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Swedish maternal health care in a multiethnic society - including the fathers
Malmö högskola. (Omvårdnadsvetenskap, teori och metod)
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Preventive work in maternal and child health care has a long history in Sweden. Today, Sweden has achieved the lowest maternal and child mortality rates globally based on a maternal health care system regulated by national recommendations; offered to every woman, free of chare, on a continuity basis, by registered midwives at municipal clinics within the community with the purpose of being assessable for all women. Despite the availability of antenatal care, immigrant women living in Sweden often have a different pattern of utilising care and in some cases immigrant women have been shown to be at risk for a negative delivery outcome. The overall aim of this thesis was to investigate differences due to country of birth and utilisation of antenatal care and the experiences of antenatal care, from the perspectives of the both the parents to be. Epidemiological design and explorative qualitative research has been used for the purpose of finding patterns of the utilisation of maternal health care as well as experiences from foreign born men and women concerning maternal health care in general, and maternal health care in the city of Malmö Sweden in particular. Qualitative research has been used to add depth and thereby attain a greater understanding in a social context. In the study population, according to the definitions set in Studies I, IV, the main finding was that 28.3-48.7% of the women had unplanned visits to a midwife and/or to a physician at the delivery ward. Women born in Sweden and in Eastern and Southern Europe had a linear relationship with few planned visits to the midwife at the municipal clinic and more unplanned visits to a midwife at the delivery ward. The women in Study II were positive to the individualised and professional care given at the MHC by empathic and professional midwives. They were positive to the increased involvement of their partner in the area of reproduction and family life since migrating to Sweden. According to the women, this may lead to an increased understanding by the fathers of the woman’s situation during pregnancy, 10 birth and caring for the children as well as it could increase the fathers own emotional as well as practical involvement in their children. The foreign born men, in Study III, were positive towards antenatal care and to be able to take part as support to women at MHC, and during the delivery process. They experienced problems with their situation of being fathers, partners and, as men living in Sweden, due often to their being un-employed and the changed situation that their migration had brought about. The health care system manager need to be aware of the fact that there are groups of women, in a low risk population, who tend to make contact with the maternal care system in a more of less unplanned fashion. By not utilising the planned care offered these women miss an opportunity to meet a midwife who is specialised in preventive care during pregnancy with the focus of treating pregnancy a normal health life event, while at the same time, ensuring the detection of eventual risk factors. A conversation with a midwife in a calm environment is beneficial to the pregnant woman. The immigrant groups need our special attention aimed at making the maternal health care system easily accessible for them, as well as making the maternity staff aware of their own attitudes towards preventive work involving pregnancy in a multiethnic setting. The organisation of care must also, in itself; offer such possibilities for both the staff and the women.

Place, publisher, year, edition, pages
Malmö: Faculty of Health and Society, Malmö University , 2007. , 93 p.
Series
Malmö University health and society dissertations, ISSN 1653-5383 ; 2007:2
Keyword [sv]
kvinnohälsovård
National Category
Nursing
Identifiers
URN: urn:nbn:se:hkr:diva-6929Libris ID: 10454585ISBN: 978-91-7104-206-4 (print)OAI: oai:DiVA.org:hkr-6929DiVA: diva2:343838
Public defence
2007-06-08, Aulan, hälsa och samhälle, Malmö högskola, UMAS ing 49 20506, Malmö, 14:13 (Swedish)
Opponent
Supervisors
Available from: 2010-08-31 Created: 2010-08-16 Last updated: 2014-02-06Bibliographically approved
List of papers
1. Utilisation of antenatal care by country of birth in a multi-ethnic population: a four-year community-based study in Malmö, Sweden
Open this publication in new window or tab >>Utilisation of antenatal care by country of birth in a multi-ethnic population: a four-year community-based study in Malmö, Sweden
2007 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 86, no 7, 805-813 p.Article in journal (Refereed) Published
Abstract [en]

Background. The aim of this study was to investigate differences in use of antenatal care in a multi-ethnic population in Malmö, Sweden, over a 4-year period. Age, parity, cohabiting status, use of an interpreter, and tobacco-use were examined to assess the potential effects of confounding factors. Methods. A 4-year (2000–2003) retrospective community-based register study was performed. Low-risk singleton pregnancies (n = 5,373) registered for antenatal care at 5 municipal clinics and at the delivery ward at Malmö University Hospital were included, and divided into 6 subgroups by country of origin. The odds for utilisation of antenatal care were analysed by means of logistic regression. Results. Significantly increased odds of lower utilisation of planned antenatal care were found among some groups of foreign-born women. Women born in Eastern and Southern Europe, Iraq and Lebanon, and Asia had fewer antenatal visits than recommended, and all foreign-born women (except for women born in Iraq and Lebanon, and South and Central America) had a late first visit compared to Swedish-born women. Foreign-born women had, in general, fewer unplanned visits to a physician at the delivery ward, but women originating from Asia, Iraq and Lebanon, and Africa had higher utilisation visits to midwives at the delivery ward compared to Swedish-born women. Conclusions. Foreign-born women had lower utilisation of planned antenatal care. Approximately 50% of women had higher utilisation of care, by making unplanned visits to the delivery ward. This puts strain on both economical as well as staff resources. The delivery clinic at the hospital level is not intended to handle routine visits, and, moreover, some of these women do not receive the full benefits of planned routine antenatal care.

Keyword
Maternal health care services, utilisation, multi-ethnic, emigration and immigration, pregnancy
National Category
Nursing
Identifiers
urn:nbn:se:hkr:diva-6932 (URN)10.1080/00016340701415095 (DOI)
Available from: 2010-08-16 Created: 2010-08-16 Last updated: 2014-02-06Bibliographically approved
2. The experience of Middle Eastern men living in Sweden of maternal and child health care and fatherhood: focus-group discussions and content analysis
Open this publication in new window or tab >>The experience of Middle Eastern men living in Sweden of maternal and child health care and fatherhood: focus-group discussions and content analysis
2008 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 24, no 3, 281-290 p.Article in journal (Refereed) Published
Keyword
Fathers, Maternal health care, Emigration and immigration, Child health services
National Category
Nursing
Identifiers
urn:nbn:se:hkr:diva-6931 (URN)10.1016/j.midw.2006.05.006 (DOI)
Available from: 2010-08-16 Created: 2010-08-16 Last updated: 2014-02-06Bibliographically approved
3. Middle Eastern mothers in Sweden, their experiences of the maternal health service and their partners involvement
Open this publication in new window or tab >>Middle Eastern mothers in Sweden, their experiences of the maternal health service and their partners involvement
2007 (English)In: Reproductive Health, ISSN 1742-4755, Vol. 4, no 9Article in journal (Refereed) Published
Abstract [en]

Background

Traditional patterns relating to how to handle pregnancy and birth are often challenged due to migration. The purpose of this study was to describe Middle Eastern mothers' experiences of the maternal health care services in Sweden and the involvement of their male partner.

Methods

Thirteen immigrant mothers from the Middle East who had used the maternal health services in Sweden were interviewed using focus group discussions and individual interviews. These were taped, transcribed and analysed according to Content analysis.

Results

The four main categories that developed were:

• Access to the professional midwife

• Useful counselling

• Stable motherhood in transition

• Being a family living in a different culture

Conclusion

According to the respondents in this study, understanding the woman's native language or her culture was not vital to develop a good relationship with the midwife. Instead the immigrant woman developed trust in the midwife based on the knowledge and the empathy the midwife imparted.

Increasing the amount of first trimester antenatal visits could avoid spontaneous visits to the emergency clinic. There was a greater need for involvement and support by the father during the perinatal period, such as caring for older children and carrying out household chores since the mothers' earlier female network was often lost.

Clinical implications

There is a need to involve immigrant parents in the available parental education in order to prepare them for parenthood in their new country as well as to explore their altered family situation. Collecting immigrant women and their partner's, experiences of maternal health care services offers a possibility to improve the existing care, both in content, access and availability where the timing of visits and content require further evaluation.

National Category
Nursing
Identifiers
urn:nbn:se:hkr:diva-6933 (URN)10.1186/1742-4755-4-9 (DOI)
Available from: 2010-08-16 Created: 2010-08-16 Last updated: 2014-02-06Bibliographically approved
4. Unplanned care seeking at the delivery ward in a low-risk multiethnic population: an obstacle for both the pregnant woman and the health care organisation
Open this publication in new window or tab >>Unplanned care seeking at the delivery ward in a low-risk multiethnic population: an obstacle for both the pregnant woman and the health care organisation
(English)In: African Journal of Midwifery and Women’s HealthArticle in journal (Refereed) Submitted
Identifiers
urn:nbn:se:hkr:diva-6934 (URN)
Available from: 2010-08-16 Created: 2010-08-16 Last updated: 2014-02-06Bibliographically approved

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