Learning from UJAMBO: Perspectives on Gynecologic Care in African Immigrant and Refugee Women in Boston, Massachusetts

  • P. K. Mehta
  • K. Saia
  • D. Mody
  • S. S. Crosby
  • A. Raj
  • S. Maru
  • L. Piwowarczyk
Original Paper
  • 146 Downloads

Abstract

African-born immigrant women, and particularly refugees and asylum seekers, are at risk for reproductive health disparities but inadequately use relevant gynecologic services. We sought to elucidate perspectives on gynecologic care in a population of Congolese and Somali immigrants. We conducted a secondary qualitative analysis of focus group data using a grounded theory approach and the Integrated Behavioral Model as our theoretical framework. Thirty one women participated in six focus groups. Participant beliefs included the states of pregnancy and/or pain as triggers for care, preferences included having female providers and those with familiarity with female genital cutting. Barriers included stigma, lack of partner support, and lack of resources to access care. Experiential attitudes, normative beliefs, and environmental constraints significantly mediated care preferences for/barriers to gynecologic health service utilization in this population. Centering of patient perspectives to adapt delivery of gynecologic care to immigrants and refugees may improve utilization and reduce disparities.

Keywords

African immigrants Refugees Health services Reproductive health Gynecology Qualitative 

Notes

Funding

This project was funded by the Office of Minority Health (Grant Number: BBCMP1002A).

Compliance with Ethical Standards

Conflict of interest

Pooja Mehta receives research funding from the American College of Obstetricians and Gynecologists and the Maternal Child Health Bureau of the Health Resources and Services Administration. Kelley Saia has no conflicts of interest to disclose. Devi Mody has no conflicts of interest to disclose. Sondra Crosby has no conflicts of interest to disclose. Anita Raj receives funding from the National Institutes of Health, the Bill and Melinda Gates Foundation, the David and Lucile Packard Foundation, Kaiser Permanente, and the California Coalition Against Sexual Assault. Sheela Maru has no conflicts of interest to disclose. Lin Piwowarczyk has received funding from the United Nations and the Office of Refugee Resettlement.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    McCabe K. African immigrants in the United States. Migration Policy Institute; 2014. http://www.migrationpolicy.org/article/sub-saharan-african-immigrants-united-states. Accessed 23 Dec 2016.
  2. 2.
    Executive Office of Health and Human Services. Refugee and immigrant health; 2017. http://www.mass.gov/eohhs/gov/departments/dph/programs/id/public-health-cdc-refugee-and-immigrant-health.html.
  3. 3.
    Terrazas A. Diasporas and development policy project. Migration Policy Institute: Washington, DC; 2010.Google Scholar
  4. 4.
    Clayton-Mathews A, Watanabe P. The immigrant learning center, Inc. Massachusetts immigrants by the numbers, second edition: demographic characteristics and economic footprint, 2012.Google Scholar
  5. 5.
    Refugee Processing Center. Worldwide refugee processing system, United States Department of State. Arrivals by region as of April 14, 2017. http://www.wrapsnet.org/admissions-and-arrivals/.
  6. 6.
    Executive Office of Health and Human Services. Refugee arrivals to Massachusetts by country of origin. 2017. http://www.mass.gov/eohhs/gov/departments/dph/programs/id/public-health-cdc-refugee-arrivals.html.
  7. 7.
    Johnson CE, Ali SA, Shipp MP. Building community-based participatory research partnerships with a Somali refugee community. Am J Prev Med. 2009;37(6 Suppl 1):S230–6. doi:  10.1016/j.amepre.2009.09.036.CrossRefPubMedGoogle Scholar
  8. 8.
    Piwowarczyk L, Bishop H, Saia K, Crosby S, Mudynba FT, Hashi N, Raj A. Pilot evaluation of a health promotion program for African immigrant and refugee women: the UJAMBO program. J Immigr Minor Health. 2012;15(1):219–23.CrossRefGoogle Scholar
  9. 9.
    Austin J, Guy S, Lee-Jones L, McGinn T, Schlecht J. Reproductive health: a right for refugees and internally displaced persons. Reproduct Health Matters. 2008;16(31):10–21.CrossRefGoogle Scholar
  10. 10.
    Pallotto EK, Collins JW, David RJ. Enigma of maternal race and infant birth weight: a population-based study of US-born black and Carribean-born black women. Am J Epidemiol. 2000;151(11):1080–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Singh GK, Siahpush M. Ethnic-immigrant differentials in health behaviors, morbidity, and cause-specific mortality in the United States: an analysis of two national databases. Hum Biol. 2002;74(1):83–109.CrossRefPubMedGoogle Scholar
  12. 12.
    Siegel LE, Horan SA, Teferra T. Health and health care status of African-born residents of metropolitan Washington, DC. J Immigr Health. 2001;3(4):213–24.CrossRefPubMedGoogle Scholar
  13. 13.
    Herrel N, Olevitch L, DuBois DK, Terry P, Thorp D, Kind E, Said A. Somali refugee women speak out about their needs for care during pregnancy and delivery. J Midwifery Womens Health. 2004;49(4):345–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Carroll JR, Epstein R, Fiscella K, Volpe E, Diaz K, Omar S. Knowledge and beliefs about health promotion and preventive health care among Somali women in the United States. Health Care Women Int 2007;28(4):360–80.CrossRefPubMedGoogle Scholar
  15. 15.
    Muhwezi WW, Kinyanda E, Mungherera M, Onyango P, Ngabirano E, Muron J, Kagugube J, Kajungu R. Vulnerability to high risk sexual behaviour (HRSB) following exposure to war Trauma as seen in post-conflict communities in Eastern Uganda: a qualitative study. Confl Health. 2011;5(22):1–15.Google Scholar
  16. 16.
    Morris MD, Popper ST, Rodwell TC, Brodine SK, Brouwer KC. Healthcare barriers of refugees post-resettlement. J Community Health 2009 34(6):529–38.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Eckstein B. Primary care for refugees. Am Fam Physician 2011;83(4):429–36.PubMedGoogle Scholar
  18. 18.
    Pavlish CL, Noor S, Brandt J. Somali immigrant women and the American health care system: discordant beliefs, divergent expectations, and silent worries. Soc Sci Med. 2010;71(2):353–61.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Lalchandani S, MacQuillan K, Sheil O. Obstetric profiles and pregnancy outcomes of immigrant women with refugee status. Ir Med J. 2001;94(3):79–80.PubMedGoogle Scholar
  20. 20.
    Glanz K, Rimer BK, Viswanath KV. Health behavior and health education. 4th ed. San Francisco: Wiley; 2008.Google Scholar
  21. 21.
    Piwowarczyk L, Bishop H, Yusuf A, Mudymba F, Raj A. Congolese and Somali beliefs about mental health services. J Nerv Ment Dis. 2014;202(3):209–16.CrossRefPubMedGoogle Scholar
  22. 22.
    Quintanilha M, Mayan MJ, Thompson J, Bell RC. ENRICH Study Team. Different approaches to cross-lingual focus groups: lessons from a cross-cultural community-based participatory research project in the ENRICH study. Int J Qual Methods 2015; 14(5):1–10.CrossRefGoogle Scholar
  23. 23.
    Corbin J, Strauss A. Grounded theory research: procedures, canons, and evaluative criteria. Qual Soc. 1990;13(1):3–21.CrossRefGoogle Scholar
  24. 24.
    Carey JW, Morhan M, Oxtoby MJ. Intercoder agreement in analysis of responses to open-ended interview questions: examples from tuberculosis research. Cult Anthropol Methods J. 1998;8:1–5.Google Scholar
  25. 25.
    Carolan M. Pregnancy health status of sub-Saharan refugee women who have resettled in developed countries: a review of the literature. Midwifery 2008; 26(4): 407–14.CrossRefGoogle Scholar
  26. 26.
    Straus L, McEwen A, Hussein FM. Somali women’s experience of childbirth in the UK: perspectives from Somali health workers. Midwifery. 2009;25(2):181–6.CrossRefPubMedGoogle Scholar
  27. 27.
    Brown E, Carroll J, Fogarty C, Holt C. “They get a C-section…they gonna die”: Somali women’s fears of obstetrical interventions in the United States. J Transcult Nurs. 2011;21(3):220–7.CrossRefGoogle Scholar
  28. 28.
    Ameresekere M, Borg R, Frederick J, Vragovic O, Saia K, Raj A. Somali immigrant women’s perceptions of cesarean delivery and patient–provider communication surrounding female circumcision and childbirth in the USA. Int J Gynaecol Obstet. 2011;115(3):227–30.CrossRefPubMedGoogle Scholar
  29. 29.
    Hillemeier MM, Weisman CS, Chase GA, Dyer A, Shaffer ML. Women’s preconceptional health and use of health services: implications for preconception care. Health Serv Res. 2008;43(1):54–75.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Uba L. Cultural barriers to health care for southeast Asian refugees. Public Health Rep. 1992;107(5):544–8.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Finnstrom B, Soderhamn O. Conceptions of pain among Somali women. J Adv Nurs 2006;54(4):418–25.CrossRefPubMedGoogle Scholar
  32. 32.
    Murray L, Windsor C. Parker E, Tewfik O. The experiences of African women giving birth in Brisbane, Australia. Health Care Women Int. 2010;31(5):458–72.CrossRefPubMedGoogle Scholar
  33. 33.
    Segal UA, Mayadas NS. Assessment of issues facing immigrant and refugee families. Child Welfare. 2005;84(5):563–83.PubMedGoogle Scholar
  34. 34.
    Sheikh-Mohammed M, Macintyre CR, Wood NJ, Leask J, Isaacs D. Barriers to access to health care for newly resettled sub-Saharan refugees in Australia. Med J Aust. 2006;185(11–12):594–7.PubMedGoogle Scholar
  35. 35.
    Woloshin S, Schwartz LM, Katz SJ, Welch GH. Is language a barrier to the use of preventive services? J Gen Intern Med. 1997;12(8):472–7.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Degni F, Suominen S, Essen B, El Ansari W, Vehvilainen-Jukunen K. Communication and cultural issues in providing reproductive health care to immigrant women: health care providers’ experiences in meeting Somali women living in Finland. J Immigr Minor Health 2012; 14(2):330–43.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • P. K. Mehta
    • 1
    • 6
  • K. Saia
    • 1
  • D. Mody
    • 2
  • S. S. Crosby
    • 3
  • A. Raj
    • 4
  • S. Maru
    • 1
  • L. Piwowarczyk
    • 5
  1. 1.Department of Obstetrics and GynecologyBoston University Medical Center & Boston University School of MedicineBostonUSA
  2. 2.Boston University School of MedicineBostonUSA
  3. 3.Department of Internal Medicine/Immigrant and Refugee Health Program, Boston University Medical CenterBoston University School of Public Health & Boston University School of MedicineBostonUSA
  4. 4.Center on Gender Equity and Health/Division of Global Public Health, Department of MedicineUniversity of California San DiegoSan DiegoUSA
  5. 5.Department of Psychiatry/Boston Center for Refugee Health and Human RightsBoston University Medical Center & Boston University School of MedicineBostonUSA
  6. 6.Department of Obstetrics & Gynecology, School of Medicine, Program in Health Policy and Systems Management, School of Public Health, Maternal & Womens Health Policy, LSU Consortium for Health TransformationLouisiana State University Health Sciences CenterNew OrleansUSA

Personalised recommendations