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Giving Birth in a New Land: Strategies for Service Providers Working with Newcomers

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Giving Birth in a New Land: Strategies for Service Providers Working with Newcomers Giving Birth in a New Land Strategies for Service Providers Working with Newcomers Table of Contents Acknowledgements . 2 Introduction . 3 Guide Overview . 4 Section 1 – Overview of Literature . 6 Section 2 – Perspectives and Approaches in Service Delivery . 9 Section 3 – Individual Challenges and Successful Strategies . 21 Section 4 – Organizations and Resources . 44 Section 5 – Key Terms . 47 Section 6 – References . 48 Appendix 1 – Census Data . 50 Appendix 2 – Demographic Projections . 56 Acknowledgements This guide could not have been developed without the contributions of the many health care professionals and community members who acted as project advisors, reviewers and key informants. In addition, the newcomer women who participated in our focus groups provided valuable information about their needs, concerns and service requirements. The Best Start Resource Centre, a program of Health Nexus, gratefully acknowledges the contributions of the following individuals and organizations: Advisory Committee Focus Groups • Arlene Carpenter, Public Health Nurse, The Best Start Resource Centre would like to thank the Reproductive Health, Peel Public Health women who participated in our focus groups, sharing • Caroline Wai, Consultant Health Promotion, invaluable information about their beliefs, their practices, Toronto Public Health their transitions to Canada and their experiences with service providers. Newcomer women were recruited by • Linda Gardner, Diversity & Community Access the following organizations: Coordinator, Women’s College Hospital • Peel Public Health, Healthy Start Program, • Linda Cornwell, Program & Communication Best Start Health Coalition of Peel Manager, Women’s Health in Women’s Hands Community Health Centre • South Riverdale Community Health Centre • Dr. Saadia Khan, Family Physician, • West Hill Community Services Healthier Babies Program Credit Valley Hospital, Mississauga • North York Prenatal Nutrition Program • Subha Sankaran, Health Promotion Consultant, Project Consultants Health Nexus Rabia Khedr and Zubeda Vahed from diversityworX Key Informants Project Lead • Dr. Maher Abou-Seido, Obstetrician, Louise Choquette, Bilingual Health Promotion Consultant, William Osler Health Centre, Brampton-Etobicoke Best Start Resource Centre • Dr. Maja Gans, Obstetrician, East Toronto General Hospital Special Thanks to: • Kevin Mossap, Social Worker, Linda Kongnetiman, Calgary Health Region, for sharing Trillium Health Centre, Mississauga the resource “Immigrant and Refugee Women’s Cultural Health Practices: A guide for health care professionals.” • Baldev Mutta, Executive Director, Punjabi Community Health Centre, Brampton Lyne Soramaki, Public Health Nurse, Thunder Bay District Health Unit, for reviewing the manual. • Phyllis Lam, Health Promoter, South Riverdale Community Health Centre, Toronto Disclaimer • Saleha Bismilla, Supervisor of Family Home Visitors, The resources and programs cited throughout this guide Toronto Public Health are not necessarily endorsed by the Best Start Resource • Muriel Abbott, Public Health Nurse, Family Health Centre. While the participation of the advisory committee Services, Middlesex-London Health Unit and key informants was critical to the development of this Best Start resource, final decisions about content • Nada Tuta, Family Home Visitor, were made by the Best Start Resource Centre. St. Joseph Immigrant Women’s Centre, Hamilton • Elaine Gayle-Thompson, Public Health Nurse, Citation: Reproductive Health, Peel Public Health (formerly Best Start Resource Centre (2009). Giving Birth in a Labour and Delivery nurse Toronto) New Land: Strategies for Service Providers Working • Jane Sumwiza, Family Home Visitor, St. Joseph with Newcomers. Toronto: Best Start Resource Centre. Immigrant Women’s Centre, Hamilton This document has been prepared with funds provided by the Government of Ontario. The information herein reflects the views of the authors and is not officially endorsed by the Government of Ontario. The Best Start Resource Centre thanks you for your interest in, and support of, our work. Best Start permits others to copy, distribute or reference the work for non-commercial purposes on condition that full credit is given. Because our resources are designed to support local health promotion initiatives, we would appreciate knowing how this resource has supported, or been integrated into, your work ([email protected]). 2 Giving Birth in a New Land 2 Introduction This guide is for service providers who work with • to assist service providers in helping newcomer pregnant women who are new to Canada. It also women and their partners familiarize themselves includes information about care during the with Ontario health practices related to pregnancy postpartum period. It is a response to the changing and the birth of their baby; and demographics in Ontario due to recent immigration • to suggest ways for service providers to trends (See Appendix 1 – Census Data and Appendix accommodate the needs of newcomer women 2 – Demographic Projections). The information within their organizational mandate. in this guide will be useful to a range of service providers who work with pregnant women, including From Immigration Canada’s point of view, the term physicians, midwives, nurse practitioners, nurses, “newcomer” refers to people who have arrived in public health workers, home visitors, support Canada within the last five years. For the purpose program staff, etc. The guide contains suggested of our guide, the definition is broader and may also guidelines that aim to be respectful of clients’ needs include women who have been here longer. Our and appropriate for health professionals who may definition also includes women who are temporary be of the same or different culture. residents, refugees, refugee claimants, foreign students, permanent residents and new Canadian The purpose of this guide is to help service citizens. Some newcomers may not have government providers find ways to provide “culturally competent medical coverage such as Ontario Health Insurance care,” which has been defined as “the ability to Plan (OHIP). Women in each of these situations may provide care with a client-centered orientation, have the need to access reproductive health services. recognizing the significant impact of cultural values While some newcomers adapt and integrate with and beliefs as well as power and hierarchy often ease, others may take a longer period given barriers inherent in clinical interactions, particularly between such as language, migratory path, education, social clients from marginalized groups and health care support and other personal experiences. Our broader organizations” (see Section 5 – Key Terms, Zine). definition of “newcomers” takes into account In order to do this, the guide has the following the strong influences that extended families and objectives: community settings may have on women in their • to share information about the beliefs and reproductive years. practices of newcomer women in relation to prenatal and postnatal health care services; Strategies for Service Providers Working with Newcomers 3 Guide Overview Content Methodology The guide focuses on the following aspects This guide evolved through the adaptation of a of women’s reproductive health: manual titled “Immigrant and Refugee Women’s • pregnancy; Cultural Health Practices: A guide for health care professionals,” which was developed by • labour and birth; and Linda Kongnetiman from the Calgary Health • postpartum. Region in 2005 and which contains Alberta- It is important to note that this guide does not specific information. provide comprehensive coverage of all areas of This guide, “Giving Birth in a New Land – women’s sexual and reproductive health care. Strategies for Service Providers Working with Hence, it does not cover reproductive choices, Newcomers,” is a snapshot of barriers to the HIV, drug and alcohol abuse, violence against delivery of services that were identified by women, women with disabilities and issues newcomers in Ontario. It shares associated pertaining to gynaecology such as sexuality, strategies to assist service providers in addressing breast health, menopause and screening tests. these barriers and focuses on Ontario-specific The guide includes a list of additional organiza- information. Although a large number of tions and resources that may be useful for newcomers settle in the Greater Toronto Area, service providers in the broader context of attention was also given to ensure input from determinants of health. other regions of the province. The guide is divided into six sections: The information for this guide was collected • Section 1 provides an overview of the literature through: on the topic. • a literature update; • Section 2 offers ways to provide services • four focus group consultations which included from the client’s point of view. This section 37 newcomer women; and includes personal narratives that voice women’s • phone interviews with ten key informants experiences pertaining to their cultural and who are health and social service professionals religious values, beliefs and perceptions within working with newcomers. the Ontario context. An assessment tool is provided for individuals and for workplaces. The literature update focused mainly on recent Canadian research related to reproductive health • Section 3 identifies specific challenges that services for newcomer women. The following have an impact on access to reproductive databases were searched: Cumulative
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