Being a bridge: Swedish antenatal care midwives’ encounters with Somali-born women and questions of violence; a qualitative study

BMC Pregnancy and Childbirth

Marie-Klingberg Allvin²  Birgitta Essén³  Pia Olsson³  Ulrika Byrskog¹ 

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

关键词: Qualitative method;    Person-centered;    Networking;    Trustful relationships;    Communication;    Antenatal care midwife;    Somali born women;    Violence;   

Others  :  1090431
DOI  :  10.1186/s12884-015-0429-z

 received in 2014-10-24, accepted in 2015-01-05,  发布年份 2015

【 摘 要 】

Background

Violence against women is associated with serious health problems, including adverse maternal and child health. Antenatal care (ANC) midwives are increasingly expected to implement the routine of identifying exposure to violence. An increase of Somali born refugee women in Sweden, their reported adverse childbearing health and possible links to violence pose a challenge to the Swedish maternity health care system. Thus, the aim was to explore ways ANC midwives in Sweden work with Somali born women and the questions of exposure to violence.

Methods

Qualitative individual interviews with 17 midwives working with Somali-born women in nine ANC clinics in Sweden were analyzed using thematic analysis.

Results

The midwives strived to focus on the individual woman beyond ethnicity and cultural differences. In relation to the Somali born women, they navigated between different definitions of violence, ways of handling adversities in life and social contexts, guided by experience based knowledge and collegial support. Seldom was ongoing violence encountered. The Somali-born women’s’ strengths and contentment were highlighted, however, language skills were considered central for a Somali-born woman’s access to rights and support in the Swedish society. Shared language, trustful relationships, patience, and networking were important aspects in the work with violence among Somali-born women.

Conclusion

Focus on the individual woman and skills in inter-cultural communication increases possibilities of overcoming social distances. This enhances midwives’ ability to identify Somali born woman’s resources and needs regarding violence disclosure and support. Although routine use of professional interpretation is implemented, it might not fully provide nuances and social safety needed for violence disclosure. Thus, patience and trusting relationships are fundamental in work with violence among Somali born women. In collaboration with social networks and other health care and social work professions, the midwife can be a bridge and contribute to increased awareness of rights and support for Somali-born women in a new society.

【 授权许可】

   
2015 Byrskog et al.; licensee BioMed Central.

【 参考文献 】

• [1]Lukasse M, Schroll AM, Ryding EL, Campbell J, Karro H, Kristjansdottir H, et al.: Prevalence of emotional, physical and sexual abuse among pregnant women in six European countries. Acta Obstet Gynecol Scand 2014, 93(7):669-77.
• [2]Svensk förening för obstetrik och gynekologi. Mödrahälsovård, sexuell och reproduktiv hälsa. ARG-rapport 59; 2008.
• [3]Spangaro J, Poulos RG, Zwi AB: Pandora doesn't live here anymore: normalization of screening for intimate partner violence in Australian antenatal, mental health, and substance abuse services. Violence Vict 2011, 26(1):130-44.
• [4]Henriksen L, Vangen S, Schei B, Lukasse M: Sexual violence and antenatal hospitalization. Birth 2013, 40(4):281-8.
• [5]Asling-Monemi K, Pena R, Ellsberg MC, Persson LA: Violence against women increases the risk of infant and child mortality: a case-referent study in Nicaragua. Bull World Health Organ 2003, 81(1):10-6.
• [6]Neroien AI, Schei B: Partner violence and health: results from the first national study on violence against women in Norway. Scand J Public Health 2008, 36(2):161-8.
• [7]Oberg M, Stenson K, Skalkidou A, Heimer G: Prevalence of intimate partner violence among women seeking termination of pregnancy compared to women seeking contraceptive counseling. Acta Obstet Gynecol Scand 2014, 93(1):45-51.
• [8]Reese Masterson A, Usta J, Gupta J, Ettinger AS: Assessment of reproductive health and violence against women among displaced Syrians in Lebanon. BMC Womens Health 2014, 14(1):25. BioMed Central Full Text
• [9]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):288-94.
• [10]Lukasse M, Henriksen L, Vangen S, Schei B: Sexual violence and pregnancy-related physical symptoms. BMC Pregnancy Childbirth 2012, 12:83. BioMed Central Full Text
• [11]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):700-5.
• [12]Levendosky AA, Bogat GA, Huth-Bocks AC: The influence of domestic violence on the development of the attachment relationship between mother and young child. Psychoanalytic Psychol 2011, 28(4):512-27.
• [13]NCK: Att fråga om våldsutsatthet som en del av anamnesen. NCK-rapport 2010:4. Nationellt Center för Kvinnofrid, Uppsala; 2010.
• [14]Krug EG, Mercy JA, Dahlberg LL, Zwi AB: The world report on violence and health. Lancet 2002, 360(9339):1083-8.
• [15]Fernbrant C: Violence against foreign-born women in Sweden. Lund, Lund University; 2013.
• [16]Radestad I, Rubertsson C, Ebeling M, Hildingsson I: What factors in early pregnancy indicate that the mother will be hit by her partner during the year after childbirth? A nationwide Swedish survey. Birth 2004, 31(2):84-92.
• [17]Wolf A, Gray R, Fazel S: Violence as a public health problem: an ecological study of 169 countries. Soc Sci Med 2014, 104:220-7.
• [18]de Jong K, van der Kam S, Swarthout T, Ford N, Mills C, Yun O, et al.: Exposure to violence and PTSD symptoms among Somali women. J Trauma Stress 2011, 24(6):628-34.
• [19]Zannettino L: " … There is No War Here; It is Only the Relationship That Makes Us Scared": factors having an impact on domestic violence in liberian refugee communities in South Australia. Violence Against Women 2012, 18(7):807-28.
• [20]Jin X, Keat JE: The effects of change in spousal power on intimate partner violence among Chinese immigrants. J Interpers Violence 2010, 25(4):610-25.
• [21]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 Public Health 2009, 99(3):462-9.
• [22]Foreign-born persons in Sweden by country of birth, age and sex. [http://www.statistikdatabasen.scb.se/]
• [23]Ekeus C, Cnattingius S, Essen B, Hjern A: Stillbirth among foreign-born women in Sweden. Eur J Public Health 2011, 21(6):788-92.
• [24]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):737-43.
• [25]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.
• [26]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.
• [27]Omar MM, Hogberg U, Bergstrom B: Maternal health and child survival in relation to socioeconomic factors. Gynecol Obstet Invest 1994, 38(2):107-12.
• [28]Binder P: The maternal migration effect. Exploring maternal healthcare in diaspora using qualitative proxies for medical anthropology. Uppsala University, Uppsala; 2012.
• [29]Binder P, Borne Y, Johnsdotter S, Essen B: Shared language is essential: communication in a multiethnic obstetric care setting. J Health Commun 2012, 17(10):1171-86.
• [30]Essen B, Bodker B, Sjoberg NO, Langhoff-Roos J, Greisen G, Gudmundsson S, et al.: Are some perinatal deaths in immigrant groups linked to suboptimal perinatal care services? BJOG 2002, 109(6):677-82.
• [31]Lewis G: Confidential Enquiry into Maternal and Child Health (CEMACH) 2000-2002. Why mothers die. The sixth report of the confidential enquiries into maternal deaths in the United Kingdom. RCOG Press, London; 2004.
• [32]Hill N, Hunt E, Hyrkas 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.
• [33]Villadsen SF, Mortensen LH, Andersen AM: Ethnic disparity in stillbirth and infant mortality in Denmark 1981-2003. J Epidemiol Community Health 2009, 63(2):106-12.
• [34]Kvale S: BS: Interviews. Learning the craft of qualitative research interviewing. Sage, Thousand Oakes; 2009.
• [35]Braun V, Clarke V: Using thematic analysis in psychology. Qualitative Res Psychol 2006, 3:77-101.
• [36]RATS guidelines for reporting qualitative studies. [http://www.biomedcentral.com/authors/rats]
• [37]Byrskog U, Olsson P, Essen B, Allvin MK: Violence and reproductive health preceding flight from war: accounts from Somali born women in Sweden. BMC Public Health 2014, 14(1):892. BioMed Central Full Text
• [38]Renfrew MJ, McFadden A, Bastos MH, Campbell J, Channon AA, Cheung NF, Silva DR, Downe S, Kennedy HP, Malata A, et al.: Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care. Lancet 2014, 384(9948):1129-45.
• [39]Ogunsiji O, Wilkes L, Jackson D, Peters K: Suffering and smiling: West African immigrant women's experience of intimate partner violence. J Clin Nurs 2012, 21(11–12):1659-65.
• [40]Bent-Goodley TB: Health disparities and violence against women: why and how cultural and societal influences matter. Trauma Violence Abuse 2007, 8(2):90-104.
• [41]O'Mahony J, Donnelly T: Immigrant and refugee women's post-partum depression help-seeking experiences and access to care: a review and analysis of the literature. J Psychiatr Ment Health Nurs 2010, 17(10):917-28.
• [42]Johnsdotter S, Ingvarsdotter K, Östman M, Carlbom A: Koran reading and negotiation with jinn: strategies to deal with mental ill health among Swedish Somalis. Mental Health Religion Culture 2011, 14(8):741-55.
• [43]Esscher A, Binder-Finnema P, Bodker B, Hogberg U, Mulic-Lutvica A, Essen B: Suboptimal care and maternal mortality among foreign-born women in Sweden: maternal death audit with application of the 'migration three delays' model. BMC Pregnancy Childbirth 2014, 14(1):141. BioMed Central Full Text
• [44]Hildingsson I, Radestad I: Swedish women's satisfaction with medical and emotional aspects of antenatal care. J Adv Nurs 2005, 52(3):239-49.
• [45]Horiuchi S, Yaju Y, Kataoka Y, Grace Eto H, Matsumoto N: Development of an evidence-based domestic violence guideline: supporting perinatal women-centred care in Japan. Midwifery 2009, 25(1):72-8.
• [46]Sidani S, Fox M: Patient-centered care: clarification of its specific elements to facilitate interprofessional care. J Interprof Care 2014, 28(2):134-41.
• [47]Karakayali N: Social distance and affective orientations. Sociol Forum 2009, 24(3):538-62.
• [48]McCormack B, Karlsson B, Dewing J, Lerdal A: Exploring person-centredness: a qualitative meta-synthesis of four studies. Scand J Caring Sci 2010, 24(3):620-34.
• [49]Berg M, Asta Olafsdottir O, Lundgren I: A midwifery model of woman-centred childbirth care in Swedish and Icelandic settings. Sex Reprod Healthc 2012, 3(2):79-87.
• [50]Dahlgren L, Emmelin M, Winkvist A: Qualitative methodology for international public health. Umeå International School of Public Health, Epidemiology and Public Health Sciences, Department of Public health and Clinical Medicine, Umeå University, Umeå; 2004.