A Qualitative Exploration of Somali Refugee Women’s Experiences with Family Planning in the U.S.

Abstract

The purpose of our study was to explore the knowledge, attitudes, and experiences of Somali refugee women with family planning in the U.S. We conducted focus groups of Somali refugee women and used grounded theory methodology to identify emergent themes. Fifty-three women, aged 18–49 years, participated. Somali refugee women’s cultural and religious beliefs and social identities strongly influence their conceptualization of family planning. Participants agreed that a woman’s fertility is ultimately decided by Allah and identified environmental changes after immigration and the desire to optimize maternal health as facilitators to modern contraceptive use. Misconceptions about and fear of side effects of modern contraceptive methods, including a fear of infertility, were identified as barriers to use. To deliver patient-centered family planning counseling to Somali refugee women, it is essential that healthcare providers approach these discussions with cultural humility and consider employing community partners or cultural brokers to help provide family planning education.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Eckstein B. Primary care for refugees. Am Fam Physician. 2011;83(4):429–36.

    PubMed  Google Scholar 

  2. 2.

    UNFPA, Programme of Action of the International Conference on Population and Development, Cairo, 5–13 September 1994, New York: UNFPA, 2004, http://www.unfpa.org/sites/default/files/event-pdf/PoA_en.pdf.

  3. 3.

    Women’s commission for refugee women and children (WCRWC), refugee women and reproductive health care: reassessing priorities, New York: WCRWC, 1994. https://www.womensrefugeecommission.org/resources/document/583-refugeewomen-and-reproductive-health-care-reassessing-priorities.

  4. 4.

    Benner MT, Townsend J, Kaloi W, et al. Reproductive health and quality of life of young Burmese refugees in Thailand. Confl Health. 2010;4:5.

    Article  Google Scholar 

  5. 5.

    McGinn T, Austin J, Anfinson K, et al. Family planning in conflict: results of cross-sectional baseline surveys in three African countries. Confl Health. 2011;5:11.

    Article  Google Scholar 

  6. 6.

    Gebrecherkos K, Gebremariam B, Gebeyehu A, Siyum H, Kahsay G, Abay M. Unmet need for modern contraception and associated factors among reproductive age group women in Eritrean refugee camps, Tigray, north Ethiopia: a cross-sectional study. BMC Res Notes. 2018;11(1):851.

    Article  Google Scholar 

  7. 7.

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

    Google Scholar 

  8. 8.

    Newell A, Sullivan A, Halai R, Boag F. Sexually transmitted diseases, cervical cytology and contraception in immigrants and refugees from the former Yugoslavia. Venereology. 1998;11(1):25–7.

    CAS  PubMed  Google Scholar 

  9. 9.

    Vangen S, Eskild A, Forsen L. Termination of pregnancy according to immigration status: a population-based registry linkage study. BJOG. 2008;115(10):1309–15.

    CAS  Article  Google Scholar 

  10. 10.

    Helstrom L, Odlind V, Zatterstrom C, et al. Abortion rate and contraceptive practices in immigrant and native women in Sweden. Scand J Public Health. 2003;31(6):405–10.

    Article  Google Scholar 

  11. 11.

    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  Google Scholar 

  12. 12.

    Barnes DM, Harrison CL. Refugee women’s reproductive health in early resettlement. J Obstet Gynecol Neonatal Nurs. 2004;33(6):723–8.

    Article  Google Scholar 

  13. 13.

    Minkler DH, Korenbrot C, Brindis C. Family planning among Southeast Asian refugees. West J Med. 1988;148(3):349–54.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Zhang Y, Quist A, Enquobahrie D. Short birth-to-pregnancy intervals among African-born black women in Washington State. J Matern Fetal Neonatal Med. 2017;7:1–7.

    Google Scholar 

  15. 15.

    Sonfield A, Hasstedt K, Kavanaugh M, Anderson R. The social and economic benefits of women’s ability to determine whether and when to have children. New York: Guttmacher Institute; 2013.

    Google Scholar 

  16. 16.

    Seattle Co. Seattle Immigrant and Refugee Data Sheet. Office of Refugee and Immigrant Affairs 2014; https://www.seattle.gov/iandraffairs/data#snapshot.

  17. 17.

    Balk G. What King County’s refugee populations look like: an interactive map. The seattle times. November 19, 2015.

  18. 18.

    Refugee Processing Center Report: Arrivals by State and Country as of September 30, 2014. U.S Department of State (DOS) Bureau of Population, Refugees, and Migration (PRM);2014.

  19. 19.

    Report to Congress FY 2012 from Office of Refugee Resettlement. Office of Refugee Resettlement: U.S. Department of Health and Human Services; 2012. https://www.acf.hhs.gov/sites/default/files/orr/fy_2012_orr_report_to_congress_final_041014.pdf.

  20. 20.

    Gure F, Dahir MK, Yusuf M, Foster AM. Emergency contraception in post-conflict Somalia: an assessment of awareness and perceptions of need. Stud Fam Plann. 2016;47(1):69–81.

    Article  Google Scholar 

  21. 21.

    Gure F, Yusuf M, Foster AM. Exploring Somali women’s reproductive health knowledge and experiences: results from focus group discussions in Mogadishu. Reprod Health Matters. 2015;23(46):136–44.

    Article  Google Scholar 

  22. 22.

    Kiura AW. Constrained agency on contraceptive use among Somali refugee women in the Kakuma refugee camp in Kenya. Gend Technol Dev. 2014;18(1):147–61.

    Article  Google Scholar 

  23. 23.

    Agbemenu K, Volpe EM, Dyer E. Reproductive health decision making among U.S. dwelling Somali Bantu refugee women: a qualitative study. J Clin Nurs. 2017;27:3355–62.

    Article  Google Scholar 

  24. 24.

    Gurnah K, Khoshnood K, Bradley E, Yuan C. Lost in translation: reproductive health care experiences of Somali Bantu women in Hartford Connecticut. J Midwifery Womens Health. 2011;56(4):340–6.

    Article  Google Scholar 

  25. 25.

    Walker D, Myrick F. Grounded theory: an exploration of process and procedure. Qual Health Res. 2006;16(4):547–59.

    Article  Google Scholar 

  26. 26.

    Morgan DL. Focus groups as qualitative research. Newbury Park: Sage Publications; 1988.

    Google Scholar 

  27. 27.

    Kitzinger J. Qualitative research: introducing focus groups. BMJ. 1995;311(7000):299–302.

    CAS  Article  Google Scholar 

  28. 28.

    Duran B. Community-based participatory research for health. San Francisco: Jossey-Bass Publishers; 2003.

    Google Scholar 

  29. 29.

    Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health. 2015;42(5):533–44.

    Article  Google Scholar 

  30. 30.

    Glaser B. The grounded theory perspective: conceptualization contrasted with description. Mill Valley: Sociology Press; 2001.

    Google Scholar 

  31. 31.

    Strauss AL, Corbin JM. Basics of qualitative research : techniques and procedures for developing grounded theory. Thousand Oaks: Sage Publications; 1998.

    Google Scholar 

  32. 32.

    Corbin JaS A. Basics of qualitative research: techniques and procedures for developing grounded theory. 4th ed. Thousand Oaks: Sage Publishing; 2015.

    Google Scholar 

  33. 33.

    Dedoose Version 7.0.23, web application for managing, analyzing, and presenting qualitative and mixed method research data (2016). Los Angeles, CA: SocioCultural Research Consultants, LLC www.dedoose.com.

  34. 34.

    Dehlendorf C, Reed R, Fox E, Seidman D, Hall C, Steinauer J. Ensuring our research reflects our values: the role of family planning research in advancing reproductive autonomy. Contraception. 2018;98:4–7.

    Article  Google Scholar 

  35. 35.

    Davidson AS, Fabiyi C, Demissie S, Getachew H, Gilliam ML. Is LARC for everyone? A qualitative study of sociocultural perceptions of family planning and contraception among refugees in Ethiopia. Matern Child Health J. 2017;21(9):1699–705.

    Article  Google Scholar 

  36. 36.

    Hill N, Hunt E, Hyrkäs K. Somali immigrant women’s health care experiences and beliefs regarding pregnancy and birth in the United States. J Transcult Nurs. 2012;23(1):72–81.

    Article  Google Scholar 

  37. 37.

    Dehlendorf C, Krajewski C, Borrero S. Contraceptive counseling: best practices to ensure quality communication and enable effective contraceptive use. Clin Obstet Gynecol. 2014;57(4):659–73.

    Article  Google Scholar 

  38. 38.

    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.

    Article  Google Scholar 

  39. 39.

    Lechuga J, Garcia D, Owczarzak J, Barker M, Benson M. Latino community health workers and the promotion of sexual and reproductive health. Health Promot Pract. 2015;16(3):338–44.

    Article  Google Scholar 

  40. 40.

    Gold R. ‘I am who I serve’—community health workers in family planning programs. Guttmacher Policy Rev. 2010;13(3):8–13.

    Google Scholar 

  41. 41.

    Ellis BH, Kia-Keating M, Yusuf SA, Lincoln A, Nur A. Ethical research in refugee communities and the use of community participatory methods. Transcult Psychiatry. 2007;44(3):459–81.

    Article  Google Scholar 

  42. 42.

    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.

    Article  Google Scholar 

  43. 43.

    Betsch C, Böhm R, Airhihenbuwa CO, et al. Improving medical decision making and health promotion through culture-sensitive health communication: an agenda for science and practice. Med Decis Mak. 2016;36(7):811–33.

    Article  Google Scholar 

  44. 44.

    Hubacher D, Trussell J. A definition of modern contraceptive methods. Contraception. 2015;92(5):420–1.

    Article  Google Scholar 

Download references

Acknowledgements

This study was funded in part by a Research Stimulation Grant (G1502RS) from the American Academy of Family Physicians Foundation and the Society of Family Planning Research Fund (SFPRF9-MC1). The content of this publication is solely the responsibility of the authors and does not necessarily represent the official position of AAFP Foundation nor the Society of Family Planning Research Fund. We thank Ladna Farah, the Somali Health Board of King County, WA and the University of Washington Family Planning Division for their help with this study.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Ying Zhang.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix 1

Appendix 1

See Table 2.

Table 2 Focus group guide & questions

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Zhang, Y., McCoy, E.E., Scego, R. et al. A Qualitative Exploration of Somali Refugee Women’s Experiences with Family Planning in the U.S.. J Immigrant Minority Health 22, 66–73 (2020). https://doi.org/10.1007/s10903-019-00887-5

Download citation

Keywords

  • Family planning
  • Somali refugees
  • Contraception
  • Birth spacing
  • Qualitative