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

Abstract

Rationale Humanitarian migration to Finland nearly ten‐folded in 2015–2016 from 3 326 asylum seekers’ yearly average to 32 476. Earlier research shows that humanitarian migrants sustain suboptimal maternal health in high‐income countries, even though care facilities are available. Aim and objective This study aimed to investigate what factors do maternity care professionals identify as hindrances and facilitators in humanitarian migrants’ maternity care process in Finland. Methodological design Study employed qualitative design. Eighteen midwives and maternity care public health nurses participated in semi‐structured qualitative interviews that were audio‐recorded and transcribed verbatim. Qualitative content analysis of the interview data produced meaning units, codes and categories. Ethical Issues Research plan was reviewed and approved by the ethics committee of the local hospital district. Participants signed an informed consent prior the interviews. Findings Hindrances and facilitators for care were organised in theoretical framework of Three Delays Model. Participants described multiple hindrances for caring process, of which language barrier constantly raised as a significant obstacle for seeking and receiving care, and for perceived quality of care. Correspondingly, interpreters facilitated the caring process at all of its phases. Rural location of asylum centres, long distances and lacking transportation to care hindered reaching the health facility. Complicated bureaucracy was described to affect negatively in receiving adequate care. Refugee and asylum centre workers facilitated decision to seek care, and reaching of health facilities. Conclusion Interpreters can influence in the caring process in more versatile ways than we might have acknowledged this far. We recommend further research on interpreters’ role in the caring process of pregnant humanitarian migrants.

Prenatal care adequacy of migrants born in conflict-affected countries and country-born parturients in Finland

“…Nevertheless, on the base of these data, it is neither exclusively confirmable or excludable if this is the reason behind the similarities of our comparison groups’ hospitalization percentages, or their difference to study reports from other similar contexts. It is important to consider the earlier reported obstacles in conflict-area born migrants access to care ( Barkensjö et al., 2018 ; Bains et al., 2021 ; Leppälä et al., 2020 ), and recognise the possibility that BiCAC group could have had less access to health care and thus, lower chance of being hospitalized. This could consequently result in the two comparison groups’ similar risk of prepartum hospitalization detected in our results.…”

“…According to earlier studies from neighbouring countries with rather similar health system to Finland's, this group may face a number of complications in accessing prenatal care ( Barkensjö et al., 2018 ). Health providers’ interviews ( Leppälä et al., 2020 ) also signal that delays and obstacles in conflict area born migrants’ maternity care process occur in Finland, even though the legislation entitles them to such care free of charge, regardless of one's residential status ( Finnish Immigration Service, 2011 ). This, and the earlier reports on migrants’ higher prevalence of pregnancy and birth complications in comparison with country-born parturients in low-risk settings ( Bastola et al., 2020 ; Bastola et al., 2019 ; Liu et al., 2019 ; Liu et al., 2020 ; Juárez et al., 2017 ; Bakken et al., 2015 ; Mæland et al., 2019 ) enforce the need to investigate, what is the status of Finnish prenatal care supply for this recently-grown user group.…”

Características do acesso aos serviços de saúde por refugiadas durante gravidez e puerpério: revisão integrativa

“…Devido à escassez de recursos financeiros e de questões éticas, um artigo finlandês, com amostra de 18 gestantes refugiadas afirmou que o uso de um tradutor é limitado a situações específicas, tais como exame físico de recém-nascido e avaliações ginecológicas. Outras situações materno-infantis dependem da disponibilidade destes tradutores, não sendo um direito garantido (Leppälä et al, 2020), como constatado nos resultados desta revisão com destaque às barreiras culturais e idiomáticas verificadas.…”

Analysis of Prehospital Care of Migrants Who Arrive Intermittently at the Coasts of Southern Spain

“…There are more studies that describe the hospital care of immigrants residing in Spain [36][37][38] in a more extensive way, but these do not address the healthcare needs when the boats arrive. In the same way, other studies address these same issues related to hospital care or access to specific services offered by different health systems in the context of other countries, analyzing their barriers and difficulties [39][40][41][42]. These studies emphasize that the attention needed by these populations are not limited to those presented at the time of their arrival, but, sometimes, the approach to the problems that appear later are much more complex.…”