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Our findings can serve to guide nurses and other healthcare providers' clinical approach to a subset of the population whose cultural beliefs and practices regarding reproductive health may be unfamiliar. Incorporating the perspective of the Somali Bantu women will facilitate the provision of person-centred care and ensure women receive appropriate, efficient and quality care that meets their needs, which may potentially reduce financial costs to the healthcare system.

Yet unknown is how they avoid obstetrical 17 interventions. This study sought to identify perceived protective mechanisms used to avoid obstetric 18 interventions as well as the underpinning factors that influence aversion to obstetrical interventions by 19 Somali refugee women. 20 Design: A descriptive, exploratory qualitative study purposively sampled Somali refugee women recruited 21 via snowball technique in Franklin County, Ohio, United States. Data was collected through audio-22 recordings of individual interviews and focus groups conducted in English and Somali languages. The 23 collected data were transcribed and analyzed using thematic analyses. 24 Results: Forty Somali refugee women aged 18 to 42 years were recruited. Participants reported engaging 25 in four perceived protective mechanisms to avoid obstetrical interventions during pregnancy and childbirth: 26 1) intentionally not seeking or misleading prenatal care, 2) changing hospitals and/or providers, 3) delayed 27 hospital arrival during labor, and 4) refusal of care. Underpinning all four avoidance mechanisms were their 28 significant fear of obstetrical interventions, and perceived lack of choice in their care processes as 29 influenced by: cultural and/or religious beliefs, feeling judged or undervalued by service providers, and a 30 lack of privacy provided to them while receiving care. 31 Conclusion: Like every woman, Somali women also have a right to choose or refuse care. If the intention 32 is to improve access to and experiences with care for this population, building trust, addressing their fears 33 and concerns, and respecting their culture is a critical first step. This should be well established prior to the 34 need for critical decisions surrounding pregnancy and childbirth wherein Somali women may feel 35 compelled to refuse necessary obstetrical care. Bridging gaps between Somali women and their providers 36 is key to advancing health equity for this vulnerable population.

This study examined maternal and reproductive health (MRH) access of Somali refugees in the U.S. across four access dimensions (willingness to seek care, gaining entry to the health system, seeing a primary provider and seeing a specialist). We conducted a cross-sectional survey of 427 Somali refugee reproductive-age women in Franklin County, Ohio. Following descriptive statistics of demographics, we conducted multivariate analyses to test associations between demographics and the four access dimensions. Most Somali refugee women were married (68%), attained primary education (92%), employed (64%) and were circumcised (82%). Young (OR 2.61, 95% CI 1.25-5.60), single (OR 1.78, 95% CI 1.15-2.78), and minors upon arrival (OR 2.36, 95% CI 1.44-3.90) were more willing to seek care. Lack of insurance, limited language fluency and being circumcised limited access to care across all dimensions. Barriers to access need to be systematically addressed. Deconstructing beliefs regarding health systems may improve access, especially among older Somali women.

Background: African refugee women in the United States are at risk of poor reproductive health outcomes; however, examination of reproductive health outcomes in this population remains inadequate. We compared:(1) prepregnancy health and prenatal behavior; (2) prenatal history and prenatal care utilization; and (3) labor and birth outcomes between African refugee women and U.S.-born Black and White women. Methods: A secondary data analysis of enhanced electronic birth certificate data was used. Univariate comparisons using chi-squared tests for dichotomous variables and analysis of variance and/or Kruskal-Wallis tests for continuous variables were conducted for Refugee versus Black versus White women. A p-value <0.05 was considered statistically significant. Results: From 2007 to 2016, 789 African refugee, 17,487 Black, and 59,615 White women in our population gave birth. African refugees experienced more favorable health outcomes than U.S.-born groups on variables examined. Compared to U.S.-born women, African refugee women had fewer prepregnancy health risks ( p < 0.001), fewer preterm births ( p < 0.001), fewer low birth weight infants ( p < 0.001), and higher rates of vaginal deliveries ( p < 0.001). These favorable outcomes occurred despite later initiation of prenatal care ( p < 0.001) and lower scores of prenatal care adequacy among refugee women compared to U.S.-born groups ( p < 0.001). Conclusions:The healthy immigrant effect appears to extend to reproductive health outcomes in our studied population of African refugee women. However, based on our data, targeted, culturally-congruent education surrounding family planning and prenatal care is recommended. Insight from reproductive health care experiences of African refugee women can provide understanding of the protective factors contributing to the healthy immigrant effect in reproductive health outcomes, and knowledge gained can be utilized to improve outcomes in other at-risk groups.

This paper examines the convergence of culture, myths, and taboos surrounding reproductive health issues African immigrant women, living in the United States, learned during childhood in their countries of origin. We also discuss how mothers' perceptions of reproductive health education (RHE) influenced the education of their own daughters aged 10-14 years. This was a qualitative descriptive study. Data were collected via interviews and demographic survey. The sample size was 20 African immigrant mothers living in a mid-sized city in the U.S. Interviews were transcribed verbatim. Qualitative data was analyzed using qualitative content analysis. Myths and taboos related to menstruation, sexual intercourse, pregnancy, and HIV/AIDS were reported by the women interviewed. Discussion of these issues was largely taboo, and most myths the mothers learned growing up pertained to sexual intercourse, pregnancy prevention, and pregnancy termination using non-hormonal ingested substances. Myths and taboos about sexual issues are widespread in Africa and are propagated to control sexual behavior, especially that of unmarried people, particularly women. By examining these myths and taboos, we are able to somewhat contextualize the mothers' immigrant experience regarding RHE. Although myths were reported, the majority of mothers did not appear to believe them. The most significant taboo reported was sexual intercourse. This in turn led to mothers' overemphasis on abstinence for their daughters. It is also noteworthy that this sample contained mainly African women who overall were highly educated, spoke English, and could adequately navigate life in the U.S. It is unclear what the results would be if we were to examine African immigrant women with less achievements in these areas.

Reproductive health disparities in the Appalachian region may be driven by barriers to healthcare access. However, the barriers specific to accessing family planning services in Appalachia have not yet been identified from the perspectives of Appalachian community members. Moreover, it is unclear how community members might perceive elevated levels of opioid use in the region to impact family planning practices. To fill this gap in knowledge, the current qualitative study explored community perspectives about family planning in Appalachia in the context of the opioid epidemic for the purpose of developing a survey instrument based on these responses. We conducted three video call focus group interviews with community stakeholders, those who live, work and are invested in Appalachia (N = 16), and analyzed the responses using Levesque, Harris, and Russell’s (2013) five pillars of healthcare access as a framework to categorize family planning practices and perceptions of service needs in the context of regional substance abuse: (1) approachability, (2) acceptability, (3) availability and accommodation, (4) affordability, and (5) appropriateness. Subthemes within each of these five categories were also identified. Our findings highlight stakeholder concerns around a lack of knowledge about and access to family planning services in Appalachia. Community members also expressed concern around the lack of availability of substance use treatment services, which may negatively impact family planning use and access in the region.

Nurses can serve as liaisons between adolescents, the community, and the Kenyan government in promoting CSEPs. Nurses should be more readily utilized in educating community members and policy makers about the need for CSEPs in all Kenyan high schools. Nursing students can also be utilized in their community health role to teach curricula of CSEPs. Nurses should advocate for all adolescents to access reproductive health services and for all healthcare providers to provide comprehensive reproductive health care to them.