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More than re-establishing the partner relationship: Intimate aftercare for Somali parents in diaspora
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Internationell kvinno- och mödrahälsovård och migration/Essén)
Faculty of Health and Society, Malmö University, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Internationell kvinno- och mödrahälsovård och migration/Essén)
2013 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, no 29, 863-70 p.Article in journal (Refereed) Published
Abstract [en]

Objective

to explore the sexual relationship and couples' perceptions about intimate partner support following childbirth.

Design

a hermeneutic design using a naturalistic inquiry framework as a qualitative proxy for medical anthropology. Data were collected using a fictional and culturally-specific narrative during focus group discussions (FGDs) in early 2011. Analysis was conducted by ‘functional narrative analysis’ and interpreted for conceptual constructions. Recruitment was by snowball and purposive sampling.

Setting

a diasporic context among participants living in six urban centres across Sweden.

Participants

successful recruitment included 16 Somali-Swedish fathers and 27 mothers. Three FDGs were conducted with fathers (3–7 participants) and seven with mothers (3–6 participants).

Findings

within day 40 post partum, parents learn to rely on each other in the absence of traditional support networks. After the first 40 days, the re-introduction of sexual intimacy is likely to occur. Of the fathers experiencing postpartum sexual aversion, these seemed to experience ‘existential angst’ resulting from a combination of profound remorse over having put the partner into what they perceived as a life-threatening situation during childbirth and their perceived moral and ethical obligations to provide support in this setting. Mothers in general did not directly discuss their own sexuality. Women could imagine men's sexual aversion after witnessing childbirth. However, they seemed unaware of men's potential for angst. Mothers are situated between the loss of traditional postpartum support networks, comprised of close female kin, and their own newly-defined responsibilities in the host setting. Fathers embrace their new role. Both partners articulated the mother's new role as enhancing autonomy and independence in the host setting. However, women held mixed attitudes about fathers replacing traditional kin support.

Implications for practice

to date, late postpartum aftercare for immigrant African parents is anecdotally linked to evidence-based recommendations, which have been identified for parents who are ethnically-congruent to a western study setting. Our findings suggest that aftercare meant for Somali parents living in these settings requires an understanding of how traditional intimate support and the postpartum sexual relationship are re-negotiated in the diasporic context. This includes recognition of the father as a willing and supportive partner.

Place, publisher, year, edition, pages
2013. no 29, 863-70 p.
Keyword [en]
postpartum, proxy for medical anthropology
National Category
Medical and Health Sciences
Research subject
International Health
Identifiers
URN: urn:nbn:se:uu:diva-182867DOI: 10.1016/j.midw.2012.09.002ISI: 000321431200008OAI: oai:DiVA.org:uu-182867DiVA: diva2:561141
Available from: 2012-10-17 Created: 2012-10-17 Last updated: 2017-12-07Bibliographically approved
In thesis
1. The Maternal Migration Effect: Exploring Maternal Healthcare in Diaspora Using Qualitative Proxies for Medical Anthropology
Open this publication in new window or tab >>The Maternal Migration Effect: Exploring Maternal Healthcare in Diaspora Using Qualitative Proxies for Medical Anthropology
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This project explores the 'maternal migration effect'. Following migration to a high-income country with a low maternal mortality rate, we assume that some immigrant women’s reliance upon maternal practices that respond to a low-income, high-mortality context can adversely affect care-seeking and utilization of treatment facilities. At highest risk in the United Kingdom and Sweden are those from Africa's Horn, particularly Somali women who have experienced diasporic migration. By applying constructivist qualitative methods as proxies for medical anthropology, we propose a framework for identifying socio-cultural factors, and then we explore how these can influence the western facility-based maternity care encounter.

Study 1 proposes a conceptual framework to understand why sub-Saharan African immigrants might experience adverse childbirth outcomes in western settings. Analysis was guided by 'naturalistic inquiry method' to explore delay-causing socio-cultural factors to optimal maternity treatment. Delays can result from (a) broken trust underlying women’s late-booking or refusal of treatment interventions, and care provider frustration; (b) over-reliance on poorly-functioning interpreter services that deny women’s access to medical expertise; and (c) mutual broken trust and miscommunication, and limited development of guidelines for treatment avoidance. Limited coherence exists in the perspectives between women and providers about caesarean section and other interventions, refusal of treatment, and coping strategies following adverse birth outcomes. Care providers' held misconceptions about women’s preferences for gender- and ethnic-congruence. Women preferred competent care. Congruent language was identified as the key ingredient for optimal culture-sensitive care.

Study 2 applied 'grounded dimensional analysis' and 'functional narrative analysis' to explore pre-migration socio-cultural factors that influence Somali parents' childbearing in Sweden. Women’s delayed care-seeking continues, despite that childbearing is still perceived as life-threatening. Decision-making is shared between the couple. Men more than women trust care providers to fill gaps in their knowledge. The postpartum period showed that fathers play an important role. "Aftercare" concerns include unarticulated sexual aversion combined with loss of traditional kin support. Women's autonomy is enhanced but greater necessity exists for intimate partner communication and reliance upon professional care services.

Medical anthropology can provide a complementary instrument for developing qualitative evidence-based strategies that target prevention of adverse childbirth outcomes in European countries.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 110 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 827
Keyword
caesarean section; care encounter; constructivist; interpreter use; migration; Somali; African immigrant; socio-cultural factors
National Category
Medical and Health Sciences
Research subject
International Health
Identifiers
urn:nbn:se:uu:diva-182870 (URN)978-91-554-8504-7 (ISBN)
Public defence
2012-12-01, Sal IX, Biskopsgatan 3, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2012-11-09 Created: 2012-10-17 Last updated: 2013-01-23Bibliographically approved

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Binder, PaulineEssén, Birgitta

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