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.Interpreter assisted qualitative in depth interviews around topics such as attitudes and strategies regarding childbirth.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.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.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. Methods Participants Results Conclusions

This study focuses on communication and conceptions of obstetric care to address the postulates that immigrant women experience sensitive care through the use of an ethnically congruent interpreter and that such women prefer to meet health providers of the same ethnic and gender profile when in a multiethnic obstetrics care setting. During 2005-2006, we conducted in-depth interviews in Greater London with immigrant women of Somali and Ghanaian descent and with White British women, as well as with obstetric care providers representing a variety of ethnic profiles. Questions focused on communication and conceptions of maternity care, and they were analyzed using qualitative techniques inspired by naturalistic inquiry. Women and providers across all informant groups encountered difficulties in health communication. The women found professionalism and competence far more important than meeting providers from one's own ethnic group, while language congruence was considered a comfort. Despite length of time in the study setting, Somali women experienced miscommunication as a result of language barriers more than did other informants. An importance of the interpreter's role in health communication was acknowledged by all groups; however, interpreter use was limited by issues of quality, trust, and accessibility. The interpreter service seems to operate in a suboptimal way and has potential for improvement.

we raise a concern that women and caregivers might overlook maternal risks with caesarean section for the benefit of the baby, a shift in focus that can have serious consequences on women's health in low-resource settings. Caregivers need to reflect on how they counsel women on caesarean section, as many women perceived a lack of indication for their operations. Supportive attendance by a relative during birth and more comprehensive antenatal care counselling about caesarean section indications and complications might enhance women's autonomy and birth preparedness.

We explored the perceptions of 39 Somali women and 62 obstetric care providers in London in relation to caesarean birth, as borne out of a paradox we recognised from evidence-based information about the Somali group. Socio-cultural factors potentially leading to adverse obstetric outcome were identified using in-depth and focus group interviews with semistructured, open-ended questions. A cultural anthropology model, the emic/etic model, was used for analysis. Somali women expressed fear and anxiety throughout the pregnancy and identified strategies to avoid caesarean section (CS). There was widespread, yet anecdotal, awareness among obstetric care providers about negative Somali attitudes. Caesarean avoidance and refusal were expressed as being highly stressful among providers, but also as being the responsibility of the women and families. For women, avoiding or refusing caesarean was based on a rational choice to avoid death and coping with adverse outcome relied on fatalistic attitudes. Motivation for the development of preventive actions among both groups was not described, which lends weight to the vast distinction and lack of correspondence in identified perspectives between Somali women and UK obstetric providers. Early booking and identification of women likely to avoid caesarean is proposed, as is the development of preventive strategies to address CS avoidance.

To explore attitudes toward female genital cutting (FGC) in a migration perspective, qualitative interviews were conducted with men and women from Ethiopia and Eritrea in Sweden. We found firm rejection of all forms of FGC and absence of a guiding motive. Informants failed to see any meaning in upholding the custom. We conclude that children of Ethiopian or Eritrean parents resident in Sweden run little risk of being subjected to FGC. A societal structure prepared to deal with suspected cases of FGC with a high level of alertness should be combined with a healthy sceptical attitude toward exaggerations of risk estimates.