The State University of New York, University at Buffalo, Buffalo, NY, USA.
Department of Health Policy, London School of Economics and Political Science, London, UK.
Ethn Health. 2021 Oct;26(7):1082-1097. doi: 10.1080/13557858.2019.1613519. Epub 2019 May 10.
Somali refugee women are known to have poor health-seeking behavior with a higher proportion of adverse pregnancy outcomes compared to US-born women. Yet unknown is how they avoid obstetrical interventions. This study sought to identify perceived protective mechanisms used to avoid obstetric interventions as well as the underpinning factors that influence aversion to obstetrical interventions by Somali refugee women. A descriptive, exploratory qualitative study purposively sampled Somali refugee women recruited via snowball technique in Franklin County, Ohio, United States. Data were collected through audio-recordings of individual interviews and focus groups conducted in English and Somali languages. The collected data were transcribed and analyzed using thematic analyses. Forty Somali refugee women aged 18-42 years were recruited. Participants reported engaging in four perceived protective mechanisms to avoid obstetrical interventions during pregnancy and childbirth: (1) intentionally not seeking or misleading prenatal care, (2) changing hospitals and/or providers, (3) delayed hospital arrival during labor, and (4) refusal of care. Underpinning all four avoidance mechanisms were their significant fear of obstetrical interventions, and perceived lack of choice in their care processes as influenced by cultural and/or religious beliefs, feeling judged or undervalued by service providers, and a lack of privacy provided to them while receiving care. Like every woman, Somali women also have a right to choose or refuse care. If the intention is to improve access to and experiences with care for this population, building trust, addressing their fears and concerns, and respecting their culture is a critical first step. This should be well established prior to the need for critical decisions surrounding pregnancy and childbirth wherein Somali women may feel compelled to refuse necessary obstetrical care. Bridging gaps between Somali women and their providers is key to advance health equity for this vulnerable population.
索马里难民妇女被认为健康寻求行为较差，不良妊娠结局的比例高于美国出生的妇女。然而，她们如何避免产科干预措施尚不清楚。本研究旨在确定避免产科干预的感知保护机制，以及影响索马里难民妇女对产科干预厌恶的潜在因素。这是一项描述性、探索性的定性研究，通过滚雪球技术在美国俄亥俄州富兰克林县招募了索马里难民妇女。通过英语和索马里语的个人访谈和焦点小组，以录音的方式收集数据。收集的数据通过主题分析进行转录和分析。共招募了 40 名年龄在 18-42 岁的索马里难民妇女。参与者报告了在怀孕期间和分娩时避免产科干预的四种感知保护机制：(1)故意不寻求或误导产前护理；(2)更换医院和/或提供者；(3)分娩时延迟入院；(4)拒绝护理。所有四种回避机制的基础都是她们对产科干预的显著恐惧，以及在文化和/或宗教信仰、服务提供者的评判或低估、缺乏隐私等因素的影响下，对护理过程缺乏选择的感知。和其他女性一样，索马里女性也有权选择或拒绝护理。如果目的是改善这一人群获得和体验护理的机会，那么建立信任、解决她们的恐惧和担忧以及尊重她们的文化是至关重要的第一步。这应该在需要围绕怀孕和分娩做出关键决策之前建立，在这些决策中，索马里妇女可能会被迫拒绝必要的产科护理。弥合索马里妇女和她们的提供者之间的差距是为这一弱势群体推进健康公平的关键。
