Violence and reproductive health preceding flight from war: accounts from Somali born women in Sweden

BMC Public Health

Marie Klingberg Allvin³  Birgitta Essén¹  Pia Olsson¹  Ulrika Byrskog² 

[1] Department of Women’s and Children’s Health, Uppsala University, Akademiska sjukhuset, S-751 85, Uppsala, Sweden;Centre for Clinical Research, Nissers väg 3, S-791 82 Falun, Sweden;School of Education, Health and Social Studies, Dalarna University, S-791 88 Falun, Sweden

关键词: Thematic analysis;    Qualitative method;    Sexual and reproductive health and rights;    Refugee;    Violence;    War;    Somalia;   

Others  :  1128114
DOI  :  10.1186/1471-2458-14-892

 received in 2014-02-10, accepted in 2014-08-21,  发布年份 2014

【 摘 要 】

Background

Political violence and war are push factors for migration and social determinants of health among migrants. Somali migration to Sweden has increased threefold since 2004, and now comprises refugees with more than 20 years of war experiences. Health is influenced by earlier life experiences with adverse sexual and reproductive health, violence, and mental distress being linked. Adverse pregnancy outcomes are reported among Somali born refugees in high-income countries. The aim of this study was to explore experiences and perceptions on war, violence, and reproductive health before migration among Somali born women in Sweden.

Method

Qualitative semi-structured individual interviews were conducted with 17 Somali born refugee women of fertile age living in Sweden. Thematic analysis was applied.

Results

Before migration, widespread war-related violence in the community had created fear, separation, and interruption in daily life in Somalia, and power based restrictions limited access to reproductive health services. The lack of justice and support for women exposed to non-partner sexual violence or intimate partner violence reinforced the risk of shame, stigmatization, and silence. Social networks, stoicism, and faith constituted survival strategies in the context of war.

Conclusions

Several factors reinforced non-disclosure of violence exposure among the Somali born women before migration. Therefore, violence-related illness might be overlooked in the health care system. Survival strategies shaped by war contain resources for resilience and enhancement of well-being and sexual and reproductive health and rights in receiving countries after migration.

【 授权许可】

   
2014 Byrskog et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Gupta J, Acevedo-Garcia D, Hemenway D, Decker MR, Raj A, Silverman JG: Premigration exposure to political violence and perpetration of intimate partner violence among immigrant men in Boston. Am J Publ Health 2009, 99(3):462-469.
• [2]United Nations High Commissioner for Refugees: UNHCR Handbook For The Protection Of Women And Girls. Geneva, Switzerland: UNHCR; 2008.
• [3]Valladares E, Ellsberg M, Pena R, Hogberg U, Persson LA: Physical partner abuse during pregnancy: a risk factor for low birth weight in Nicaragua. Obstet Gynecol 2002, 100(4):700-705.
• [4]Nerum H, Halvorsen L, Oian P, Sorlie T, Straume B, Blix E: Birth outcomes in primiparous women who were raped as adults: a matched controlled study. BJOG 2010, 117(3):288-294.
• [5]Binder P: The Maternal Migration Effect. Exploring Maternal Healthcare in Diaspora Using Qualitative Proxies for Medical Anthropology. Uppsala, Sweden: Uppsala University: PhD Thesis; 2012.
• [6]Somalia - Country Brief [http://www.worldbank.org/ webcite]
• [7]United Nations High Commissioner for Refugees: Global Trends: Displacement. The New 21st Century Challenge . Geneva, Sweitzerland: UNHCR; 2012.
• [8]Statistiska Centralbyrån. Befolkningsstatistik [http://www.scb.se/BE0101 webcite]
• [9]Johnson EB, Reed SD, Hitti J, Batra M: Increased risk of adverse pregnancy outcome among Somali immigrants in Washington state. Am J of Obst gynecol 2005, 193(2):475-482.
• [10]Malin M, Gissler M: Maternal care and birth outcomes among ethnic minority women in Finland. BMC Public Health 2009, 9:84. BioMed Central Full Text
• [11]Vangen S, Stoltenberg C, Johansen RE, Sundby J, Stray-Pedersen B: Perinatal complications among ethnic Somalis in Norway. Acta Obstet Gynecol Scand 2002, 81(4):317-322.
• [12]Essen B, Hanson BS, Ostergren PO, Lindquist PG, Gudmundsson S: Increased perinatal mortality among sub-Saharan immigrants in a city-population in Sweden. Acta Obstet Gynecol Scand 2000, 79(9):737-743.
• [13]Ekeus C, Cnattingius S, Essen B, Hjern A: Stillbirth among foreign-born women in Sweden. Eur J Public Health 2011, 21(6):788-792.
• [14]Rassjo EB, Byrskog U, Samir R, Klingberg-Allvin M: Somali women's use of maternity health services and the outcome of their pregnancies: a descriptive study comparing Somali immigrants with native-born Swedish women. Sex Reprod Healthc 2013, 4(3):99-106.
• [15]Essen B, Bodker B, Sjoberg NO, Langhoff-Roos J, Greisen G, Gudmundsson S, Ostergren PO: Are some perinatal deaths in immigrant groups linked to suboptimal perinatal care services? BJOG 2002, 109(6):677-682.
• [16]Baaz ME, Stern M: Why do soldiers rape? masculinity, violence, and sexuality in the Armed Forces in the Congo (DRC). Int Stud Q 2009, 53(2):495-518.
• [17]Lev-Wiesel R, Chen R, Daphna-Tekoah S, Hod M: Past traumatic events: are they a risk factor for high-risk pregnancy, delivery complications, and postpartum posttraumatic symptoms? J Women's Health 2009, 18(1):119-125.
• [18]Asling-Monemi K, Naved RT, Persson LA: Violence against women and the risk of fetal and early childhood growth impairment: a cohort study in rural Bangladesh. Arch Dis Child 2009, 94(10):775-779.
• [19]Galtung J: Cultural violence. J Peace Res 1990, 27(3):291-305.
• [20]Krug EG, Mercy JA, Dahlberg LL, Zwi AB: The world report on violence and health. Lancet 2002, 360(9339):1083-1088.
• [21]Heise LL: Violence against women: an integrated ecological framework. Violence Against Women 1998, 4(3):262-290.
• [22]Acevedo-Garcia D, Sanchez-Vaznaugh EV, Viruell-Fuentes EA, Almeida J: Integrating social epidemiology into immigrant health research: a cross-national framework. Soc Sci Med 2012, 75(12):2060-2068.
• [23]Finnbogadottir H, Dykes AK: Midwives' awareness and experiences regarding domestic violence among pregnant women in southern Sweden. Midwifery 2012, 28(2):181-9.
• [24]Baird K, Salmon D, White P: A five year follow-up study of the Bristol pregnancy domestic violence programme to promote routine enquiry. Midwifery 2013, 29(8):1003-1010.
• [25]Dahlgren LEW, Winkvist A: Qualitative Methodology for International Public Health. Umeå, Sweden: Umeå International School of Public Health, Epidemiology and Public Health Sciences, Department of Public health and Clinical Medicine, Umeå University; 2004.
• [26]Braun V, Clarke V: Using thematic analysis in psychology. Qual Res Psychol 2006, 3:77-101.
• [27]RATS guidelines for reporting qualitative studies http://www.biomedcentral.com/authors/rats webcite
• [28]Barter C, Renold E: 'I wanna tell you a story': exploring the application of vignettes in qualitative research with children and young people. Int J Soc Res Methodol 2000, 3(4):307-323.
• [29]Ibrahim RM: Women's Role In The Pastoral Economy. In Somalia The Untold Story The War Through The Eyes Of Somali Women. Edited by Gardner J, Bushra JE. London: Pluto Press; 2004.
• [30]Johnsdotter S: Somali women in western exile: reassessing female circumcision in the light of Islamic teachings. J Muslim Minor Aff 2003, 23(2):361-373.
• [31]Kelly J, Kabanga J, Cragin W, Alcayna-Stevens L, Haider S, Vanrooyen MJ: 'If your husband doesn't humiliate you, other people won't': gendered attitudes towards sexual violence in eastern Democratic Republic of Congo. Glob Public Health 2012, 7(3):285-298.
• [32]Skjelsbaek I: Victim and survivor: narrated social identities of women who experienced rape during the war in Bosnia-Herzegovina. Feminism & Psychology 2006, 16(4):373-403.
• [33]Scott J, Averbach S, Modest AM, Hacker MR, Cornish S, Spencer D, Murphy M, Parmar P: An assessment of gender inequitable norms and gender-based violence in South Sudan: a community-based participatory research approach. Conflict Health 2013, 7(1):4. BioMed Central Full Text
• [34]Uthman OA, Lawoko S, Moradi T: Sex disparities in attitudes towards intimate partner violence against women in sub-Saharan Africa: a socio-ecological analysis. BMC Public Health 2010, 10:223. BioMed Central Full Text
• [35]Fulu EWX, Miedema S, Jewkes R, Roselli T, Lang J: Why Do Some Men Use Violence Against Women And How Can We Prevent It? Quantitative Findings From The United Nations Multi-Country Study On Men And Violence In Asia And The Pacific. Bangkok: UNDP, UNFPA, UN Women, UNV; 2013.
• [36]Jewkes R: Intimate partner violence: causes and prevention. Lancet 2002, 359(9315):1423-1429.
• [37]Tankink MT: The silence of South-Sudanese women: social risks in talking about experiences of sexual violence. Cult Health Sex 2013, 15(4):391-403.
• [38]Payne YA: Site of resilience: a reconceptualization of resiliency and resilience in street life–oriented Black men. J Black Psychol 2011, 37(4):426-451.
• [39]Luthar SS, Cicchetti D: The construct of resilience: implications for interventions and social policies. Dev Psychopathol 2000, 12(4):857-885.
• [40]El-Bushra J: Fused in combat: gender relations and armed conflict. Dev Pract 2003, 13(2–3):252-265.
• [41]Horst C: Buufis amongst Somalis in Dadaab: the transnational and historical logics behind resettlement dreams. J Refug Stud 2006, 19(2):143-157.
• [42]Whittaker S, Hardy G, Lewis K, Buchan L: An exploration of psychological well-being with young somali refugee and asylum-seeker women. Clin child Psychol Psychiatry 2005, 10(2):177-196.
• [43]Isakson BL, Jurkovic GJ: Healing after torture: the role of moving on. Qual Health Res 2013, 23(6):749-761.
• [44]Schweitzer R, Greenslade J, Kagee A: Coping and resilience in refugees from the Sudan: a narrative account. Aust N Z J Psychiatry 2007, 41(3):282-288.
• [45]Pavlish C: Action responses of Congolese refugee women. J Nurs Scholarsh 2005, 37(1):10-17.
• [46]Kroo A, Nagy H: Posttraumatic growth among traumatized Somali refugees in Hungary. J Loss Trauma 2011, 16(5):440-458.
• [47]Omar MM, Hogberg U, Bergstrom B: Maternal health and child survival in relation to socioeconomic factors. Gynecol Obstet Invest 1994, 38(2):107-112.
• [48]The Universal Declaration of Human Rights (UDHR), United Nations General Assembly [http://www.un.org/en/documents/udhr/history.shtml webcite]
• [49]Carroll JK: Murug, Waali, and Gini: expressions of distress in refugees from Somalia. Prim Care Companion J Clin Psychiatry 2004, 6(3):119-125.
• [50]Onyut LP, Neuner F, Ertl V, Schauer E, Odenwald M, Elbert T: Trauma, poverty and mental health among Somali and Rwandese refugees living in an African refugee settlement - an epidemiological study. Confl Health 2009, 3:6. BioMed Central Full Text
• [51]Johnsdotter S, Ingvarsdotter K, Östman M, Carlbom A: Koran reading and negotiation with jinn: Strategies to deal with mental ill health among Swedish Somalis. Ment Health Relig Cult 2011, 14(8):741-755.