Maternal health services: an equal or framed territory?

Abstract

Purpose Despite the high prevalence of immigrant women at the national level, studies on migration have been indifferent to the gender perspective. The purpose of this paper is to discuss the engagement of Ukrainian immigrant women, one of the most expressive nationalities of female immigration in Portugal, on maternal and child healthcare services, exploring their perceptions and experiences in these contexts. Design/methodology/approach On the basis of critical and social constructionism assumptions, this research focusses on discourse. Assuming that immigrant women have access to different resources, as well as different competences to interpret and intervene within the context they are in (Topa et al., 2010; UNFPA, 2006), the best method to deeply understand their experiences was to analyse how discourse is organized and how it creates and produces meanings that become practices (Nogueira, 2001a). The present study adopted a qualitative methodology for collecting (semi-structured interviews) and analysing the data (thematic analysis) and was based on discourses of ten Ukrainian women, living in the metropolitan area of Oporto, who were pregnant or were mothers in Portugal. Findings Ukrainian women were misinformed about their legal rights and free access to maternal health services. Some dissatisfaction emerges among them with regard to the quality of information provided by health professionals and their communication skills. Their opinion is that they are given limited access to medical specialties, especially in primary care and that their doubts are inappropriately clarified during medical appointments. Originality/value This research also argues that cultural and intersectional considerations are fundamental to promote inclusive health policies for immigrants.

Migrant women’s experiences of pregnancy, childbirth and maternity care in European countries: A systematic review

“…Before accessing maternity care women considered the value [35, 51,52,60,81,82], and necessity [65] of care. They also weighed up the financial costs of accessing care [37, 49,61], and the consequences of accessing care, particularly when they had a lack of trust in healthcare providers (HCPs) [39,75], previous poor experiences with HCPs [38], or were fearful that their visibility in maternity services could result in deportation [35,36,66,82].…”

“…For some migrant women who wanted to access care, there were difficulties in finding the way into the system. The system was unfamiliar and different to that of their country of origin and the women were often unaware of their rights and entitlement to care [34,36,42,53,61,65,72,78,82,83]. There was a lack of information about the services that were available and if the services were free [36, 53,61,82].…”

“…The system was unfamiliar and different to that of their country of origin and the women were often unaware of their rights and entitlement to care [34,36,42,53,61,65,72,78,82,83]. There was a lack of information about the services that were available and if the services were free [36, 53,61,82]. Some women faced difficulties in being accepted for registration for primary healthcare services [36, 53,82], were refused entry to healthcare facilities [75], and struggled to provide the required documentation or insurance that were prerequisites for care [66,80].…”

“…I was offered appointments but they were cancelled at short notice without anyone telling me why." (Phillimore 2015, pp.576) [35] Costs related to transportation and payment for care were identified as factors influencing ongoing access to care [34,44,53,61,83]. Those who received free care identified that this enabled them to access care, which was often in contrast to the situation in their country of origin [37, 49,67,81].…”

“…Those who received free care identified that this enabled them to access care, which was often in contrast to the situation in their country of origin [37, 49,67,81]. Flexibility in the system in relation to the timing and location of appointments influenced access [61,65,70]. Inflexibility in the system, such as the rigid use of telephone booking systems for appointments were an ongoing barrier that women faced when trying to navigate the system in a new language [34, 75,82].…”