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Violence, wellbeing, and being approached with questions about violence in maternity care encounters. A qualitative study with Somali-born women in the context of recent migration to Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
högskolan Dalarna.
(English)Article in journal (Refereed) Submitted
Abstract [en]

Background: Somali-born women constitute one of the largest groups of childbearing refugee women in Sweden after more than two decades of political violence in Somalia. In Sweden, these women encounter a midwifery care system that includes antenatal care visits where routine questions on violence are asked. The aim of this study is to explore Somali-born women’s views on being approached with questions on violence in Swedish maternity care and how they understand and relate to violence and wellbeing.

Method: Qualitative interviews (22) with Somali-born women (17) living in Sweden were conducted and analysed using thematic analysis.

Findings: A balancing act between keeping private life private and the new welfare system was identified, where the midwife’s questions on violence were met with hesitance. The midwife was, however, considered a resource in gaining access to support services in the new society. A focus set on pragmatic strategies to move on in life, rather than dwelling on potential experiences of violence and related traumas, was prominent. Social networks, spiritual faith and motherhood were crucial for regaining coherence in the aftermath of war. Own experiences of intimate partner violence or non-partner sexual violence were not revealed. Dialogue and mutual adjustments were identified as strategies used to overcome power tensions in intimate relationships undergoing transition.

Conclusions: For beneficial violence prevention and identification, midwives’ questions on violence need to be justified in relevant ways and embedded in contexts of trustful relationships. Approaches of rationality and “moving on”, without focusing on violence or adversities, indicate strength and access to alternative resources, but need to be balanced against risks for hidden needs in care encounters. Collaborations between Somali communities, maternal health care and social service providers can support families in transition and bridge gaps to formal social and care services.

Keyword [en]
Somali-born women, maternity care, qualitative, thematic analysis, violence, wellbeing, Sweden
National Category
Medical and Health Sciences
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:uu:diva-259880OAI: oai:DiVA.org:uu-259880DiVA: diva2:845753
Available from: 2015-08-13 Created: 2015-08-13 Last updated: 2015-10-01
In thesis
1. ’Moving On’ and Transitional Bridges: Studies on migration, violence and wellbeing in encounters with Somali-born women and the maternity health care in Sweden
Open this publication in new window or tab >>’Moving On’ and Transitional Bridges: Studies on migration, violence and wellbeing in encounters with Somali-born women and the maternity health care in Sweden
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

During the latest decade Somali-born women with experiences of long-lasting war followed by migration have increasingly encountered Swedish maternity care, where antenatal care midwives are assigned to ask questions about exposure to violence. The overall aim in this thesis was to gain deeper understanding of Somali-born women’s wellbeing and needs during the parallel transitions of migration to Sweden and childbearing, focusing on maternity healthcare encounters and violence. Data were obtained from medical records (paper I), qualitative interviews with Somali-born women (II, III) and Swedish antenatal care midwives (IV). Descriptive statistics and thematic analysis were used. Compared to pregnancies of Swedish-born women, Somali-born women’s pregnancies demonstrated later booking and less visits to antenatal care, more maternal morbidity but less psychiatric treatment, less medical pain relief during delivery and more emergency caesarean sections and small-for-gestational-age infants (I). Political violence with broken societal structures before migration contributed to up-rootedness, limited healthcare and absent state-based support to women subjected to violence, which reinforced reliance on social networks, own endurance and faith in Somalia (II). After migration, sources of wellbeing were a pragmatic “moving-on” approach including faith and motherhood, combined with social coherence. Lawful rights for women were appreciated but could concurrently risk creating power tensions in partner relationships. Generally, the Somali-born women associated the midwife more with providing medical care than with overall wellbeing or concerns about violence, but new societal resources were parallel incorporated with known resources (III). Midwives strived for woman-centered approaches beyond ethnicity and culture in care encounters, with language, social gaps and divergent views on violence as potential barriers in violence inquiry. Somali-born women’s strength and contentment were highlighted, and ongoing violence seldom encountered according to the midwives experiences (IV). Pragmatism including “moving on” combined with support from family and social networks, indicate capability to cope with violence and migration-related stress. However, this must be balanced against potential unspoken needs at individual level in care encounters.With trustful relationships, optimized interaction and networking with local Somali communities and across professions, the antenatal midwife can have a “bridging-function” in balancing between dual societies and contribute to healthy transitions in the new society.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. 92 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1127
Keyword
Somali-born women, violence, transition, migration, childbearing, midwife, maternal health, perinatal health, wellbeing, qualitative, case-control
National Category
Medical and Health Sciences
Research subject
International Health
Identifiers
urn:nbn:se:uu:diva-259881 (URN)978-91-554-9302-8 (ISBN)
Public defence
2015-10-01, Universitetshuset Sal IX, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2015-09-09 Created: 2015-08-13 Last updated: 2015-10-01

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