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      Providers' Perceptions of Challenges in Obstetrical Care for Somali Women

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          Abstract

          Background. This pilot study explored health care providers' perceptions of barriers to providing health care services to Somali refugee women. The specific aim was to obtain information about providers' experiences, training, practices and attitudes surrounding the prenatal care, delivery, and management of women with Female Genital Cutting (FGC). Methods. Individual semi-structured interviews were conducted with 14 obstetricians/gynecologists and nurse midwives in Columbus, Ohio. Results. While providers did not perceive FGC as a significant barrier in itself, they noted considerable challenges in communicating with their Somali patients and the lack of formal training or protocols guiding the management of circumcised women. Providers expressed frustration with what they perceived as Somali patients' resistance to obstetrical interventions and disappointment with a perception of mistrust from patients and their families. Conclusion. Improving the clinical encounter for both patients and providers entails establishing effective dialogue, enhancing clinical and cultural training of providers, improving health literacy, and developing trust through community engagement.

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          Patient centeredness, cultural competence and healthcare quality.

          Sarah Cooper, Somnath Saha, Mary Beach (2008)
          Cultural competence and patient centeredness are approaches to improving healthcare quality that have been promoted extensively in recent years. In this paper, we explore the historical evolution of both cultural competence and patient centeredness. In doing so, we demonstrate that early conceptual models of cultural competence and patient centeredness focused on how healthcare providers and patients might interact at the interpersonal level and that later conceptual models were expanded to consider how patients might be treated by the healthcare system as a whole. We then compare conceptual models for both cultural competence and patient centeredness at both the interpersonal and healthcare system levels to demonstrate similarities and differences. We conclude that, although the concepts have had different histories and foci, many of the core features of cultural competence and patient centeredness are the same. Each approach holds promise for improving the quality of healthcare for individual patients, communities and populations.
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            Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries.

            Emily Banks, Olav Meirik, Tim Farley … (2006)
            Reliable evidence about the effect of female genital mutilation (FGM) on obstetric outcome is scarce. This study examines the effect of different types of FGM on obstetric outcome. 28 393 women attending for singleton delivery between November, 2001, and March, 2003, at 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal, and Sudan were examined before delivery to ascertain whether or not they had undergone FGM, and were classified according to the WHO system: FGM I, removal of the prepuce or clitoris, or both; FGM II, removal of clitoris and labia minora; and FGM III, removal of part or all of the external genitalia with stitching or narrowing of the vaginal opening. Prospective information on demographic, health, and reproductive factors was gathered. Participants and their infants were followed up until maternal discharge from hospital. Compared with women without FGM, the adjusted relative risks of certain obstetric complications were, in women with FGM I, II, and III, respectively: caesarean section 1.03 (95% CI 0.88-1.21), 1.29 (1.09-1.52), 1.31 (1.01-1.70); postpartum haemorrhage 1.03 (0.87-1.21), 1.21 (1.01-1.43), 1.69 (1.34-2.12); extended maternal hospital stay 1.15 (0.97-1.35), 1.51 (1.29-1.76), 1.98 (1.54-2.54); infant resuscitation 1.11 (0.95-1.28), 1.28 (1.10-1.49), 1.66 (1.31-2.10), stillbirth or early neonatal death 1.15 (0.94-1.41), 1.32 (1.08-1.62), 1.55 (1.12-2.16), and low birthweight 0.94 (0.82-1.07), 1.03 (0.89-1.18), 0.91 (0.74-1.11). Parity did not significantly affect these relative risks. FGM is estimated to lead to an extra one to two perinatal deaths per 100 deliveries. Women with FGM are significantly more likely than those without FGM to have adverse obstetric outcomes. Risks seem to be greater with more extensive FGM.
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              Somali women and their pregnancy outcomes postmigration: data from six receiving countries

              R Small, A Gagnon, M Gissler … (2008)
              Objective This study aimed to investigate pregnancy outcomes in Somali-born women compared with those women born in each of the six receiving countries: Australia, Belgium, Canada, Finland, Norway and Sweden. Design Meta-analyses of routinely collected data on confinements and births. Setting National or regional perinatal datasets spanning 3–6 years between 1997 and 2004 from six countries. Sample A total of 10 431 Somali-born women and 2 168 891 receiving country-born women. Methods Meta-analyses to compare outcomes for Somali-born and receiving country-born women across the six countries. Main outcome measures Events of labour (induction, epidural use and proportion of women using no analgesia), mode of birth (spontaneous vaginal birth, operative vaginal birth and caesarean section) and infant outcomes (preterm birth, birthweight, Apgar at 5 minutes, stillbirths and neonatal deaths). Results Compared with receiving country-born women, Somali-born women were less likely to give birth preterm (pooled OR 0.72, 95% CI 0.64–0.81) or to have infants of low birthweight (pooled OR 0.89, 95% CI 0.82–0.98), but there was an excess of caesarean sections, particularly in first births (pooled OR 1.41, 95% CI 1.25–1.59) and an excess of stillbirths (pooled OR 1.86, 95% CI 1.38–2.51). Conclusions This analysis has identified a number of disparities in outcomes between Somali-born women and their receiving country counterparts. The disparities are not readily explained and they raise concerns about the provision of maternity care for Somali women postmigration. Review of maternity care practices followed by implementation and careful evaluation of strategies to improve both care and outcomes for Somali women is needed.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Obstet Gynecol Int
                Journal ID (iso-abbrev): Obstet Gynecol Int
                Journal ID (publisher-id): OGI
                Title: Obstetrics and Gynecology International
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 1687-9589
                ISSN (Electronic): 1687-9597
                Publication date (Print): 2013
                Publication date (Electronic): 7 October 2013
                Volume: 2013
                Electronic Location Identifier: 149640
                Affiliations
                1Lifestages Samaritan Centers for Women, 2200 Philadelphia Drive, Suite 101, Dayton, OH 45406, USA
                2School of Social Work, Southwest Interdisciplinary Research Center (SIRC), College of Public Programs, Arizona State University, 411 North Central Avenue, Suite 720, MC 4320, Phoenix, AZ 85004, USA
                3Hugh Downs School of Human Communication, Principal Investigator, Community Engagement/Outreach Core (CEOC), Southwest Interdisciplinary Research Center (SIRC), College of Public Programs, Arizona State University, 411 North Central Avenue, Suite 720, MC 4320, Phoenix, AZ 85004, USA
                4College of Health Sciences, Walden University, 100 Washington Avenue South, Minneapolis, MN 55401, USA
                Author notes
                *Crista E. Johnson-Agbakwu: cejohn11@ 123456asu.edu

                Academic Editor: Johanne Sundby

                Article
                DOI: 10.1155/2013/149640
                PMC ID: 3816065
                PubMed ID: 24223041
                SO-VID: 0aa20ec4-7375-4ea1-bb9a-adf04c31f647
                Copyright © Copyright © 2013 Jalana N. Lazar et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 29 March 2013
                Date revision received : 27 August 2013
                Date accepted : 2 September 2013
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Obstetrics & Gynecology
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology

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