Maternity Care For Refugees and Asylum Seekers. Research Critique

Introduction

With many parts of the world under political turmoil, the waves of the impetus are causing effects on the neighboring countries. With security threats, more people are fleeing their countries to their bordering neighbors to ensure personal safety. Although their original perception is of a good life free from threats and other risks, they are usually oblivious of the other unknown atrocities that await them. These are brought up as a result of hostilities that the original inhabitants of the country of refuge direct to them. The hardships range from securing jobs, housing, school, participation in community activities and access to services like health care. The researches by Judith Nabb (2009), Pregnant asylum- Seekers: Perceptions of Maternity Service Provision and Leslie Briscoe and Tina Lavender, Exploring maternity Care for Asylum Seekers and Refugees therefore give an insight into how these group of people experiences hardships when registering with the maternity while pregnant and professionally prescribe the possible solutions to the malpractice.

The fact that these women experience difficulties is doubtless owing to the circumstances that surround them. Asylum seekers and refugees, therefore, face a lot of difficulties in their effort to access good health care and maternity services.

Exploring maternity Care for Asylum Seekers and Refugees

Leslie Briscoe and Tina Lavender

To understand the issue, Briscoe & Lavender (2009) had to give it a psychological approach. According to the two, to access health care, one of the greatest drawbacks is the psychological position of the patient. The way a patient perceives her, “self” played a great role in the influencing her access to adequate medical care during maternity. The research explains that forced displacement in women may result in a shift in their self-identity one referred to as nomadic. The researchers show that the meaning of the word self may be viewed from two perspectives. One perspective is from the individual and the second one is the perception from a multiple entities. The individual perspective comes in terms of the personal experiences that one has undergone like rape or any physical abuse while entity perception comes when the refugee or asylum seeker tries to interpret the symbols during the process of communication. The newly arrived asylum seekers therefore interpret their “selves” through the gazes of the society, the image drawn by the media and practices of other professionals.

Other researchers have also pointed out the issue of self-perception as a form of problem to the refugee’s access to good maternity care. This is formed by the negative self-image that the refugees develop after the several traumatic experiences that they undergo. UK refugee council (2006) identifies that fear; grief and shame form a basis of refugee psychology as a result of the experiences they have undergone. This includes incidences like rape, torture, detention, social upheaval, death of loved ones, etc. flight experiences, uncertainty and poverty in the countries of origin also contribute greatly to the issue of having a low self-identity and which later causes a problem in the access to standard health care to refugees.

Consequently, this self-image as exhibited by the refugees and asylum seekers creates a great impact on their interpretation. As Goffman (1961) puts it, self-perception as a multiple entity makes the individual try and wear different faces under different circumstances to fit into the environment. this makes the refugees and asylum seekers have a personal interpretation of the messages read from the looks of other people. with the negative interpretation of the other people’s looks, one is likely to respond in the same way through his actions. As a refugee, one feels worthless and meaningless.

Another great cause of problems experienced by this group of people is what the researchers refer to as “understanding in practice.” (Briscoe & Lavender, 2009). In normal situations, the principal aim of communication is understanding the meaning. This does not only occur in terms of understanding the language but also understanding the circumstances under which the communication is taking place. This is referred to as the context. According to Briscoe & Lavender (2009), the meaning in communication can be highly shaped by other factors. They specify media’s influences, the gender of the speaker and the person being spoken to and the political environment.

In line with the same, most of these women experience problems when it comes to language barriers and also the explanation of other concepts that cannot be explained in other languages. This forces the communication to be done through gesticulation which has its own shortcomings. In other cases, the respondent is forced to lie having understood when in a real sense she has understood nothing. Furthermore, the problem of communication may occur as a result of medical jargon that is difficult for the patient to understand. According to the research, the communication between the health care professionals and the women during their maternity was met with several barriers as their interpretations differed due to their different cultures and other incidents that form a context. For example, Abeba, one of the respondents in the research confesses to having been completely frightened by the knowledge that she was to have a caesarian birth. An operation to her was synonymous with death. This is the common belief from where she comes from.

This point can be taken as true based on other researches findings concerning the same issue. In their research, Bulman and McCourt (2002) indicate that most Somali refugees in the UK have identified language barriers as one of their most conspicuous barriers to the access to proper maternity care. The only solution that remained was providing their interpreters who unfortunately were unreliable. under the issue of context, attitude of the Somali women played another great role in the promotion of communication barriers. The research identifies the effect of the self-perception and the stereotypical of the Somali women by the general public as an impediment to the general provision of maternity care. Most of the communication fails to work because the refugees have formed a self-perception forming the context under which interpretation of information takes place. This hinders the efficiency of the health care provision.

Social policies play a great role in the denial of asylum seekers’ and refugees’ proper access to maternity services. The most common was the policy of dispersion. All the respondents of the research confessed to having been made to feel powerless and without any control of their lives (Lehmann, 2002). This occurred as a result of being moved from one point to another without choice. It prevented them from settling down and starting their lives once again. These conditions are usually worse under the conditions of childbirth. It is from them that most of the refugees and asylum seekers find themselves prey to depression and suicidal tendencies. This comes as a result of being in no position to make a decision. As one respondent puts it, one is taken to a completely new region where he knows no one but due to her inability to decide, she has to accept the decision quietly and submissively.

Another policy that puts pressure on the shoulders of the refugees and asylum seekers is the fact that they cannot be employed within their first six months of arrival into the country of refuge. This contributes to pathetic living conditions as they are restrained not to move towards economic freedom through working and earning money. They are forced to live in poverty with poor housing and as a result poor medical care. In such conditions, the chances of getting good medical attention are so low.

One point to put into consideration is that 45-50% of women asylum seekers are pregnant (Kennedy and Lawless 2003). This means that the women need special treatment. Problems resulting from the poor services offered to the pregnant asylum seekers and refugees have resulted in several deaths and a line of court cases. This shows the impact of the situation. The two argue that the impact of the issue is great on the psychological, physiological and social status within the community. To further highlight this issue, they point out that in Bosnia, the number of perinatal mortality stood at 38.6 for every 1000 births in 1995. this was accompanied by a double in the number of underweight births and congenital abnormalities.

Recommendations

In addition to this, Briscoe & Lavender (2009) recommended that medical practitioners should pay extra attention to those parts of communication that they consider negligible and which they take for granted in most cases. These issues include the use of non-verbal cues. Most of the cues may impact greatly both negatively or positively to the patient. Therefore, the use of gestures, smiles and other facial expressions should be considered greatly when attending to patients. This should be assisted with the provision of adequate interpreters in cases of a complete difference in the languages spoken.

Bulman and McCourt (2002) point out that the cultural aspects of the refugees will be of great importance to any practitioner dealing with the refugees and asylum seekers. The cultural effects include the perceptions of some practices from the home country as related to the practitioner’s perception. This will enhance communication. In addition, they indicate that provision of more interpreters will be of great importance in the general effort of ensuring that communication is facilitated.

Pregnant asylum- Seekers: Perceptions of Maternity Service Provision

Judith Nabb

Hostility from host communities plays a great role in ensuring that refugees and asylum seekers do not adequately access maternity care. Nabb (2009) narrows the spectrum to the UK when he points out that asylum seekers and refugees in the United Kingdom usually undergo distressing experiences on their arrival. This is because they are viewed as threats to the social structure and stability. They are also viewed as possible competition for jobs. Nonetheless, the hosts view the visitors as a drain on public services and lastly isolate them as a result of their difference in cultural identity. This leads to another problem where the refugees and asylum seekers are taken as secondhand patients. Nabb (2009), in her research finds out that the English women could not condone waiting for more than fifteen minutes for an asylum seeker to be attended to (Richman, 1998). The result could be complaints and shouting that the asylum seekers were out to bring competition on the available social resources. To check this, the health care professionals are forced to come up with strategies that would ensure that all these people got their medical attention without offending any group. This actually meant giving first priority to the native English women.

The importance of this point cannot be disputed. This has been identified by other researchers who did not only pinpoint the hostility from the common citizens but also the media and the politicians. This played a great role in the formation of stress and psychological trauma (Burnett and Peel 2001). the more the media forms a negative image of the refugees and asylum seekers, the more hostile the common citizens become. This contributes to the worsening of conditions of a refugee translating to suicidal tendencies.

The role of poverty in the refugee and asylum seeker is greatly brought out in the research by Nabb. This involves the unfortunate policies during the landing where the refugee in most cases doesn’t know anybody in the new world and cannot be allowed to work within a span of six months. This makes them unable to raise money that could enable her to go to a decent medical institution. In addition, Nabb (2009) states that asylum seekers are forced to attend medical check-ups every passing week because they do not have phones through which they could communicate to the medical practitioner can assess the progress of the pregnancy. This is mostly done to women in their late stages of pregnancy.

In addition to this contribution, Nottingham city’s joint strategic needs analysis (2009) point out that many asylum seekers undergo hardships due to their impoverished life. This translates to many medical conditions that occur as a result of poverty. This shows that pregnant women also have to undergo such painful situations because of their inability to access adequate health services. These conditions include psychological conditions, HIV/AIDS, Hepatitis, TB etc. these conditions adversely affect the mother and the born baby jointly.

Their Recommendations

Nabb (2009)’s, greatest concern is the issue of more intensive involvement of midwives in the whole procedure of maternity care for refugees and asylum seekers. This includes ensuring the availability of a midwife at every health care center together with a nurse or in rare cases instead of a nurse. In addition to this, she stresses a more flexible communication channel between the midwife and the immigration officers and also a more flexible structure within midwives and women in an emergency that would allow them to be in position to attend to them at any given time whenever the need arises.

Midwives have had greater contribution to the issue of caring for pregnant women. With their care and ability, refugees will be subjected to better care as compared to the nurses (Rochelle 2004). This has been evidenced by the lower rates of neonatal, maternal and infant mortality rates, in countries whose main practitioners are midwives like Germany as compared to those who restrict the midwife practices like the United States. In addition, the midwife practice is less prone to practical and economic barriers. This makes it a more flexible method of containing this problem as experienced by the refugees and asylum seekers.

Conclusion

The two types of research give a clear insight into what women who are asylum seekers and refugees undergo during their process of searching for maternity care. These problems range from language and communication barriers, government policies in terms of methods of dispersals, less involvement of midwives, withstanding instances of racism and other hostilities, economic hardships, etc can only be addressed if a proper adherence to the recommendations is put up. In addition, much study should be done to give even more accurate studies that will not be weighed down by the need for translation between the interviewee and the interviewer. With these put in place, the problems will be reduced therefore allowing these vulnerable group of people to live.

References:

  1. Briscoe, Leslie and Lavender, Tina. “Exploring Maternity Care for Asylum Seekers and Refugees.” British Journal of Midwifery.2009, 17,1: 17-22
  2. Burnett, A. and Peel, M. (2001). Asylum Seekers and Refugees in Britain. BMJ Journal. 2001.
  3. Cottrell, R., Jones, B., and McKenzie, J. (2005). Health Promotion and Education Research Methods: Using the Five Chapter Thesis/Dissertation Method. Jones and Bartlett Publishers.
  4. Dentin NK, Lincoln YS (ends) (2000) Handbook of Qualitative Research. Sage, London
  5. Lehman, A. (2002). Safe Abortion: A Right for Refugees? Reproductive Health Matters 10: 151-55
  6. Nabb (2009), Judith. “Pregnant Asylum-seekers: Perceptions of Maternity Service Provision.” The Royal College of Midwives. Updated 2009.
  7. Nottingham City Joint Strategic Assessment. (2009) Asylum Seekers, Refugees and Migrant Workers.
  8. Richman N. (1998) In the midst of the whirlwind. Trentham Books: Stokeon-Trent.
  9. Rochelle,t. Mona. (2004) “Minimal Intervention – Nurse Midwives in the United States.” The New England Journal of Medicine. 2004. 351(19):1929-1931.
  10. Straus, L., McEwen, A,. and Hussein F. Somali Women’s Experience of Child Birthin the UK:
  11. Perspectives From Somali Health Workers. Science Direct. 2009. 25(2): 181-186
  12. Refugee Council Conference. Safe From Harm? Health and Social Care for Vulnarable Refugees and Asylum Seekers.