- Top of page
Objective To explore the attitudes, strategies and habits of Somalian immigrant women related to pregnancy and childbirth, in order to gain an understanding as to how cultural factors might affect perinatal outcome.
Methods Interpreter assisted qualitative in depth interviews around topics such as attitudes and strategies regarding childbirth.
Participants Fifteen women from the Somalian community in a city in Sweden, between the ages of 20 and 55 years with delivery experience in Somalia and Sweden.
Results The interviews describe how the women themselves perceived their experiences of childbirth in the migrant situation. Many voluntarily decreased food intake in order to have a smaller fetus, an easier delivery and to avoid caesarean section. The participants considered a safe delivery to be the same as a normal vaginal delivery They reduced food intake in order to diminish the growth of the fetus, thereby avoiding caesarean section and mortality. The practice of food intake reduction, while rational for the participants when in Somalia, was found less rational in Sweden and may lead to suboptimal obstetric surveillance.
Conclusions Somalian women have childbirth strategies that differ from those of Swedish women. These strategies should be seen as ‘survival behaviours’ related to their background in an environment with high maternal mortality. The hypothesis generated is that there is a relationship between the strategies during pregnancy and adverse perinatal outcome among Somalian immigrants. Considering the strong association of the habits to safe birth, it seems doubtful whether the women will change their habits as long as health care providers are unaware of their motives. We suggest a more culturally sensitive perinatal surveillance.
- Top of page
Sweden enjoys one of the lowest perinatal mortality rates in the world and the decrease in perinatal mortality has been attributed to socio-economic improvements and to better perinatal care1,2. Swedish studies from the seventies and the eighties have not shown higher perinatal mortality among immigrant women3,4. However it has recently been shown that children born in Sweden, to women originating from sub Saharan Africa, have a higher risk of perinatal mortality and of being small for gestational age (SGA)5. Differences in perinatal mortality still remained, even after adjustments for obstetric risk factors or maternal background factors6. The population of 20,000 Somalies in Sweden is believed to be one of the most segregated immigrant groups as well as the one with the highest proportion of unemployment in Sweden (The National Integration office, Report 99:4).
Migration is associated with increased physical and psychological illness and the global migration process is said to create, not only new patterns of disease, but also new challenges for the health care systems in the countries of reception7. Links to perinatal mortality and morbidity among women emigrated from developing countries could be discussed. Part of the explanation for increased low birthweight and perinatal death lies in the characteristics of the mothers own intrauterine and childhood environment which might interfere with their optimal growth and development8,9. Culturally related factors such as malnutrition, sub optimal care and reduced psychosocial resources after a migration process might be more important among immigrant groups from low-income countries. Previous studies from Somalia have described a tradition of routinely reducing food intake during pregnancy in order to prevent the fetus from gaining too much weight10,11. Social factors, such as being a single immigrant mother with low psychosocial resources, are also associated with small for gestational age infants12. Another factor is the standard of perinatal care, which has been claimed to be one of the most important factors when achieving lower perinatal mortality13.
Giving birth in a foreign country is an experience that provides little access to the normal traditions and support of the home environment. Qualitative methods are commonly used in anthropology concerning the experience of childbirth and interaction between patients and health care professionals. Medical-anthropological studies seem to be appropriate to provide additional information regarding the results of earlier epidemiological studies and may provide a new hypothesis14.
The aim of the present study was to explore the culturally determined attitudes, strategies and habits of Somalian immigrant women towards pregnancy and childbirth in Somalia as well as in Sweden, in order to gain an understanding of how such factors affect perinatal outcome.