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Conceptualising the prevention of adverse obstetric outcomes among immigrants using the 'three delays' framework in a high-income context
Department of Women’s and Children’s Health (IMCH), Uppsala University Hospital, 75185 Uppsala, Sweden.
Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).ORCID iD: 0000-0002-7625-5873
Department of Women’s and Children’s Health (IMCH), Uppsala University Hospital, 75185 Uppsala, Sweden.
2012 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 75, no 11, p. 2028-2036Article in journal (Refereed) Published
Abstract [en]

Women from high-mortality settings in sub-Saharan Africa can remain at risk for adverse maternal outcomes even after migrating to low-mortality settings. To conceptualise underlying socio-cultural factors, we assume a 'maternal migration effect' as pre-migration influences on pregnant women's post-migration care-seeking and consistent utilisation of available care. We apply the 'three delays' framework, developed for low-income African contexts, to a high-income western scenario, and aim to identify delay-causing influences on the pathway to optimal facility treatment. We also compare factors influencing the expectations of women and maternal health providers during care encounters. In 2005-2006, we interviewed 54 immigrant African women and 62 maternal providers in greater London, United Kingdom. Participants were recruited by snowball and purposive sampling. We used a hermeneutic, naturalistic study design to create a qualitative proxy for medical anthropology. Data were triangulated to the framework and to the national health system maternity care guidelines. This maintained the original three phases of (1) care-seeking, (2) facility accessibility, and (3) receipt of optimal care, but modified the framework for a migration context. Delays to reciprocal care encounters in Phase 3 result from Phase 1 factors of 'broken trust, which can be mutually held between women and providers. An additional factor is women's 'negative responses to future care', which include rationalisations made during non-emergency situations about future late-booking, low-adherence or refusal of treatment. The greatest potential for delay was found during the care encounter, suggesting that perceived Phase 1 factors have stronger influence on Phase 3 than in the original framework. Phase 2 'language discordance' can lead to a 'reliance on interpreter service', which can cause delays in Phase 3, when 'reciprocal incongruent language ability' is worsened by suboptimal interpreter systems. 'Non-reciprocating care conceptualisations', 'limited system-level care guidelines', and 'low staff levels' can additionally delay timely care in Phase 3.

Place, publisher, year, edition, pages
Elsevier, 2012. Vol. 75, no 11, p. 2028-2036
Keywords [en]
socio-cultural factors, maternal care encounter, immigrant women, health communication, obstetric intervention, ethnicity, migrant-friendly hospitals, maternity guidelines
National Category
Public Health, Global Health and Social Medicine
Research subject
Health and society
Identifiers
URN: urn:nbn:se:mau:diva-5227DOI: 10.1016/j.socscimed.2012.08.010ISI: 000310385200015PubMedID: 22940012Scopus ID: 2-s2.0-84866888634Local ID: 14235OAI: oai:DiVA.org:mau-5227DiVA, id: diva2:1402081
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2025-02-20Bibliographically approved

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Johnsdotter, Sara

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