Antenatal care for Somali-born women in Sweden: Perspectives from mothers, fathers and midwives

Malin Ahrne; Erica Schytt; Ewa Andersson; Rhonda Small; Aisha Adan; Birgitta Essén; Ulrika Byrskog

doi:10.1016/j.midw.2019.03.022

Antenatal care for Somali-born women in Sweden: Perspectives from mothers, fathers and midwives

Midwifery. 2019 Jul:74:107-115. doi: 10.1016/j.midw.2019.03.022. Epub 2019 Mar 29.

Authors

Malin Ahrne¹, Erica Schytt², Ewa Andersson³, Rhonda Small⁴, Aisha Adan⁵, Birgitta Essén⁶, Ulrika Byrskog⁷

Affiliations

¹ Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18A, 8th floor, SE-171 77 Stockholm, Sweden. Electronic address: malin.ahrne@ki.se.
² Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18A, 8th floor, SE-171 77 Stockholm, Sweden; Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden; Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Norway. Electronic address: Erica.Schytt@ltdalarna.se.
³ Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18A, 8th floor, SE-171 77 Stockholm, Sweden. Electronic address: Ewa.Andersson@ki.se.
⁴ Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18A, 8th floor, SE-171 77 Stockholm, Sweden; Judith Lumley Centre, La Trobe University, Melbourne, Australia. Electronic address: R.Small@latrobe.edu.au.
⁵ Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18A, 8th floor, SE-171 77 Stockholm, Sweden.
⁶ Women's and Children's Health, IMCH, Uppsala University, Sweden. Electronic address: birgitta.essen@kbh.uu.se.
⁷ School of Education, Health and Social Studies, Dalarna University, Falun, Sweden. Electronic address: uby@du.se.

PMID: 30953966
DOI: 10.1016/j.midw.2019.03.022

Abstract

Objective: To explore Somali-born parents' experiences of antenatal care in Sweden, antenatal care midwives' experiences of caring for Somali-born parents, and their respective ideas about group antenatal care for Somali-born parents.

Design: Eight focus group discussions with 2-8 participants in each were conducted, three with Somali-born mothers, two with fathers and three with antenatal care midwives. The transcribed text was analysed using Attride-Stirling's tool "Thematic networks".

Setting: Two towns in mid-Sweden and a suburb of the capital city of Sweden.

Participants: Mothers (n = 16), fathers (n = 13) and midwives (n = 7) were recruited using purposeful sampling.

Findings: Somali-born mothers and fathers in Sweden were content with many aspects of antenatal care, but they also faced barriers. Challenges in the midwife-parent encounter related to tailoring of care to individual needs, dealing with stereotypes, addressing varied levels of health literacy, overcoming communication barriers and enabling partner involvement. Health system challenges related to accessibility of care, limited resources, and the need for clear, but flexible routines and supportive structures for parent education. Midwives confirmed these challenges and tried to address them but sometimes lacked the support, resources and tools to do so. Mothers, fathers and midwives thought that language-supported group antenatal care might help to improve communication, provide mutual support and enable better dialogue, but they were concerned that group care should still allow privacy when needed and not stereotype families according to their country of birth.

Key conclusions: ANC interventions targeting inequalities between migrants and non-migrants may benefit from embracing a person-centred approach, as a means to counteract stereotypes, misunderstandings and prejudice. Group antenatal care has the potential to provide a platform for person-centred care and has other potential benefits in providing high-quality antenatal care for sub-groups that tend to receive less or poor quality care. Further research on how to address stereotypes and implicit bias in maternity care in the Swedish context is needed.

Keywords: Antenatal care; Father; Focus group discussions; Group antenatal care; Midwife; Migrant; Mother.

MeSH terms

Adult
Communication Barriers
Fathers / psychology
Female
Focus Groups / methods
Humans
Mothers / psychology
Nurse Midwives / psychology*
Nurse Midwives / standards
Nurse-Patient Relations
Parents / psychology*
Patient Satisfaction / ethnology
Perception*
Pregnancy
Prenatal Care / methods
Prenatal Care / standards*
Qualitative Research
Somalia / ethnology
Sweden