“It’s Different Here” Afghan Refugee Maternal Health Experiences in the United States

Abstract

Background: The number of Afghan families in the U.S. has grown over the past two decades, yet there is a paucity of research focused on their healthcare experiences. Afghan families have one of the highest fertility rates in the world and typically have large families. As the U.S. faces rising maternal mortality rates, it is crucial to understand factors that affect health outcomes for culturally distinct groups. We aimed to better understand Afghan women’s experiences of giving birth in the U.S. and to identify protective and risk factors that affect Afghan women’s reproductive health. Methods: Twenty Afghan women who had given birth in the U.S. within the past two years participated in audio-recorded interviews. The first and second authors conducted each interview using a semi-structured interview guide. The authors used a deductive, in vivo coding method to analyze the transcribed narrative data. Results: We identified three over-arching categories with corresponding sub-categories: 1) Healthcare: pregnancy, birthing, and postpartum, 2) Culture: communication, husband, and family, 3) Access to Care: transportation, financial, and insurance. The participants expressed perspectives of gratefulness and positive experiences, yet some described stories of poor birth outcomes that led to attitudes of mistrust and disappointment. Distinct cultural preferences were shared, providing invaluable insights for healthcare providers. Conclusions: The fact that the Afghan culture is strikingly different than the U.S. mainstream culture can lead to stereotypical assumptions, poor communication, and poor health outcomes. The voices of Afghan women should guide healthcare providers in delivering patient-centered, culturally sensitive maternity care that promotes healthy families and communities. The women’s stories highlight risk factors, including communication barriers, discordant cultural values, lack of social/community networks, and lack of transportation/healthcare navigation. The protective factors to nurture are attitudes of gratefulness and resilience, strong husband support, commitment to breastfeeding, openness to child spacing, and desire to learn more.