Publications
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Author:
Binder, Pauline (Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH))
Title:
The Maternal Migration Effect: Exploring Maternal Healthcare in Diaspora Using Qualitative Proxies for Medical Anthropology
Department:
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH)
Publication type:
Doctoral thesis, comprehensive summary (Other academic)
Language:
English
Place of publ.: Uppsala Publisher: Acta Universitatis Upsaliensis
Pages:
110
Series:
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206; 827
Year of publ.:
2012
URI:
urn:nbn:se:uu:diva-182870
Permanent link:
http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-182870
ISBN:
978-91-554-8504-7
Subject category:
Medical and Health Sciences
Research subject:
International Health
Keywords(en) :
caesarean section; care encounter; constructivist; interpreter use; migration; Somali; African immigrant; socio-cultural factors
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.

Public defence:
2012-12-01, Sal IX, Biskopsgatan 3, Uppsala, 09:15 (English)
Degree:
degree of Doctor of Philosophy (Faculty of Medicine)
Supervisor:
Essén, Birgitta (Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH))
Johnsdotter, Sara (Malmö University)
Opponent:
Lambert, Helen (University of Bristol, United Kingdom)
Available from:
2012-11-09
Created:
2012-10-17
Last updated:
2013-01-23
Statistics:
745 hits
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3323 kb
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Type:
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390 hits