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Factors Associated with Access to Maternal and Reproductive Health Care among Somali Refugee Women Resettled in Ohio, United States: A Cross-Sectional Survey

Abstract

This study examined maternal and reproductive health (MRH) access of Somali refugees in the U.S. across four access dimensions (willingness to seek care, gaining entry to the health system, seeing a primary provider and seeing a specialist). We conducted a cross-sectional survey of 427 Somali refugee reproductive-age women in Franklin County, Ohio. Following descriptive statistics of demographics, we conducted multivariate analyses to test associations between demographics and the four access dimensions. Most Somali refugee women were married (68%), attained primary education (92%), employed (64%) and were circumcised (82%). Young (OR 2.61, 95% CI 1.25–5.60), single (OR 1.78, 95% CI 1.15–2.78), and minors upon arrival (OR 2.36, 95% CI 1.44–3.90) were more willing to seek care. Lack of insurance, limited language fluency and being circumcised limited access to care across all dimensions. Barriers to access need to be systematically addressed. Deconstructing beliefs regarding health systems may improve access, especially among older Somali women.

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References

  1. 1.

    Refugee Processing Center. Admissions & Arrivals [Internet]. Reports. 2018. http://www.wrapsnet.org/admissions-and-arrivals/. Accessed 14 April 2018.

  2. 2.

    The White House. Executive Order Protecting the Nation from Foreign Terrorist Entry into the United States [Internet]. United States of America; 2017. https://www.whitehouse.gov/presidential-actions/executive-order-protecting-nation-foreign-terrorist-entry-united-states/.

  3. 3.

    Davidson PM, Mbaka-Mouyeme F. The refugee crisis: we cannot ignore this for much longer. Health Care Women Int. 2016;37(9):945–5.

    Article  PubMed  Google Scholar 

  4. 4.

    Department Homeland Security. United States Department of Homeland Security. Washington, DC; 2010.

  5. 5.

    Caulford P, Vali Y. Providing health care to medically uninsured immigrants and refugees. Can Med Assoc J. 2006;174(9):1253–4.

    Article  Google Scholar 

  6. 6.

    Keygnaert I, Vettenburg N, Temmerman M. Hidden violence is silent rape: sexual and gender-based violence in refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. Cult Health Sex. 2012;14(5):505–20.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Aptekman M, Rashid M, Wright V, Dunn S. Unmet contraceptive needs among refugees. Can Fam Physician. 2014;60(12):e613–9.

    PubMed  PubMed Central  Google Scholar 

  8. 8.

    Banke-Thomas A, Gieszl S, Nizigiyimana J, Johnson-Agbakwu C. Experiences of refugee women in accessing and utilizing a refugee-focused prenatal clinic in the United States: a mixed methods study. Glob Women’s Health. 2017;1(1):14–20.

    Google Scholar 

  9. 9.

    Khanlou N, Haque N, Skinner A, Mantini A, Kurtz Landy C. Scoping review on maternal health among immigrant and refugee women in Canada: prenatal, intrapartum, and postnatal care. J Pregnancy. 2017;2017:1–14.

    Article  Google Scholar 

  10. 10.

    WHO. Packages of interventions for family planning, safe abortion care, maternal, newborn and child health. Geneva: WHO; 2010.

    Google Scholar 

  11. 11.

    Small R, Gagnon A, Gissler M, Zeitlin J, Bennis M, Glazier R, et al. Somali women and their pregnancy outcomes postmigration: data from six receiving countries. BJOG. 2008;115(13):1630–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Deacon Z, Sullivan C. Responding to the complex and gendered needs of refugee women. Affilia. 2009;24(3):272–84.

    Article  Google Scholar 

  13. 13.

    UNICEF. Female genital mutilation/cutting: a statistical overview and exploration of the dynamics of change [Internet]. New York; 2013. pp. 1–194. http://data.unicef.org/wp-content/uploads/2015/12/FGMC_Lo_res_Final_26.pdf.

  14. 14.

    WHO. Care of girls and women living with female genital mutilation: a clinical handbook [Internet]. Geneva, Switzerland: World Health Organization; 2018. p. 1–458. http://apps.who.int/iris/bitstream/handle/10665/272429/9789241513913-eng.pdf?ua=1.

  15. 15.

    Gulliford M, Figueroa-Munoz J, Morgan M, Hughes D, Gibson B, Beech R, et al. What does “access to health care” mean? J Health Serv Res Policy. 2002;7(3):186–8.

    Article  PubMed  Google Scholar 

  16. 16.

    Institute of Medicine. Access to Health Care in America [Internet]. Millman M, editor. Access to Health Care in America. Washington DC: National Academies Press (US); 1993. pp. 1–240. http://www.ncbi.nlm.nih.gov/pubmed/25144064. Accessed 6 May 2018.

  17. 17.

    Toubia N. Female genital mutilation: a full color quick reference chart. New York: Research, action and information network for bodily integrity of women (RAINBO); 1999.

    Google Scholar 

  18. 18.

    Lee C-C, Li D, Arai S, Puntillo K. Ensuring cross-cultural equivalence in translation of research consents and clinical documents: a systematic process for translating English to Chinese. J Transcult Nurs. 2009;20(1):77–82.

    Article  PubMed  Google Scholar 

  19. 19.

    Johnson CE, Ali SA, Shipp MP-L. Building community-based participatory research partnerships with a somali refugee community. Am J Prev Med. 2009;37(6S1):230–6.

    Article  Google Scholar 

  20. 20.

    Department of Health and Human Services. U.S. federal poverty guidelines used to determine financial eligibility for certain federal programs [Internet]. Poverty guidelines. 2018. https://aspe.hhs.gov/poverty-guidelines. Accessed 20 Nov 2017

  21. 21.

    Gele AA, Johansen EB, Sundby J. When female circumcision comes to the West: attitudes toward the practice among Somali Immigrants in Oslo. BMC Public Health. 2012;12:697.

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Kim W, Keefe RH. Barriers to healthcare among Asian Americans. Soc Work Public Health. 2010;25(3–4):286–95.

    Article  PubMed  Google Scholar 

  23. 23.

    Morris MD, Popper ST, Rodwell TC, Brodine SK, Brouwer KC. Healthcare barriers of refugees post-resettlement. J Community Health. 2009;34(6):529–38.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Fang ML, Sixsmith J, Lawthom R, Mountian I, Shahrin A. Experiencing “pathologized presence and normalized absence”; understanding health related experiences and access to health care among Iraqi and Somali asylum seekers, refugees and persons without legal status. BMC Public Health. 2015;15:923.

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Riggs E, Davis E, Gibbs L, Block K, Szwarc J, Casey S, et al. Accessing maternal and child health services in Melbourne, Australia: reflections from refugee families and service providers. BMC Health Serv Res. 2012;12:117.

    Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Bulman KH, McCourt C. Somali refugee women’s experiences of maternity care in west London: a case study. Crit Public Health. 2002;12(4):365–80.

    Article  Google Scholar 

  27. 27.

    Kita S, Minatani M, Hikita N, Matsuzaki M, Shiraishi M, Haruna M. A systematic review of the physical, mental, social, and economic problems of immigrant women in the perinatal period in Japan. J Immigr Minor Health. 2015;17(6):1863–81.

    Article  Google Scholar 

  28. 28.

    Yoong W, Kolhe S, Karoshi M, Ullah M, Nauta M. The obstetric performance of United Kingdom asylum seekers from Somalia: a case-control study and literature review. Int J Fertil Womens Med. 2005;50(4):175–9.

    CAS  PubMed  Google Scholar 

  29. 29.

    Hamid A, Grace KT, Warren N. A Meta-synthesis of the birth experiences of African immigrant women affected by female genital cutting. J Midwifery Womens Health. 2018;63(2):185–95.

    Article  PubMed  Google Scholar 

  30. 30.

    Lazar JN, Johnson-Agbakwu CE, Davis OI, Shipp MP-L. Providers’ perceptions of challenges in obstetrical care for somali women. Obstet Gynecol Int. 2013;2013:149640.

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    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. 2010;21(3):220–7.

    Article  PubMed  Google Scholar 

  33. 33.

    Carroll J, 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.

    Article  PubMed  Google Scholar 

  34. 34.

    Herrel N, Olevitch L, DuBois DK, Terry P, Thorp D, Kind E, et al. Somali refugee women speak out about their needs for care during pregnancy and delivery. J Midwifery Womens Health. 2004;49(4):345–9.

    Article  PubMed  Google Scholar 

  35. 35.

    Small R, Roth C, Raval M, Shafiei T, Korfker D, Heaman M, et al. Immigrant and non-immigrant women’s experiences of maternity care: a systematic and comparative review of studies in five countries. BMC Pregnancy Childbirth. 2014;14:152.

    Article  PubMed  PubMed Central  Google Scholar 

  36. 36.

    Grove NJ, Zwi AB. Our health and theirs: Forced migration, othering, and public health. Soc Sci Med. 2006;62(8):1931–42.

    Article  PubMed  Google Scholar 

  37. 37.

    Johnson JL, Bottorff JL, Browne AJ, Grewal S, Hilton BA, Clarke H. Othering and being othered in the context of health care services. Health Commun. 2004;16(2):255–71.

    Article  PubMed  Google Scholar 

  38. 38.

    Johnson-Agbakwu CE, Helm T, Killawi A, Padela AI. Perceptions of obstetrical interventions and female genital cutting: insights of men in a Somali refugee community. Ethn Health. 2014;19(4):440–57.

    Article  PubMed  Google Scholar 

  39. 39.

    UNHCR. Convention and protocol relating to the status of refugees. Geneva: UNHCR 2010.

    Google Scholar 

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Acknowledgements

This study was funded by the Robert Wood Johnson Foundation Clinical Scholars Program and the University of Michigan, Department of Obstetrics & Gynecology. Data analysis and manuscript development was supported by the Research Education and Training Core (RETC) of the Southwest Interdisciplinary Research Center (SIRC) at Arizona State University and the Early Career Faculty Fellowship from the National Institute on Minority Health and Health Disparities of the National Institutes of Health (NIMHD/NIH), award P20 MD002316 (F. Marsiglia, P.I.). We would like to thank Dr. Lubayna Fawcett for providing technical support, data entry error checking and data cleaning. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMHD or the NIH.

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Correspondence to Crista Johnson-Agbakwu.

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Ethical Approval

Ethics approval for this study was obtained from the ethics committee of the University of Michigan Institutional Review Board (IRB) (HUM00009502).

Informed Consent

Participants’ written informed consent was obtained using an informed consent form, which had been reviewed and approved by the IRB. For those participants who could not read and write, the enumerators read out the research information sheet and the informed consent form, and their thumbprint was taken as proof of consent. All participation was voluntary, and participants were allowed to exit the survey if they desired.

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Banke-Thomas, A., Agbemenu, K. & Johnson-Agbakwu, C. Factors Associated with Access to Maternal and Reproductive Health Care among Somali Refugee Women Resettled in Ohio, United States: A Cross-Sectional Survey. J Immigrant Minority Health 21, 946–953 (2019). https://doi.org/10.1007/s10903-018-0824-4

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Keywords

  • Refugee
  • Access
  • Somali
  • Maternal health
  • Reproductive health