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


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.


African immigrants Refugees Health services Reproductive health Gynecology Qualitative 



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.


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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

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