Experiences of Pregnancy, Childbirth and Post-Partem Period in Urban
Total Page：16
File Type：pdf, Size：1020Kb
Cprht Wrnn & trtn h prht l f th Untd Stt (tl , Untd Stt Cd vrn th n f phtp r thr rprdtn f prhtd trl. Undr rtn ndtn pfd n th l, lbrr nd rhv r thrzd t frnh phtp r thr rprdtn. On f th pfd ndtn tht th phtp r rprdtn nt t b “d fr n prp thr thn prvt td, hlrhp, r rrh. If , r rt fr, r ltr , phtp r rprdtn fr prp n x f “fr tht r b lbl fr prht nfrnnt, h ntttn rrv th rht t rf t pt pn rdr f, n t jdnt, flfllnt f th rdr ld nvlv vltn f prht l. l t: h thr rtn th prht hl th r Inttt f hnl rrv th rht t dtrbt th th r drttn rntn nt: If d nt h t prnt th p, thn lt “ fr: frt p t: lt p n th prnt dl rn h n tn lbrr h rvd f th prnl nfrtn nd ll ntr fr th pprvl p nd brphl th f th nd drttn n rdr t prtt th dntt f I rdt nd flt. ASAC EEIECES O EGACY, CII A OSAUM EIO I UA A SUUA IMMIGA AKISAI WOME By bb Itrt Qrh A body of research suggests that immigrants arrive in the U.S. in good health, a healthy immigrant effect. As immigrants acculturate and absorb dominant cultural norms (measured by proxy variables such as language preference, employment, smoking and alcohol consumption), their health status deteriorates. There is a nd to understand how immigrants adapt to a changed social and cultural environment and how this may influence health. A study of pregnancy, childbirth and the postpartum prd in immigrant Pakistani women living in New Jersey explored the interface of culture, immigration and health. The study employed a three pronged approach. Census dt were analyzed to identify areas with the largest Pakistani immigrant populations in r. A sample of 26 women from urban (Jersey City) and suburban (Parsippany and Edison) towns were then interviewed, and tours of their neighborhoods were undertaken to describe their environments. The in-depth interview data revealed that the pregnancy experience of these women was influenced by the timing of their pregnancy, the quality of their social networks, socio-economic status, and knowledge and ease of negotiation of the U.S. healthcare system. Initially, these women experienced a weakening of social networks and a fall in socio-economic status. Moreover, women who experienced a pregnancy soon after immigrating to the U.S. also encountered a healthcare system that was difficult to navigate. These women adapted by building new networks (friends and neighbors), strengthening kinship ties (in-laws), investing in relationships (exchange of favors) and consequently deepening embeddedness in these new networks. These new networks also functioned as conduits of information that facilitated the obtaining of healthcare. Social networks in Pakistan were linked via a range of transnational mechanisms. Differences in socio-cultural adaptation occurred based on urban and suburban location, and these influenced the women's pregnancy experience. Urban and suburban networks differed in composition (e.g. urban networks were comprised of other Pakistani immigrants vs. suburban networks that were more diverse) and collective social capital, and these women used their social capital to address different needs and to achieve different goals. Urban women tended to be more conservative in their adaptations and maintained old social patterns, while suburban women were comparatively more flexible. Additionally, these individual adaptations have collectively shaped urban and suburban Pakistani immigrant communities. EEIECES O EGACY, CII A OSAUM EIO I UA A SUUA IMMIGA AKISAI WOME By bb Itrt Qrh A rttn Sbttd t th lt f r Inttt f hnl tr, h Stt Unvrt f r Unvrt f Mdn nd nttr f r In rtl lfllnt f th rnt fr th r f tr f hlph n Urbn St M 200 Copyright 2010 by Rubab Itrat Qureshi ALL RIGHTS RESERVED AOA AGE EEIECES O EGACY, CII A OSAUM EIO I UA A SUUA IMMIGA AKISAI WOME bb Itrt Qrh Dr. Jeffrey R. Backstrand, DissertatiAdvisor Date Associate Professor of Urban Health, University of Medicine and Dentistry of New Jersey Dr. Dula Pacquiao, Committee Member 'Date / Associate Professor of Nursing, University of Medicine and Dentistry of New Jersey Jamie Lew, Committee Member Date Associate Professor of Sociology, Rutgers, The State University of New Jersey Dr. Barbara Caldwell, Committee Member Date Professor, University of Medicine and Dentistry of New Jersey IOGAICA SKEC Athr: Rubab Itrat Qureshi r: Doctor of Philosophy t: May 2010 Undrrdt nd Grdt Edtn: • Doctor of Philosophy in Urban Systems, New Jersey Institute of Technology, Newark, NJ, 2010 • Bachelor of Medicine and Bachelor of Surgery, Khyber Medical College, Peshawar University, Peshawar, Pakistan Mjr: Urban Systems rnttn: Redeker, N.S., Campbell, D., & Qureshi, R. "Gender differences in sleep, symptoms, and functional performance in patients with stable heart failure." (Abstract). Proceedings of the Eastern Nursing Research Society 19th Scientific Sessions, 24. Providence, RI. April, 2007. v I would like to dedicate this dissertation to my parents Itrat and Mubarik Qureshi. ACKNOWLEDGMENT I would like to thank my advisor Dr. Jeffrey Backstrand for the guidance and support he has extended to me from the inception to the conclusion of this project. He helped me focus the research, devise the methodology, and analyze the census and the interview data. He listened patiently and encouraged me when I felt lost in qualitative data or when I was trying to tackle the mysteries of SAS. He was extremely generous with his time and his expert comments and reviews were invaluable. This dissertation would not have been possible without his continuous support. Second, I would like to thank Dr. Dula Pacquiao. Dr. Pacquiao was a member of my committee and also the Director of the Urban Systems program. She assisted me in analyzing the qualitative data and understanding the problem at hand. Third, I would like to thank all the participants who made this study possible. I am grateful to them for sharing their experiences with me and for their hospitality. They welcomed me into their homes, told me their stories and also served tea and snacks to accompany the interviews. I would especially like to thank Uzma Bukhari for her time and help in introducing me to these wonderful women. Additionally, I would like to thank my husband, Asgher Qureshi, and my sons Shahzore, Haraval and Husain for being so patient. They provided an environment where I could work and helped me by being so undemanding and understanding. vi TABLE OF CONTENTS Chapter Page 1 RESEARCH PROBLEM 1 1.1 Introduction 1 1.2 Problem Statement 3 1.3 Research Questions 4 1.4 Significance of Research 4 1.4.1 Scarcity of Literature 4 1.4.2 Birth Outcomes 5 1.4.3 The Immigrant Pregnancy, Childbirth and Postpartum 6 Experience 1.4.4 Social and Cultural Context 6 1.4.5 Place of Residence: Urban vs. Suburban 7 2 REVIEW OF LITERATURE- PART 1 8 2.1 Immigration and the U.S 8 2.2 Health and Immigration 9 2.2.1 Changing Immigrant Health Status 9 2.2.2 Birth Outcomes 9 2.2.3 Biomedical Factors 10 2.2.4 Human Ecology 12 2.3 Toward a Theory of Immigrant Health 15 2.3.1 Definitions 15 vii AE O COES (Cntnd Chptr Page 2.3.2 Complementary Theories 16 2.4 Framework 28 3 REVIEW OF LITERATURE-PART 2 PAKISTAN AN OVERVIEW... 30 3.1 Demography 30 3.2 Push Factors Favoring Emigration from Pakistan 33 3.2.1 Labor Force Participation 34 3.2.2 Employment 34 3.2.3 Trends in Migration 35 3.2.4 Government Policy: Export of Manpower 35 3.2.5 Remittances and the Economy 36 3.3 Pakistani Immigration to the U.S 37 3.3.1 Who Migrates 38 3.4 Pakistani Society 40 3.4.1 Culture 40 3.4.2 Gender and Society 42 3.5 Healthcare System and Utilization 46 3.6 Pakistanis and Issues Related to Reproduction 47 3.6.1 Marriage 47 3.6.2 Role of Family 48 3.6.3 Sex, Contraception and Conception 49 3.6.4 Infertility 50 v AE O COES (Cntnd Chptr Page 3.6.5 Gender Preference 51 3.6.6 Diet in Pregnancy 51 3.6.7 Childbirth 53 3.6.8 Post-partum Period 54 3.6.9 Newborn Care 55 3.6.10 Religious Beliefs 55 3.6.11 Pregnancy Related Complications 56 3.7 Pakistani Immigrants in the United States 59 4 RESEARCH DESIGN 61 4.1 A Qualitative Paradigm 61 4.1.1 Pilot Study 62 4.1.2 Method 63 4.2 Informed Consent and Ethical Considerations 70 4.2.1 Informed Consent 70 4.2.2 Confidentiality 71 4.2.3 Audio Tapes 71 4.3 Validity 71 4.4 Reliability 73 4.5 Limitations 74 5 THE PAKISTANI POPULATION IN NEW JERSEY 76 Demographics 76 x TABLE OF CONTENTS (Continued) Chapter Page 5.1 Pakistani Immigrants in New Jersey 78 5.1.1 Family 79 5.1.2 Education 80 5.1.3 Language 80 5.1.4 Employment Status 81 5.1.5 Occupation 82 5.1.6 Household Income 84 5.1.7 Immigration Status 85 5.2 Pakistani Immigrants in New Jersey Counties 87 5.3 Urban and Suburban Pakistani Immigrants Populations 88 5.3.1 Family Type 90 5.3.2 Age 91 5.3.3 Marital Status 91 5.3.4 Educational Attainment 91 5.3.5 Employment Status 92 5.3.6 Language Proficiency 94 5.3.7 Place of Residence 95 5.3.8 Enrollment in College or Graduate Schools 96 5.3.9 Industry 97 5.3.10 Occupation 98 AE O COES (Cntnd Chptr Page 6 JERSEY CITY AND SUBURBAN NEW JERSEY 101 6.1 Jersey City 101 6.2 New Jersey Suburbs 113 6.2.1 Edison/Iselin Area 114 6.2.2 Parsippany Area 8 7 MAKING A HOME IN NEW JERSEY 122 7.1 The Study Participants 122 7.2 Family and Gender in Pakistani Society 124 7.3 Immigration to the U.S 128 7.3.1 American ht (marriage proposal) 128 7.3.2 A New Beginning and Role of Networks 131 7.4 Settling in Urban and Suburban New Jersey 139 7.4.1 Pakistani Immigrant Women in Jersey City 140 7.4.2 Pakistani Immigrant Women in Suburban New Jersey...