An exploration of the experience of midwifery care by women asylum seekers and refugees

Background: There were approximately 63,097 known asylum seekers in England in 2002 (Heath et aL 2003). Women asylum seekers may be more seriously affected by displacement than men, leading to increased isolation, poverty, hostility and racism (Burnett and Peel, 2001a). In England, Black African including asylum seekers and newly arrived refugees had a seven times greater chance of maternal modality than White women (CEMACH, 2004 p244). Furthermore, women from ethnic groups other than white are twice as likely to die as women in the white group. In the CEMACH report a large number of women who died spoke little English. Access to local information about asylum seekers and refugees was difficult to obtain and suggested a disorganised service provision for this group of women. Aim: It was the intention of this study to explore and synthesise the experience of midwifery care by women asylum seekers and refugees in one large maternity unit in England. Design: Longitudinal exploratory case study research utilising a series of interviews. Sample: Four women from: Afghanistan, Rwanda, Somalia and Zaire. Three women were asylum seekers and one was a refugee. One woman spoke fluent English. Setting: Liverpool Women's Hospital and the women's homes. Years: The study took place from December 2002 - July 2003. Methodology: The research was developed from a constructionist paradigm which identifies that multiple realities can exist for individuals who experience 10 a similar phenomenon. Truth within this perspective is constructed by the individual. The researcher (LB) was the main instrument of data collection. Interpretation was generated via the researcher and was verified by the women at the final interview. The underpinning foundation for this study emerged as symbolic interaction theory (Mead, cited in Morris, 1967 p43; Blumer, 1969). Methods: Following ethical approval consent was obtained with the help of professional interpreters. Exploration was facilitated by in-depth interviews at five time points throughout the antenatal and postnatal period. Photographs taken by the women themselves were used as a prompt for conversation. Analysis: The researcher's interpretation of the data identified emerging themes and categories. The process of analysis involved decontextualisation, display, data complication and re-conceptualisation (Miles and Huberman, 1994 p10). Three key themes were generated: the influence of social policy, understanding in practice and the perception of 'self. Results: Synthesis of the results suggested that social policy directly affected the lives of the women. At times, "taken for granted" communication created a barrier to understanding for the women. Stereotype was socially constructed and pervaded the care environment. The women perceived 'self as a response to social interaction. The midwife-woman relationship relied heavily on gestures and symbols and the women's descriptions are related to symbolic interaction theory. Midwives capable of understanding the subtle cues in communication may be able to negotiate negative stereotypical images generated by society. Women had little or no information around childbirth. Recommendations: Midwifery care would benefit from a deeper understanding of how the women in this study perceived 'self. An advisory post may provide the link between maternity care and broader public health issues. Midwives should engage with asylum seekers and refugees to develop partnerships in care. A collaborative partnership may assist in creating relevant information around childbirth for other asylum seekers and refugees. Innovative methods of dissemination of information related to childbirth should be facilitated by a collaborative approach with non-governmental and community organisations.