Factors Associated with Access to Maternal and Reproductive Health Care among Somali Refugee Women Resettled in Ohio, United States: A Cross-Sectional Survey

Abstract

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.

Hindrances and facilitators in humanitarian migrants’ maternity care in Finland: qualitative study applying the three delays model framework

“…Just as the participants had described in the present study, also their study participants were reported to use walk‐in clinics – and additionally also emergency rooms – in care seeking, instead of planned, pre‐booked and more continuous care contacts . Even though the contexts of medical care in Finnish, Canadian and earlier mentioned US systems are very different from each other, interestingly the humanitarian migrants in these dissimilar systems seem to face similar kinds of hindrances .…”

“…Residential status and barriers to maternal health have recently been described in paper by Banke-Thomas et al (19), who investigated maternal health care in Somali migrants with refugee status in the United States. The study's statistical findings support the significance of language barrier as a key hindrance to seek and access maternity care as a refugee woman (19). In the present study, reservation of the first maternity care appointment via the telephone booking system was described to be difficult for the HMW.…”

Reproductive Health Outcomes in African Refugee Women: A Comparative Study

“…Prenatal care underutilization among African refugee women may also reflect poor health care utilization by refugees upon resettlement in general, in addition to avoidance of health care, and specifically reproductive health care, due to histories of trauma, including female genital cutting. [30][31][32][33][34] Additional social and language barriers and experiences of discrimination both outside and within the health care system, especially related to reproductive health, may also worsen health care utilization among African refugee women. 33,34 These findings are particularly relevant because of their implication for women's public health and for maternal health care providers who take care of African refugee women in the prenatal and birthing process.…”

“…In other qualitative studies conducted by the lead author, women have reported feeling ostracized and marginalized by the medical community, in regards to their culture, religion, language barriers, and other social factors. 35 As such, they are at times hesitant to seek care, and when they do seek care, it is typically at a time when the problem has escalated. It is also of note that this community typically thinks very highly of health care providers and, seldom, questions or inquires for more information about the decisions made regarding their treatment.…”

“…This scenario was heard often in prior studies in which women had emergency cesarean sections. 35 In regard to family planning, the lead author has an ongoing study, which indicates that women want to space out pregnancies but are reluctant to use family planning methods due to cultural beliefs, such as birth control leading to infertility, among other concerns.…”