Koopmanschap Isabel, Martin Linda, Gitsels-van der Wal Janneke T, Suurmond Jeanine
Amsterdam University Medical Center, Department of Public and Occupational Health, University of Amsterdam, Amsterdam, Netherlands.
Department of Midwifery Science, Academy Midwifery Amsterdam and Groningen (AVAG), Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Eur J Midwifery. 2022 May 19;6:29. doi: 10.18332/ejm/147911. eCollection 2022.
Large ethnic inequalities exist in the prenatal screening offer, counselling, informed decision-making, and uptake of prenatal anomaly tests. More insight into midwives' experiences with offering prenatal counselling to migrant women may provide better insight into the origins and consequences of these ethnic inequalities.
We conducted interviews with 12 midwives certified as counsellors for prenatal anomaly screening for women they identified as migrants. Interviews were analyzed using thematic analysis.
Midwives reported most difficulties in communicating with women of 'non-western migrant background', which include first- and second-generation migrants from Africa, Latin-America, Asia, and Turkey. They experienced barriers in communication related to linguistics, health literacy, sociocultural and religious differences, with midwife stereotyping affecting all three aspects of counselling: health education, decision-making support, and the client-midwife relation. Health education was difficult because of language barriers and low health-literacy of clients, decision-making support was hampered by sociocultural and religious midwife-client differences, and client-midwife relations were under pressure due to sociocultural and religious midwife-client differences and midwife stereotyping.
Barriers to optimal communication seem to contribute to suboptimal counselling, especially for women of 'non-western migrant background'. Client-midwife communication thus potentially adds to the ethnic disparities observed in the offer of and informed decision-making about prenatal anomaly screening in the Netherlands. The quality of prenatal counselling for women from all ethnic backgrounds might be improved by addressing linguistic, health literacy, sociocultural and religious barriers in future training and continuing education of prenatal counsellors.
在产前筛查服务、咨询、知情决策以及产前异常检测的接受度方面存在巨大的种族不平等现象。深入了解助产士为移民妇女提供产前咨询的经历，可能有助于更好地洞察这些种族不平等的根源和后果。
我们对12名获得产前异常筛查咨询师认证的助产士进行了访谈，这些助产士所服务的是她们认定为移民的女性。采用主题分析法对访谈进行了分析。
助产士报告称，与“非西方移民背景”的女性沟通最为困难，这些女性包括来自非洲、拉丁美洲、亚洲和土耳其的第一代和第二代移民。她们在沟通中遇到了与语言、健康素养、社会文化和宗教差异相关的障碍，助产士的刻板印象影响了咨询的三个方面：健康教育、决策支持以及助产士与客户的关系。由于语言障碍和客户健康素养较低，健康教育存在困难；社会文化和宗教方面助产士与客户的差异阻碍了决策支持；社会文化和宗教方面助产士与客户的差异以及助产士的刻板印象使助产士与客户的关系面临压力。
最佳沟通的障碍似乎导致了不理想的咨询，尤其是对于“非西方移民背景”的女性。因此，助产士与客户的沟通可能加剧了荷兰在产前异常筛查服务及知情决策方面存在的种族差异。通过在未来产前咨询师的培训和继续教育中解决语言、健康素养、社会文化和宗教障碍，或许可以提高所有种族背景女性的产前咨询质量。
