Cultural Diversity in Perinatal Care: Somali New Mothers’ Experiences with Health Care in Norway Kari Glavin1*, Berit Sæteren2
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Research Article iMedPub Journals Health Science Journal 2016 http://www.imedpub.com/ Vol.10 No.4:17 ISSN 1791-809X Cultural Diversity in Perinatal Care: Somali New Mothers’ Experiences with Health Care in Norway Kari Glavin1*, Berit Sæteren2 1 Department of Nursing, Diakonova University College, Oslo, Norway 2 Oslo and Akershus University College of Applied Science, Norway *Correspondence: Kari Glavin, Diakonova University College, Fredensborgveien 24Q, N-0177 Oslo, Norway, E-mail: [email protected] Received: 08.06.2016; Accepted: 22.06.2016; Published: 02.07.2016 Introduction Abstract The transition to motherhood can be stressful and may lead to feelings of vulnerability and challenge [1-3]. Even when the Objective: To explore Somali new mothers’ experiences circumstances, such as first-time parenting, are similar, the with the Norwegian health care system and their transitions are experienced in different ways by different experienced needs during the hospital stay and the mothers [1]. Events such as pregnancy and birth lead to a postpartum period. process of transition. Women need help and support to feel safe in parenting and to develop the skills needed for Methods: A qualitative design with individual motherhood, and first-time mothers need greater semistructured interviews. Qualitative content analysis confirmation and support because they are more uncertain was used to analyze the transcripts from the interviews. [4-6]. Social support can help a mother’s transition to motherhood [3,4,7]. The provision of psychological support Results: Ten women aged 25 to 34 years were interviewed. The women had lived in Norway 4-16 years and information to parents during both pregnancy and the and had 1-4 children. Analyses of the interviews indicated childbirth period is recommended [3,8]. that there were cultural differences between Somalia and Women who are away from their support system in the Norway, and that these affected the women during postpartum period are likely to feel vulnerable. Most cultures pregnancy and childbirth. Four main categories were have rituals associated with birth and the postpartum period. central in the women’s stories: (1) inadequate integration For example, within Islam, women are mandated 40 days of into Norwegian society; (2) need for and fear of a rest. During this time, postpartum women are considered to caesarean delivery; (3) family support around the be “unclean” and are not allowed to wash or cook in the belief postpartum period; and (4) support from health services. that this may result in contamination. Housework must therefore be performed by others. One consequence is that Conclusion: Even though these women lived in Norway, their language skills were poor and they were poorly the woman is allowed to rest [9]. In a systematic literature integrated into Norwegian society. Health professionals review of 20 original research papers, Lee et al. [10] found that should use an interpreter when dealing with Somali immigrant women have a higher incidence of postpartum women with poor language skills, especially when depression than the overall population. This incidence was discussing issues relating to birth and the hospital stay. To even higher among immigrant women from minority groups. help integrate these women into society, they should be Another systematic review found that, even though immigrant encouraged to learn the Norwegian language. Well-child women in Canada are provided the opportunity to receive clinics should offer immigrant mothers the opportunity to necessary services, there are barriers such as a lack of participate in maternity groups to strengthen their social information about the services, lack of support or help to relationships and to integrate better. Public health nurses access these services, and differences in expectations between play an important role in supporting immigrant mothers. the women and their service providers [11]. The findings of this study will help broaden the understanding of the support immigrant women need Cultural aspects are important for integration, especially in during the hospital stay and the postpartum period. view of the growing immigrant population in Norway. Immigrants in Norway come from 222 different countries and Keywords: Somali immigrant mothers; Postpartum autonomous regions, and comprise people who have period; Birth experience; Qualitative design; Public health immigrated as refugees or labor immigrants, for education, or nurse to join a family member already in Norway. Presently, there are about 698,600 persons living in Norway who are immigrants and 149,700 Norwegians born to immigrant parents. Together these groups constitute 16.3% of the population. Many immigrants live in Oslo, where immigrants © Copyright iMedPub | This article is available from: www.hsj.gr/archive 1 Health Science Journal 2016 ISSN 1791-809X Vol.10 No.4:17 make up about 33% of the population. The extent of Norwegian municipalities are required to provide health immigration contributes to a complex pattern of integration, services in maternity care, well-child clinics (WCCs) for the 0-5- education, religion, employment, and equality [12]. year-old population, school health services, and youth health centers. Publicly organized services are offered to pregnant The largest groups of immigrants come from Poland, women and to all parents with children and adolescents aged Lithuania, Sweden, Somalia, Pakistan, and Iraq [12]. Somalis 0-20 years. The service keeps a record of physical, mental, and comprise the largest non-Western immigrant group in Norway. social health status, and other matters of concern for In 2014, there were about 36,000 Somali immigrants living in children’s health and welfare [19]. Public health nurses (PHNs) Norway [13], which represents a large increase from the play a central role in this service and are the health care 22,000 Somalis living in Norway at the beginning of 2008 [14]. workers who meet with families most frequently [21]. For a The first Somalis came to Norway in the 1970s [15]. The civil woman who does not speak or read Norwegian, the war in Somalia broke out in 1991, and the number of asylum information provided must be sufficient for a woman to seekers increased significantly thereafter. Almost all Somalis participate and make choices about her own and her child’s are Muslims, but the significance of religion in their society health. Information is tailored to each woman according to her varies between individuals and different communities. age, maturity, experience, and cultural and linguistic Another important political–organizational system is the background. Health professionals are obliged to use an clan system. There are no religious differences between the interpreter if there are language barriers [22]. clans [16]. Both women and men belong to a particular clan Studies have focused on Somali immigrant women in the from birth to death, and one has both rights and duties in USA [23-30] and in the UK [31-33]. The Nordic countries relation to the clan. For newly arrived refugees, clans provide Finland and Sweden have similar health care systems to an important opportunity for developing networks and Norway. Two studies from Finland explored health care obtaining information [17]. According to the Norwegian providers’ experience in meeting Somali women’s needs and Ministry of Labour and Social Inclusion [18], most Somalis Somali-born immigrant women’s experiences with maternity seeking asylum in Norway before 1991 belonged to the Issaq care services [34,35]. One Swedish study described Somali clan, which is the dominant clan family in northwest Somalia. women’s use of maternity health services and the outcomes of From 1991 until about 2000, most asylum seekers stated that their pregnancies [36]. A few Norwegian studies have focused they belonged to the Hawiye clan from the southern parts of on Somali immigrant women during the perinatal period: one Somalia. Clan affiliation seems to have less impact with study focused on women undergoing caesarean delivery [37], increasing time spent living in Norway. another on perinatal complications [38], and another on Most Somalis have come to Norway as refugees, and have perinatal care experience to explore how perinatal care had a relatively short period of residence in Norway; most practice may influence labor outcomes among circumcised have come since 1998 with a record year of intake in 2002. women [39]. However, no studies have explored the Forty-four percent of Somali immigrants in Norway live in Oslo. experiences of Somali new mothers during the postpartum Many of the Somalis are in secondary education, which period even though this is the largest non-Western immigrant reflects the collapse of the education system in Somalia in group in Norway. Immigrant women’s experiences in the 1991 [17]. The Somali immigrant population in Norway is very postpartum period may help broaden the understanding of the young. In 2006, 83% of first-generation immigrants were type of support women need and may help inform the practice younger than 40 years, and 30% were younger than 20 years. of health care professionals. Of their descendants, 86% were younger than 10 years at the The objective of this study was to explore Somali new time [15]. Somali women in Norway give birth to more mothers’ experiences with the Norwegian health care system children than the average among Norwegian women. In 2004, and the mothers’ experienced needs during their hospital stay the average number of children among first-generation and the postpartum period. immigrant women with a Somali background was 3.7. There are many single parents, especially single mothers, with 29% of all Somalis in Norway living in a one-parent household [17]. Methods Norwegian public health services cover all pregnant women A qualitative design with individual interviews was chosen. and families with children [19]. The prevention of ill health is a This form seeks to understand more than explain individual key principle of the new Public Health Act [20]. The national experiences [40].