Barriers to reproductive health care for migrant women in Geneva: a qualitative study

Taghizade

et al. 2020

Preprint

Background: An estimated 96% of registered refugees in Iran are Afghan. Almost half of them are young women at the reproductive age. The adequate maternity care is crucial for healthy pregnancy. There is limited knowledge regarding the access and adequacy of maternity care among Afghan women in Iran. The reports from ministry of health (MOH) implicates higher prevalence of perinatal complication in Afghan population. This mainly attributed to the inadequate prenatal care in during pregnancy. Therefore, this paper explores the access and potential barriers to prenatal care among Afghan women in Iran.Methods: Using purposive convenient sampling, thirty pregnant Afghan women were recruited at three community health centers with the highest number of Afghan visitors in Tehran, the capital city of Iran. Data were collected through face-to-face interviews in Persian language using an interview guide. The interviewers were two bilingual Afghan graduate midwifery students. Each interview lasted for an hour. The interviews were transcribed into original language (Persian) and analyzed using content analysis. The MAXQD v.10 software was used in data analysis. The main themes were extracted grouping the similar codes and categories after careful consideration and consensus between the researchers.Results: The financial constraints and lack of affordable health insurance with adequate coverage of prenatal care services, particularly the diagnostic and screening tests, were the most frequent reported obstacles by Afghan women. In addition, personnel behavior, transportation issues, stigma and discrimination, cultural concerns, legal and immigration issues were also mentioned as the source of disappointment and inadequate utilization of such services.Conclusions: The findings of present study emphasize the necessity of available and most importantly, affordable prenatal care for Afghan women in Iran. Providing an affordable health insurance with adequate coverage of prenatal and delivery services, could reduce the financial burden, facilitate the access, and ensure the maternal and child health in this vulnerable population. The issues of fear and concern of deportation must be removed for at least illegal Afghan mothers to ensure their access to maternity care and improve the health of both mother and offspring.

Section: Introductionmentioning

confidence: 99%

“It is good, but I can’t afford it…” potential barriers to adequate prenatal care among Afghan women in Iran: a qualitative study in south Tehran

Taghizade

et al. 2020

Preprint

“…Recent research has assessed challenges to effective health messaging in migrant populations [20–22], and efficacy of visual health messaging to populations with low literacy [1, 23, 24], but most studies have been conducted in high-income countries. Posters as health promotion tools are appealing as they are a low-cost intervention that can potentially reach a wide audience [25], and are commonly used in health promotion programs in low-income countries.…”

Section: Introductionmentioning

confidence: 99%

“I can’t read and don’t understand”: Health literacy and health messaging about folic acid for neural tube defect prevention in a migrant population on the Myanmar-Thailand border

et al. 2019

Health literacy is increasingly recognized as an important determinant of health outcomes, but definition, measurement tools, and interventions are lacking. Conceptual frameworks must include both individual and health-systems domains which, in combination, determine an individual’s health literacy. Validated tools lack applicability in marginalized populations with very low educational levels, such as migrant worker communities on the Myanmar-Thailand border. We undertake a comprehensive health literacy assessment following a case study of a recent public health campaign promoting preconceptual folic acid uptake in this community. A mixed-methods design utilized quantitative analysis of the prevalence and predictors of low Health literacy, and focus group discussions to gather qualitative data from women about proposed and actual posters used in the campaign. Health literacy was measured with a locally developed tool that has been used in surveys of the population since 1995. Health literacy was low, with 194/525 (37.0%) of tested women demonstrating adequate health literacy, despite 63.1% (331/525) self-reporting being literate. Only one third of women had completed 4th grade or above and reported grade level attained in school was more predictive of health literacy than self-reported literacy. Focus group discussions revealed that low literacy, preconceived associations, and traditional health beliefs (individual domain) interacted with complex images, subtle concepts, and taboo images on posters (health-systems domain) to cause widespread misunderstandings of the visuals used in the campaign. The final poster still required explanation for clarity. Low health literacy is prevalent among pregnant women from this migrant community and barriers to communication are significant and complex. Public health posters need piloting prior to implementation as unanticipated misperceptions are common and difficult to overcome. Verbal communication remains a key method of messaging with individuals of low health literacy and educational system strengthening and audiovisual messaging are critical for improvement of health outcomes.

“…The interviewers were female Afghan graduate students at Tehran University of Medical Science and could speak Persian fluently. Although, language has been reported as a barrier in immigrant studies [19]; in present study, it was not an issue as the Persian is the first language of majority of Afghan people. Prior to the study, all the interviewers were trained and instructed about the objectives of the study and become familiar with the content of interview guide and the interview procedure.…”

Section: Data Collectionmentioning

confidence: 51%

“…This is mainly due to the inadequate utilization of prenatal care in Afghan women. In other countries such as Canada, USA, and Switzerland; the lower utilization of maternity health services among refugees and asylum seekers has been attributed to a number of cultural and social factors such as stigma, language barrier, financial issue, gender-and cultural-sensitive issues [17][18][19]. However, in Iran as the second country with the highest number of Afghan refugees and immigrants in the world, there is no study that explored and addressed the issues in seeking maternity care and obstacles in having adequate access to such services among Afghan women.…”

Section: Introductionmentioning

confidence: 99%

“It is good, but I can’t afford it …” potential barriers to adequate prenatal care among Afghan women in Iran: a qualitative study in South Tehran

Taghizade

BMC Pregnancy Childbirth

et al. 2020

Background: An estimated 96% of registered refugees in Iran are Afghan. Almost half of them are young women at the reproductive age. The adequate maternity care is crucial for healthy pregnancy. There is limited knowledge regarding the access and adequacy of maternity care among Afghan women in Iran. The reports from ministry of health (MOH) implicate higher prevalence of perinatal complications in Afghan population. This mainly attributed to the inadequate prenatal care during pregnancy. Therefore, this paper explores the potential barriers to prenatal care among Afghan women in Iran. Methods: Using convenience sampling, thirty pregnant Afghan women were recruited at three community health centers with the highest number of Afghan visitors in Tehran, the capital city of Iran. Data were collected through faceto-face interviews in Persian language using an interview guide. The interviewers were two bilingual Afghan graduate midwifery students. Each interview lasted for an hour. The questions regarding the concerns and experienced obstacles in seeking prenatal care were asked. The interviews were transcribed into original language (Persian) and analyzed using content analysis and further translated back into English. The main themes were extracted grouping the similar codes and categories after careful consideration and consensus between the researchers. Results: The financial constraints and lack of affordable health insurance with adequate coverage of prenatal care services, particularly the diagnostic and screening tests, were the most frequent reported obstacles by Afghan women. In addition, personnel behavior, transportation issues, stigma and discrimination, cultural concerns, legal and immigration issues were also mentioned as the source of disappointment and inadequate utilization of such services. Conclusions: The findings of present study emphasize the necessity of available and most importantly, affordable prenatal care for Afghan women in Iran. Providing an affordable health insurance with adequate coverage of prenatal and delivery services, could reduce the financial burden, facilitate the access, and ensure the maternal and child health in this vulnerable population. The issues of fear and concern of deportation must be removed for at least illegal Afghan mothers to ensure their access to maternity care and improve the health of both mother and offspring.